Differential contributions of childhood abuse and neglect to maladaptive personality domains in eating disorders

Objective: Childhood maltreatment is highly prevalent among individuals with eating disorders (EDs) and has been associated with greater clinical severity and poorer treatment outcomes. However, little is known about whether different forms of childhood maltreatment are differentially associated with maladaptive personality functioning within a dimensional framework. The present study investigated the independent contributions of childhood abuse and neglect to maladaptive personality domains in a transdiagnostic sample of patients with EDs.

Methods: A cross-sectional study was conducted in 113 adult inpatients with DSM-5 EDs. Childhood maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ), and maladaptive personality traits were evaluated with the Personality Inventory for DSM-5 (PID-5). Hierarchical multiple regression analyses examined the independent associations of childhood abuse and neglect with the five higher-order PID-5 domains after controlling for age and body mass index. Exploratory analyses subsequently examined the contribution of individual CTQ maltreatment subtypes.

Results: Childhood abuse, but not neglect, was independently associated with maladaptive personality functioning. The strongest association was observed for Psychoticism (β = .362, p = .002), with additional associations for Detachment (β = .272, p = .031) and a trend-level association for Disinhibition (β = .222, p = .074). Exploratory analyses demonstrated that emotional abuse emerged as the only independent childhood maltreatment subtype associated with both Psychoticism (β = .460, p = .001) and Disinhibition (β = .313, p = .043), while showing a trend-level association with Detachment. Hierarchical analyses further indicated that childhood abuse explained incremental variance in Psychoticism beyond childhood neglect, whereas neglect did not contribute additional explanatory value once abuse was considered.

Conclusions: Childhood maltreatment is not uniformly associated with maladaptive personality functioning in eating disorders. Emotional abuse appears to represent the principal developmental correlate of maladaptive personality traits, particularly Psychoticism. These findings support a more differentiated conceptualization of childhood adversity in EDs and highlight the importance of integrating trauma-informed and dimensional personality assessment into individualized case formulation.