Childhood sexual abuse and disordered eating: distinct pathways linking complex PTSD with binge eating disorder and night eating syndrome

While childhood sexual abuse (CSA) is a known risk factor for disordered eating, the specific mechanisms linking CSA to symptoms of Complex Post-traumatic stress disorder (CPTSD), Binge Eating Disorder (BED), and Night Eating Syndrome (NES) remain under-researched. This study investigated the relationships between CSA, CPTSD, and bulimic-spectrum symptoms, specifically testing whether depression, anxiety, and somatization function as mediators in these pathways. A sample of 332 adults (mean age 34.85 ± 14.51) completed an online survey including the International Trauma Questionnaire (ITQ), Binge Eating Scale (BES), Night Eating Questionnaire (NEQ), the Brief Symptom Inventory-18 (BSI-18), and Satisfaction with Life Scale (SWLS). We hypothesized that emotional distress (depression, anxiety and somatization) would mediate the associations between trauma exposure, CPTSD symptoms, and eating pathology. Structural equation modeling indicated good model fit (χ² = 33.90, p < .001; CFI = 0.99; RMSEA = 0.079; SRMR = 0.05). CSA predicted CPTSD (β = 0.39, p<.001). Anxiety fully mediated the path from CPTSD to NES (beta=0.45, p<.001), while somatization partially mediated the path to BED (β = 0.20, p<.001). Notably, despite a strong link between CPTSD and depression (β = 0.82, p<.001), depression did not significantly mediate either eating disorder pathway. Findings suggest that anxiety may play a particularly important role in the association between CPTSD symptoms and NES symptoms, while somatization may contribute to the association between CPTSD symptoms and BED symptoms. However, these findings should be interpreted cautiously given the cross-sectional design, reliance on retrospective self-report of childhood sexual abuse, absence of clinical diagnoses, and the predominantly Jewish female, non-clinical online sample. Our results provide a preliminary basis for further investigation of trauma-related and psychological factors associated with binge- and night-eating symptoms. Childhood sexual abuse has been linked to both trauma symptoms and problems with eating, but we still know relativelylittle about how these difficulties are connected. In this study, 332 adults completed questionnaires about childhood sexual abuse, complex PTSD,emotional distress, binge eating, night eating, and well-being. People who reported more severe childhood sexual abuse also reported more complex PTSDsymptoms and more binge eating and night eating. Complex PTSD was also strongly linked with depression, anxiety, and physical symptoms related toemotional distress. Anxiety seemed to be especially important in the link between complex PTSD and night eating, while physical symptoms related toemotional distress seemed to play a greater role in the link between complex PTSD and binge eating. These findings suggest that binge eating and nighteating in people with a history of childhood sexual abuse may be connected with broader trauma-related difficulties, not only with eating itself. Understanding anxiety, physical symptoms related to emotional distress, and complex PTSD may therefore be important when assessing these eating problems.