Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span

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.