Structural equation modeling of adverse childhood experiences, ultra-processed food intake, and symptoms of post-traumatic stress disorder, ultra-processed food addiction, and eating disorder among adults seeking nutrition counseling in Los Angeles, CA

Adverse childhood experiences (ACEs), such as abuse, neglect, or household violence, have been identified as significant risk factors for a multitude of physical and psychological conditions, motivating research to identify contributing mechanisms and conditions. Substantial evidence exists that supports strong associations between ACEs and symptoms of post-traumatic stress disorder (PTSD), eating disorders (EDs), and addictive disorders. Recent research has also elucidated a link between ACEs and ultra-processed food addiction (UPFA), a clinical presentation resembling a substance use disorder with ultra-processed foods (UPFs; e.g., pastries, packaged snacks, sweetened beverages). Yet, no research to our knowledge has explored causal mediation pathways between ACEs, consumption patterns of UPFs, and symptoms of PTSD, UPFA, and ED. In a sample of 304 adults seeking dietary counseling in a private practice specializing in mental health nutrition, this study conducted mediation analyses and structural equation modeling to test a conceptual model of the hypothesized contributions of UPF intake and UPFA in explaining the relationships between ACEs with symptoms of PTSD and ED. Symptoms of PTSD fully mediated (99.4%) the positive relationship between ACEs and ED symptoms and 51.0% of the ACE-UPFA association. Greater UPF consumption frequency mediated 23.7% of the positive relationship between ACEs and UPFA symptoms, and UPFA symptoms mediated 73.8% of the positive relationship between UPF intake and ED symptomology. Relatedly, symptoms of UPFA explained 46.0% of the positive association between symptoms of PTSD and indicators of ED pathology. Structural equation modeling indicated significant associations of all hypothesized relationships when analyzed simultaneously. This study found that the influences of UPF consumption and UPFA represent a blind spot in current trauma-informed treatment approaches for disordered eating.