Is it time for a paradigm shift? Trauma in the development of anorexia nervosa in adolescents

Anorexia nervosa (AN) in adolescents is a severe disorder with complex aetiology. The role of childhood maltreatment (CM) in the development and course of AN remains unclear. The study aimed to analyse the co-occurrence of CM with the severity of psychopathology in patients with AN and to assess their relationship with the dynamics of clinical improvement.

The study included only girls under 18 years of age: 39 patients hospitalised for the first time with a diagnosis of AN and 43 healthy participants from the control group (CG). Questionnaires were used to assess trauma (CTQ), symptoms of depression (BDI), anxiety (STAI), eating disorders (EAT), impulsivity (BIS), self-harm (NSSI), and suicidal behaviour (SB).

The analysis did not reveal any statistically significant differences between the AN and control groups in overall frequency or specific CM subtypes. Despite no differences in trauma exposure, the clinical group showed a significant co-occurrence of emotional abuse with higher levels of self-destructive behaviour and anxiety as a trait, while emotional neglect correlated with anxiety as a state. Notably, the presence of reported trauma did not differentiate patients in terms of response to hospital treatment or rate of symptom reduction.

In the sample of adolescent girls studied, the mere occurrence of reported trauma was not a factor differentiating patients with AN from healthy peers, nor was it a negative predictor of early hospital treatment outcomes. These results suggest that although specific forms of emotional abuse may co-occur with a more severe psychopathological picture (anxiety, self-destruction), childhood maltreatment does not necessarily constitute a direct obstacle to symptomatic improvement during the first hospitalisation.