Adverse childhood experiences, low self-esteem, and salient stimulus response in eating disorders

BackgroundAdverse childhood experiences (ACEs) are elevated in individuals with eating disorders (EDs), but how the neurobiology of EDs and ACEs interact is unclear.MethodsWomen 18-45 years old with anorexia nervosa (AN, n = 38), bulimia nervosa (BN, n = 32), or healthy controls (n = 60) were assessed for ACEs and ED behaviours and performed a taste-conditioning task during brain imaging. Mediation analyses tested relationships between ACE score, self-esteem, and ED behaviours.ResultsACE scores were elevated in EDs and correlated positively with body mass index (p = 0.001), drive for thinness (p = 0.001), and body dissatisfaction (p = 0.032); low self-esteem mediated the relationship between ACEs and body dissatisfaction, drive for thinness, and bulimia severity. ACE scores correlated negatively (FDR-corrected) with unexpected, salient stimulus receipt in AN (substantia nigra) and BN (anterior cingulate, frontal and insular cortex, ventral striatum, and substantia nigra). When ACE scores were included in the model, unexpected stimulus receipt brain response was elevated in EDs in the anterior cingulate and ventral striatum.ConclusionsACEs attenuate unexpected salient stimulus receipt response, which may be a biological marker for altered valence or hedonic tone perception in EDs. Low self-esteem mediates the relationships between ACEs and ED behaviours. Adverse childhood experiences should be assessed in biological studies, and their effects targeted in treatment. The study replicates that low self-esteem mediates the effects of adverse childhood experiences (ACEs) on drive for thinness, body dissatisfaction, and the tendency to binge eat. This study provides a neurobiological mechanism for how ACEs affect stimulus valence or hedonic tone processing long after the trauma has occurred. Assessing ACEs is important to control for their effects when studying salient stimulus responses in eating disorders (EDs), and low self-esteem and the effects of ACEs should be targeted in treatment.