From Childhood Trauma to Disordered Eating Behaviors in Adolescence: Sex-Specific Associations via Distinct Emotion Regulation Difficulties

Exposure to childhood trauma can hinder the development of emotion regulation skills and increase the risk for disordered eating behaviors (DEBs) in adolescence. Despite well-known sex differences in trauma exposure and DEBs, underlying mechanisms remain poorly understood, as most research has been conducted exclusively among adult women diagnosed with eating disorders. This study aims to disentangle which emotion regulation difficulties link childhood trauma to subtypes of DEBs, according to sex. Adolescents ( n = 384, 62% girls) were recruited through Quebec schools and completed measures related to childhood trauma, emotion regulation, and DEBs. Bootstrapped Structural Equation Models explained modest to moderate variance in DEBs (10-34%), with sex-specific patterns. In girls, limited access to effective emotion regulation strategies emerged as a significant mechanism linking trauma to most DEBs (dietary restraint, eating and shape/weight concerns, and excessive physical exercise). In boys, trauma was directly associated with DEBs, pointing to distinct underlying mechanisms. We found an indirect effect of non-acceptance of negative emotions linking trauma to excessive physical exercise, whilst lack of emotional clarity was directly associated with this outcome in boys. However, emotion regulation did not mediate the link between trauma and binge eating in either girls or boys. This study highlights the importance for practitioners working with trauma-exposed youth to consider sex and various eating-related symptoms. Fostering access to effective emotion regulation strategies in girls, and strengthening emotion identification and acceptance in boys, may buffer the effects of childhood trauma on disordered eating, by providing adolescents alternative ways of managing their emotions.