The impact of traumatic events on dissociative experiences in hospitalized patients with anorexia nervosa: a moderated mediation study

Unresolved traumatic experiences are empirically associated with the development of a spectrum of severe mental health difficulties. This study explores the relationship between retrospectively reported traumatic events and dissociative symptoms (psychoform, somatoform, structural) in individuals with anorexia nervosa (AN) at present, as well as potential explanatory mechanisms of this association. We tested the mediating role of complex post-traumatic stress (CPTSD) symptoms and the moderating role of length of inpatient stay. In this cross-sectional survey of a clinical sample of 107 individuals with AN, we used internationally validated measures with strong psychometric properties (Cronbach's alphas ≥ .87): the ITQ for ICD-11 CPTSD symptoms, the TLEQ for intensity of traumatic experiences, and the SDQ-20 and DES-B for trauma-related dissociative experiences. Our findings indicated significant positive correlations between the retrospective ratings of intensity of traumatic events prior to AN onset and psychoform (<i>r</i>_<i>s</i> = .68, <i>p</i> = .006), somatoform (<i>r</i>_<i>s</i> = .59, <i>p</i> = .008), structural dissociation (<i>r</i>_<i>s</i> = .67, <i>p</i> = .006), and CPTSD symptoms (<i>r</i>_<i>s</i> = .53, <i>p</i> = .009). CPTSD symptoms were strongly associated with all forms of dissociation and mediated the relationship between retrospectively assessed trauma intensity and dissociative symptoms. Moreover, length of inpatient stay moderated these associations <i>(all p < .05)</i>. In conclusion, traumatic experiences may contribute to complex psychological outcomes in AN and should receive more attention in treatment settings.