Childhood maltreatment, shame, psychological distress, and binge eating: testing a serial mediational model

Plain English summaryDespite research showing a clear link between past childhood maltreatment (e.g., childhood emotional abuse, sexual abuse, physical abuse, neglect) and developing binge eating disorder as an adult, research cannot currently fully explain why this link exists. In this study, we explored several ways that childhood maltreatment might lead to binge eating. We examined whether different types of childhood maltreatment led to increased levels of shame or psychological distress (e.g., symptoms of depression, anxiety, and stress), and whether increased shame or psychological distress then contributed to the use of binge eating as a strategy to manage these emotions (e.g., through emotional binge eating). The results of our study showed that specific types of childhood maltreatment did lead to increased shame and binge eating. For instance, we found that adults who had experienced childhood emotional abuse tended to experience higher levels of shame about themselves, as well as higher levels of psychological distress and higher levels of binge eating. Findings from this study suggest that specific types of therapy (e.g., compassion-focused therapy for eating disorders for high levels of shame in eating disorders) might be useful for adults who have experienced childhood maltreatment and experience high levels of shame and psychological distress that accompany their binge eating. ObjectiveDespite evidence of causal relationships between childhood maltreatment and the development of binge eating disorder (BED), research on mediating mechanisms is lacking. The present study sought to understand the childhood maltreatment-binge eating relationship more fully by examining three types of shame (internal, external, body) and psychological distress as mediators in this relationship. There is evidence that shame and psychological distress are associated with both childhood maltreatment and binge eating pathology. It was hypothesised that shame stemming from childhood maltreatment would contribute to psychological distress, and to binge eating as a dysfunctional emotion regulation strategy, in a serial mediational model.MethodFive hundred and thirty adults with self-reported binge eating symptoms completed an online survey, which included measures of childhood maltreatment, internal shame, external shame, body shame, psychological distress, and binge eating and other eating disorder symptoms.ResultsPath analyses showed three specific relationships: (1) a relationship between childhood emotional maltreatment and binge eating, which was serially mediated by internal shame and psychological distress; (2) a relationship between childhood sexual abuse and binge eating, which was mediated by body shame; and (3) a relationship between childhood physical maltreatment and binge eating, which was mediated by psychological distress. We also found a feedback loop, whereby binge eating might lead to increased overvaluation of body shape and weight (possibly due to increased weight) and then to an increase in internal shame and body shame. The final model showed excellent fit for the data.DiscussionFindings extend our understanding of the link between childhood maltreatment and BED. Future intervention research should focus on examining the efficacy of interventions for different forms of childhood maltreatment, based on the key mediating factors.