Childhood adversity and empathy in eating disorders: Exploring transdiagnostic profiles and socio-emotional functioning

Adverse childhood experiences (ACEs), including abuse and neglect, have been associated with difficulties in developing empathy. People with eating disorders (EDs) often report higher rates of ACE and display empathy-related impairments, which may contribute to maladaptive interpersonal functioning. This study explored the associations between childhood adversities and empathy-related outcomes in individuals with ED compared to a general population sample (GP). Participants included 210 people with EDs (94 anorexia nervosa restrictive, 34 binge-purge anorexia nervosa, 36 bulimia nervosa, 36 binge-eating disorder, 24 OSFED) from national ED clinics and 151 participants from the GP. Participants completed the Childhood Trauma Questionnaire (CTQ) and the Empathy Quotient (EQ). Multivariate analyzes evaluated group differences and associations between specific forms of childhood adversity and subdomains of EQ: cognitive empathy (CE), emotional reactivity (ER) and social skills (SS). ACEs were more prevalent in the ED group (56 %) than in the GP (33 %, χ 2 = 31.81, p < 0.001). Emotional abuse and neglect were associated with a lower ER and SS, and physical neglect was associated with a reduction in CE and ER. No significant effects for physical or sexual abuse. Group membership alone was not associated with empathy outcomes. Cluster analysis identified two profiles: one with high trauma exposure and lower empathy, and another with lower trauma and more preserved socio-emotional functioning. Findings highlight the specific impact of emotional forms of childhood adversity on empathy in EDs and support trauma-informed, individualized interventions based on socio-emotional profiles. • Emotional trauma is linked to empathy deficits in eating disorder populations. • Emotional neglect and abuse impair social and emotional empathy components. • Physical and sexual abuse were not associated with empathy outcomes. • Cluster analysis revealed two transdiagnostic trauma-empathy profiles. • Trauma-informed care should address socio-emotional functioning in EDs.