Disordered Eating Attitudes and Behaviors in Maltreated Children and Adolescents Receiving Forensic Assessment in a Child Advocacy Center

ABSTRACT

Previous studies have indicated that childhood sexual abuse (CSA) and other forms of child maltreatment (CM), as well as their subsequent posttraumatic symptoms, are significant risk factors for the development of disordered eating behaviors and attitudes and eating disorders (EDs). However, there are no known reports of CM based on forensic interview and assessment that have been linked to disordered eating behaviors and attitudes, or eating disorders (EDs), especially in children and adolescents. We, therefore, examined the hypothesis that ED-related symptoms would be significantly associated with trauma-related symptoms in children with reported maltreatment. Girls (n = 179, 11.9 ± 2.4 years) and boys (n = 99, 11.7 ± 2.8 years) referred for forensic assessment of alleged maltreatment completed the Kids’ Eating Disorders Survey, the Eating Disorders Inventory for Children (EDI-C), the Trauma Symptom Checklist for Children, and the Adolescent Dissociative Experiences Scale, among others. Significant positive correlations between most EDI-C subscale scores and most TSC-C subscale scores (PTSD, dissociation, anxiety, depression, sexual concerns) were found (p ≤.001) in the total sample and girls alone. Participants with credible, substantiated disclosures had significantly higher scores on several ED-related measures than those with non-credible, non-substantiated disclosures. Linear regression analysis indicated that PTSD and dissociative symptoms were significant predictors of EDI-C scores in those with substantiated disclosures (p ≤.001). Findings support the hypothesis that ED-related symptoms are significantly linked to authenticated CM.

KEYWORDS:

• Eating disorders
• disordered eating
• child advocacy center
• child maltreatment
• childhood sexual abuse
• physical abuse
• PTSD
• dissociation

Disclosure of interest

None of the authors have any relevant conflicts of interest to report.

Ethical standards and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation [Medical University of South Carolina] and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Additional information

Notes on contributors

Timothy D. Brewerton

Timothy D. Brewerton, MD, DLFAPA, FAED, DFAACAP, CEDS-S is Affiliate Professor of Psychiatry & Behavioral Sciences at the Medical University of South Carolina in Charleston, SC, and is in private practice in Mt. Pleasant, SC.

M. Elizabeth Ralston

M. Elizabeth Ralston, Ph.D., is Founding Director of the Dee Norton Child Advocacy Center, Charleston, SC.

Michelle Dean

Michelle Dean, M.S., is Vice President and Network Partner Director for the Team Support Services Division of Multi-Systemic Treatment (MST) Services.

Sarah Hand

Sarah Hand, BS, is a graduate of the University of North Carolina at Chapel Hill with bachelor’s degrees in Psychology and Computer Science. She currently attends Carnegie Mellon University, pursuing a master’s degree in Human Computer Interaction.

Lisa Hand

Lisa Hand, MD, BCC is Affiliate Associate Professor of Psychiatry and Behavioral Sciences at the Medical University of South Carolina in Charleston, SC, and is in private practice in Johns Island, SC.