Page 82 - JCBP-2-4

Journal of Clinical and
Basic Psychosomatics Adverse life events and body image

Trauma exposure is considered a non-specific risk with bulimic symptoms or body mass index (BMI).
3,5
factor for ED, and several adverse life events (ALEs), We hypothesized that patients with ED who experienced
mostly occurring within a trusting relationship, have interpersonal ALEs before the age of 13 years (pre-13
been implicated in the onset and maintenance of the interpersonal ALEs) are more likely to present with BID.
illness. However, it remains unclear whether the onset of This study aimed to examine the relationship between pre-
4-7
psychopathology is due to maltreatment or other factors 13 interpersonal ALEs and both visual and non-visual BID
such as the timing or frequency of traumatic experiences. 8 in patients with ED. In addition, this study examined the
Various forms of ALEs, including physical abuse, relationship between pre-13 interpersonal ALEs and the
physical neglect, emotional abuse, emotional neglect, and development of perfectionism and impulsivity.
sexual abuse, have been identified as child maltreatment. 2. Methods
9
Interpersonal trauma has been classified as maltreatment
and associated with post-traumatic symptoms. ALEs 2.1. Study design and participants
10
have also been linked to the development of body image, We conducted an observational, cross-sectional, case–
along with personal, social, and interpersonal factors. control study. Eligible participants (n = 187) underwent
11
In addition, childhood experiences of pain and hunger, an assessment to determine whether they met the
exploration of the environment, and relationships inclusion and exclusion criteria. This study involved three
with parents have been found to contribute to the comparison groups: A study group (ED group) of patients
12
development of altered body image. The body image with ED and two control groups consisting of patients
construct includes attitudes, perceptions, emotions, and with recurrent major depressive disorder (RMDD) and
thoughts. 11,13 A growing body of research indicates that participants with no history of mental illness. The control
body representation relies on multisensory perceptions groups were selected from non-clinical populations
toward which therapeutic efforts can be directed. 14 with mood disorders who showed BID. 11,21 In addition,
2
A recent systematic review of the effects of maltreatment affective disorders are known to be associated with ED.
on patients with ED reported alterations in the parietal Psychiatrists and psychologists of the relevant treatment
cortex and thalamic areas involved in the visual perception units performed the initial selection of outpatients. Based
of shape. 15,16 The early years of development are critical on the inclusion criteria, 107 eligible patients with ED
for neurobiological maturation and enhancement of and 35 with RMDD were consecutively recruited by their
relationship skills. Adverse childhood experiences before therapists when they attended their follow-up. For the
17
the age of 6 years can interfere with the development recruitment of the control group with no history of mental
of secure attachment and good emotion regulation. illness, we distributed information leaflets describing the
14
Exposure to physical or sexual abuse in early childhood study and containing contact information on the hospital
has been associated with depression, post-traumatic bulletin boards, and 45 eligible candidates were selected.
symptoms, and anxiety in adulthood. Patients with The inclusion criteria were as follows: Age 18 – 65 years;
17
ED who have experienced humiliation from peers or diagnosis of restricting and purging anorexia nervosa,
intrafamilial abuse show greater body dissatisfaction, bulimia nervosa, or binge ED and RMDD according to
with shame as a mediating factor between ALEs and body the diagnostic and statistical manual of mental disorders,
image. In addition, ALEs have been associated with 5 Edition ; good command of the Spanish language;
15
th
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alterations in the glucocorticoid or noradrenergic system. 15 and provision of written informed consent. The exclusion
2
Perfectionism has been identified as a predictor of ED criteria were as follows: BMI of <15 kg/m , high suicide risk,
development. Quilliot et al. revealed that bullying, sexual presence of psychotic symptoms, or intellectual disability.
18
abuse, and dissociative symptoms are associated with Finally, the study included 140 participants, including
19
emotional dysregulation in patients with ED. Armour 79 (56.4%) patients with ED, 20 (14.3%) patients with
et al. reported that impulsivity was associated with self- RMDD, and 41 (29.3%) controls. The mean age of the
injurious behaviors and body rumination in patients with participants (total sample) was 38.5 (range: 18 – 60, standard
ED and those with affective disorders who had experienced deviation [SD]: 12.3) years; 90% of the participants were
interpersonal ALEs. Emotional dysregulation may be females, 68.6% completed college education, and 70% were
20
related to body dissatisfaction through perfectionism, employed. ALEs were reported by 89.3% of the participants.
according to Donahue et al. 18
To date, no study has evaluated the relationship between 2.2. Measurement and procedure
ALEs and BID in patients with ED. Some studies have Recruitment was conducted between January 2021 and
examined different subtypes of ALEs and their association May 2022. Participants attended a face-to-face interview at

Volume 2 Issue 4 (2024) 2 doi: 10.36922/jcbp.4662