Childhood trauma and eating psychopathology : a mediating role for dissociation and emotion dysregulation?
Moulton, Stuart J.
Objectives: This thesis aimed to investigate whether a history of childhood trauma was indirectly associated with eating psychopathology through mediation by dissociation and/or emotion dysregulation. Method: Firstly, a systematic review was conducted to appraise the current level of evidence within the literature that supported dissociation as a potential mediator. To this end, studies that assessed the variables of childhood trauma, dissociation and eating psychopathology within a single study were identified and systematically reviewed. Secondly, an empirical cross-sectional study was undertaken to investigate a multiple mediation model of the association between childhood trauma and eating psychopathology which included dissociation and emotion dysregulation as potential mediators. 165 undergraduate Psychology students took part in this study. Participants completed measures of childhood trauma, eating psychopathology, dissociation and emotion dysregulation. Experiences of multiple forms of childhood trauma were assessed, including emotional abuse (CEA), physical abuse (CPA), sexual abuse (CSA), emotional neglect (CEN) and physical neglect (CPN). Results: The results of the systematic review were inconclusive regarding the potential role of dissociation as a mediator in the relationships between childhood trauma and eating psychopathology. Findings within the reviewed studies generally offered more support for associations between childhood trauma and dissociation and dissociation and eating psychopathology. Studies reported more inconsistent findings regarding the association between childhood trauma and eating psychopathology. The results from the empirical study indicated that CEA and CEN were both significantly associated with increased eating psychopathology within the whole sample. These relationships were significantly mediated by both dissociation and emotion dysregulation. A separate analysis with female participants only, indicated that CPA and CPN in addition to CEA and CEN were significantly associated with increased eating psychopathology. The associations between CEA, CEN, CPN and eating psychopathology were all significantly mediated by both dissociation and emotion dysregulation. Dissociation and emotion dysregulation did not mediate the association between CPA and eating psychopathology. Conclusions: The studies included within the systematic review offered tentative support for an indirect relationship between childhood trauma and eating psychopathology through dissociation. Firm conclusions were limited, however, due to a number of methodological shortcomings identified within the included studies. The main methodological shortcomings concerned the definition and measurement of childhood trauma and the failure of a number of studies to address theoretical models within their research design. Addressing both of these methodological limitations, the results of the empirical study provided support for the growing consensus that emotional maltreatment may be an important risk factor for the development of eating psychopathology. Further, the results of this study indicate that childhood trauma impacts indirectly on eating psychopathology through an enduring effect on both dissociative and emotion regulation processes.