Esperienze Avverse In età Evolutiva e Disturbi Alimentari: Uno Studio Multimetodo

Background: Adverse Childhood Experiences (ACEs) are a well-established risk factor for the development of psychopathology in adulthood, including feeding and eating disorders (FEDs). Previous research has suggested that post-traumatic stress symptoms (PTSD) and emotional dysregulation may act as mechanisms through which early trauma contributes to the onset and maintenance of eating-related psychopathology (Trottier et al., 2017; Cortés-García et al., 2019). Furthermore, depressive symptomatology may function as a moderating factor, either amplifying or attenuating these associations, thereby explaining the high comorbidity observed among eating disorders, post-traumatic stress symptoms, and depression (Brewerton, 2022). The aim of the present study was to examine, through a multimethod approach, the relationships among adverse childhood experiences, post-traumatic stress symptoms, emotional dysregulation, and eating disorder symptomatology, assessing also the moderating role of depression within these associations. Methods: The sample consisted of 79 participants (77 females, 2 males), aged 18 to 28 years, recruited from specialized eating disorder treatment centers. Participants were divided into two diagnostic subgroups: Restrictive Anorexia Nervosa (AN-R; n = 32) and the Bulimic/Binge spectrum group (BB; n = 47). Self-report measures included the Maltreatment and Abuse Chronology of Exposure (MACE) to assess ACEs, the International Trauma Questionnaire (ITQ) for post-traumatic stress symptoms, the Difficulties in Emotion Regulation Scale (DERS) for emotional dysregulation, the Body Shape Questionnaire (BSQ) for body image disturbance, and the Symptom Checklist-90-Revised (SCL-90-R) for depressive symptomatology. Additionally, two opened questions were administered: (1) “Describe an episode in which you experienced a strong emotion,” and (2) “Describe your subjective experience of the treatment process.” Quantitative data were analyzed using serial mediation and moderated mediation models (PROCESS Model 80, Hayes, 2022), and qualitative data were thematically analyzed to integrate subjective narratives with statistical results. Results: Participants in the BB group reported significantly higher levels of ACEs than those in the AN-R group (p < .01). Serial mediation analysis revealed a significant pathway in which ACEs increased post-traumatic stress symptoms, which in turn promoted emotional dysregulation, subsequently influencing eating disorder symptom severity. Depressive symptomatology showed two significant interactions, amplifying the association between adverse experiences and PTSD, as well as between emotional dysregulation and eating-related symptoms—both at low (β = 1.15; p < .001; CI [.77, 1.53]) and moderate (β = .63; p < .001; CI [.31, .95]) levels of depression. Qualitative findings supported and enriched the quantitative data, revealing recurring themes of emotional emptiness, hyperactivation, difficulty identifying and labeling emotions, and the use of eating behaviors (restriction, bingeing, purging) as maladaptive coping strategies. Conclusions: The multimethod approach allowed for the integration of quantitative evidence and subjective experiences, emphasizing the need for treatment approaches that will address not only eating symptomatology, but also early adverse experiences, emotional regulation difficulties, post-traumatic stress symptoms, and depressive features. These findings highlight the importance of integrated, trauma-informed interventions aimed at improving clinical outcomes and reducing chronicity in feeding and eating disorders. Keywords: adverse childhood experiences; eating disorders; PTSD; emotional dysregulation; depression.