Background: Multiple published sources from around the world have confirmed an association between an array of adverse childhood experiences (ACEs) and other traumatic events with eating disorders (EDs) and related adverse outcomes, including higher morbidity and mortality.
Methods: In keeping with this Special Issue's goals, this narrative review focuses on the ACEs pyramid and its purported mechanisms through which child maltreatment and other forms of violence toward human beings influence the health and well-being of individuals who develop EDs throughout the life span. Relevant literature on posttraumatic stress disorder (PTSD) is highlighted when applicable.
Results: At every level of the pyramid, it is shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide.
Conclusions: The implications of these cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. This overview offers multiple opportunities at every level for the palliation and prevention of EDs and other associated trauma-related conditions, including PTSD.
Keywords: Adverse childhood experiences; Comorbidity; Eating disorders; Environment; Epigenetics; Genetics; Outcome; Posttraumatic stress disorder; Trauma; Treatment.
Adverse childhood experiences (ACEs) and other traumatic experiences commonly occur in the great majority of individuals with EDs. The mechanisms by which ACEs and EDs emerge and interact with each other to lead to early death is reviewed from the perspective of the ACEs pyramid and the escalating cascade of problems that it depicts. The levels of the ACEs pyramid as they apply to EDs and their overlap with trauma-related disorders, especially PTSD, are explored and discussed and include 1) genetics (heredity) and historical trauma (epigenetics); 2) social and local context as predisposing and protective factors; 3) the ACEs themselves as precipitating factors; 4) disrupted development of the brain; 5) social, emotional and cognitive impairments; 6) the adoption of risky or self-harming behaviors; 7) the increased disease, disability and social problems that ensue; and 8) subsequent early death by suicide or fatal medical complications. A better understanding of how these mechanisms are interwoven with each other may lead to improved and integrated interventions at all points, including prevention, screening and treatment.
© 2022. The Author(s).