Recognizing and Responding to Child Maltreatment: Strategies to Apply When Delivering Family-Based Treatment for Eating Disorders

Abstract

Child maltreatment encompasses a constellation of adverse parental behaviors that include physical, sexual, or emotional abuse, physical or emotional neglect, as well as exposure to violence between parents. A growing body of literature indicates that exposure to child maltreatment is a significant risk factor for the development and maintenance of eating disorders (EDs) and that practitioners experience challenges related to recognizing and responding to various forms of child maltreatment in their practice. Parent-child interactions signifying possible child maltreatment can be subtle; furthermore, the emotional and behavioral symptoms associated with an ED can overlap with those linked with child maltreatment, making it difficult for practitioners to distinguish whether children's symptoms are attributable to underlying psychopathology versus exposure to child maltreatment. This challenge can be further complicated in the context of delivering family-based treatment (FBT); FBT reaffirms that there is no single cause of EDs and asserts the leadership role of parents in their child's recovery processboth of which may lead practitioners to inadvertently miss indicators of child maltreatment. In this article, we provide an overview of the evidence linking child maltreatment to EDs among children and adolescents, as well as evidence-informed strategies for practitioners to safely recognize and respond to suspected child maltreatment when delivering FBT to children and adolescents in their practice.

The Effects of Childhood Emotional and Physical Maltreatment on Adolescents' Disordered Eating Behaviors

“…According to Sansone and Sansone (2007, 2010), BPFs might represent preexisting risk factors for the development of DEBs, with which they share the common etiological matrix in experiences of childhood maltreatment in a chaotic crossroads (Khosravi, 2020b; Newton, 2019; Sansone and Levitt, 2004; Sansone and Sansone, 2007, 2010; Spiegel et al, 2021; Zanarini et al, 2010). Thus, in the present study, emotional maltreatment represents the beginning of a developmental cascade (Sansone and Sansone, 2007) that culminates in DEBs as a maladaptive coping strategy in response to negative emotions (Kimber et al, 2017, 2020; Pignatelli et al, 2017), through BPFs characterized by more resistance to change, multi-impulsivity behaviors, affective instability, feeling of emptiness, rejection sensitivity, and difficulties in trustfulness (Fonagy et al, 2015; Meneguzzo et al, 2021; Spiegel et al, 2021). On the contrary, in the present findings, physical maltreatment seems to be less involved in the developmental cascade.…”

“…Experiences of trauma at earlier ages like childhood abuse and neglect represent boundary violations and can lead to different expressions of developmental arrest in adolescence and adulthood, such as difficulties in emotional dysregulation, identity issues, affected self-esteem, suicidal ideation, and possible comorbidity with psychiatric disorders (Caslini et al, 2016; Castellini et al, 2018; Frias et al, 2016; Gargiulo et al, 2021; Hibbard et al, 2012; Kimber et al, 2020; Mattingley et al, 2022; Meneguzzo et al, 2021; Musetti et al, 2021a, 2021c; Sansone and Sansone, 2007; Spertus et al, 2003; Van der Kolk et al, 1994). In particular, during adolescence, the influence of childhood experiences of maltreatment might continue to exert powerful influences, whereas these influences might decrease during the transition to adulthood, and the adolescents are more likely exposed to psychopathological symptoms, including disordered eating behaviors (DEBs) (Hopwood et al, 2011).…”

“…Evidence suggested that childhood maltreatment experiences in their different types and severity expose individuals to eating disorders, in particular binge-purge behaviors (Caslini et al, 2016;Hazzard et al, 2019;Molendijk et al, 2017;Monteleone et al, 2021). Likely, because eating behaviors often perform the function of modifying psychological and physiological states (Kent and Waller, 2000), the development of DEBs and overt eating disorders has been considered a maladaptive coping strategy in response to negative emotions raising from childhood experiences of abuse and neglect (Kimber et al, 2017(Kimber et al, , 2020Pignatelli et al, 2017). According to Trottier and MacDonald (2017), disordered eating might allow to escape and avoid trauma-related emotions in a dysfunctional way, maintaining symptomatology of DEBs and trauma.…”