Associations Between Adverse Childhood Experiences and Disordered Eating in US Youth: The PLATE Study

To examine associations between individual adverse childhood experiences (ACEs) and disordered eating behaviors (DEBs) in US youth. In addition, to test mediation and moderation by psychosocial and contextual factors.

The study was based on a cross-sectional analysis of 47,617 children 10 to 17 years of age from the 2022-2023 National Survey of Children's Health. Survey-weighted logistic regression estimated ACE-DEB links adjusted for demographics; mediation was assessed with structural equation modeling and moderation with interaction terms.

Overall, DEBs were reported for 29% of youth. Household mental illness and economic insecurity showed the strongest and most consistent associations, each paired with 4 or more DEBs. For compensatory weight-control behaviors specifically, adjusted odds ratios were 1.82 for household mental illness and 2.05 for economic insecurity. Depression, anxiety, and food insecurity demonstrated robust mediation effects across a variety of DEB-ACE pairings. Family resilience and ≥4 shared meals weekly reduced DEB odds, but protection weakened with mental illness or financial strain. Bullying victimization raised DEB risk, but this association was attenuated among youth facing racial discrimination.

Household mental illness and financial hardship confer broad risk for disordered eating in youth, largely through internalizing symptoms and, in the context of poverty, food scarcity. Family strengths and peer experience can buffer or amplify these risks. Together, these findings highlight the value of trauma-informed and developmentally sensitive assessment of DEBs that consider emotional, nutritional, and family context, including exposure to adversity, to support early identification and prevention in youth.