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. 2025 Jul 29;13(1):159.
doi: 10.1186/s40337-025-01355-2.

Childhood maltreatment and longitudinal trajectories of disordered eating behaviors: sociodemographic moderators and behavior-specific sensitivity analyses

Lina Modjarrad  1 , Nicole Marlow  2 , Avery Bollinger  3 , Yenan Zhu  2
Affiliations

Childhood maltreatment and longitudinal trajectories of disordered eating behaviors: sociodemographic moderators and behavior-specific sensitivity analyses

Lina Modjarrad et al. J Eat Disord. .

Abstract

Objective: Disordered eating behaviors (DEBs) represent a significant public health issue, with childhood maltreatment emerging as a potential contributing factor. However, the longitudinal impact of maltreatment on the progression of disordered eating behaviors from adolescence to adulthood remains inadequately understood. This study aims to explore how childhood maltreatment influences the trajectory of disordered eating behaviors, focusing on potential moderating factors such as sociodemographic variables, race, and sex.

Methods: Data from Waves I-III of Add Health (ages 11-26) were used to assess DEB trajectories, with retrospective childhood maltreatment data collected in Wave IV. Repeated measures mixed-effects models accounted for intra-individual variability, adjusting for relevant covariates. Interaction effects between maltreatment subtypes and sociodemographic covariates (sex, race/ethnicity, income) were analyzed to examine how these intersections influenced DEB trajectories.

Results: Among the 15,363,384 participants, 49.2% experienced childhood maltreatment. Adjusted models indicated significant increases in DEBs over time, particularly between Waves II and III (β = 19.9, p < 0.001). Although physical abuse (β = 1.88, p = 0.1330), verbal abuse (β = -0.67, p = 0.4529), and sexual abuse by a parent (β = 1.59, p = 0.4204) were not significant predictors of worsening behaviors, stratified analyses revealed that low-income individuals exposed to non-familial sexual abuse demonstrated the steepest worsening of DEBs (β = 26.5, p = 0.0048). Interaction effects revealed that Asian or Pacific Islander participants experiencing verbal abuse, and low-income individuals exposed to non-familial sexual abuse demonstrated pronounced worsening of DEBs. We observed significant sex differences: males exhibited higher levels of worsening behaviors over time (β = -10.8, p < 0.0001).

Conclusion: Our findings suggest that sociodemographic characteristics (sex, race, income) may moderate the persistence of DEBs, underscoring the need for trauma-informed and tailored interventions. Addressing childhood adversity through public health, policy, and clinical efforts can help support those at highest risk. Future research should examine these trajectories beyond early adulthood and explore protective factors that may buffer against long-term DEB risk.

Keywords: Childhood maltreatment; Disordered eating behaviors; Eating disorders; Longitudinal analysis; Mental health disparities; Precision psychiatry; Sex differences; Sociodemographic factors; Socioeconomic factors; Trauma-informed interventions.

Plain language summary

Eating disorders are serious and complex mental health conditions that can persist for many years, often beginning in adolescence and continuing into adulthood. While much research focuses on young people, adults with long-term eating disorders are often overlooked in treatment and research, leaving them without adequate support. This study examines how childhood experiences, particularly maltreatment such as verbal, physical, and sexual abuse, may contribute to the persistence and worsening of disordered eating behaviors over time. Using data from a large national study that followed participants from adolescence into adulthood, we explored patterns of disordered eating across different life stages. We found that early-life trauma is linked to more severe and long-lasting eating disorder symptoms, with some groups—particularly those from disadvantaged backgrounds—at even greater risk of worsening symptoms. Although not all forms of childhood maltreatment were equally predictive of illness progression, certain subgroups experienced more significant worsening, highlighting the importance of personalized approaches to treatment. These findings reinforce the need for eating disorder care that goes beyond weight restoration and short-term symptom management. Many adults with long-term eating disorders have complex histories that shape their illness, yet current treatments often fail to address these deeper psychological and emotional factors. This research highlights the importance of trauma-informed, individualized care approaches that recognize the long-term effects of early adversity. By tailoring treatment to the needs of each individual, healthcare providers may improve outcomes and offer better long-term support for those who have struggled with eating disorders for many years.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study used data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) and adhered to ethical guidelines for human research. Ethical approval for the Add Health study was obtained from the institutional review boards of the participating institutions. Informed consent was obtained from all participants at each wave of data collection. Consent for publication: Not applicable. This manuscript does not include individual data or images requiring consent for publication. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Trajectories of disordered eating behaviors stratified by childhood maltreatment status across three waves Legend: This figure presents the mean trajectory of disordered eating behaviors among participants over three waves of data collection, stratified by childhood maltreatment status. The x-axis represents the three waves of data collection (Wave I, Wave II, and Wave III), while the y-axis indicates the mean count of reported disordered eating behaviors. The solid line represents participants with a history of childhood maltreatment, and the dashed line represents participants without a history of childhood maltreatment. The figure illustrates that individuals with a history of childhood maltreatment had higher baseline levels of disordered eating behaviors and a more pronounced escalation in symptoms over time compared to their non-maltreated counterparts
Fig. 2
Fig. 2
Behavior-Specific Trajectories of Disordered Eating Over Time: Dieting/Exercise vs. Severe Behavior Legend: This figure illustrates the distinct trajectories of disordered eating behaviors among participants based on the severity of behaviors engaged in over three waves of data collection. The x-axis represents the three waves of data collection, while the y-axis indicates the mean count of reported disordered eating behaviors. The blue line represents participants who exclusively engaged in dieting and/or exercise as weight-control methods, while the red line represents participants who engaged in severe behaviors, such as purging, laxative use, or diet pill consumption. The figure demonstrates that participants engaging in severe disordered eating behaviors had a significantly steeper increase in symptoms over time compared to those who only engaged in dieting/exercise behaviors
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