Adverse Childhood Experiences Predict Treatment Drop Out in Adolescents and Young Adults With Eating Disorders

Childhood adversity is associated with elevated risk of developing an eating disorder. The objective of the current study was to examine whether different types of childhood adversity, such as parental separation or abuse exposure, predicted treatment completion in a sample of adolescents and young adults with eating disorders.

A retrospective chart review was conducted at an eating disorders clinic in Calgary, Canada. Childhood adversity was measured using the adverse childhood experiences (ACEs) scale. Eating disorders diagnoses were determined by physicians following a comprehensive assessment. Logistic regressions were performed with ACEs as predictors of likelihood to complete treatment and including diagnoses and age as covariates.

Data were analyzed for 128 patients aged 11-24. Higher ACE scores were associated with a reduced likelihood of completing treatment before and after adjusting for diagnosis and age (adjusted odds ratio = 0.76). Examining individual ACE items, people were less likely to complete treatment if they were exposed to verbal abuse, physical abuse, emotional neglect, or if they witnessed intimate partner violence or substance abuse in the home. However, after adjusting for diagnosis, age, and other ACE exposures, no individual ACE was an independent predictor of treatment completion.

This study suggests that ACE exposure increases youth attrition from eating disorders treatment in a stepwise manner. Treatment programs for youth with eating disorders should focus additional effort on early intervention for youth who have dealt with childhood adversities, potentially by implementing trauma-informed practice into assessments and treatment.