Naturalistic Associations Between Childhood Maltreatment, Compulsivity, and Eating Disorder Symptoms Over a 12‐Months Period Among Individuals With Anorexia Nervosa

Introduction Childhood maltreatment is associated with more severe eating disorder (ED) symptoms and compulsivity, and compulsivity is implicated in anorexia nervosa (AN). However, the role of childhood maltreatment and compulsivity in shaping the clinical course of AN remains unclear. Objective We investigated whether childhood maltreatment was associated with compulsivity, and whether childhood maltreatment and compulsivity moderated changes in ED symptoms over time following discharge from treatment in AN. Method Individuals ( N = 194; Age = 16–62) with AN restricting type (AN‐R) and AN binge‐eating/purging type (AN‐BP) completed a diagnostic interview and self‐report measures of compulsivity and childhood maltreatment upon admission to treatment. They completed follow‐up assessments of ED symptoms at discharge and three, six, and 12 months post‐discharge. Results Higher exposure to childhood maltreatment was associated with greater compulsivity at admission in individuals with AN‐BP. Childhood maltreatment moderated changes in ED symptoms from discharge to 12 months post‐discharge in individuals with AN‐R, such that those with lower levels of maltreatment showed symptom improvement, whereas those with higher levels of maltreatment showed no change in symptoms. Compulsivity did not moderate changes in symptoms. Conclusions Findings highlight childhood maltreatment as a potentially important factor to account for in improved interventions for AN.