Relationships Among Childhood Maltreatment,Limbic System Dysfunction,and Eating Disorders in College Women

Abstract

The mechanisms linking childhood maltreatment and eating pathology are not fully understood. We examined the mediating role of limbic system dysfunction in the relationships between three forms of childhood maltreatment (parental psychological maltreatment, parental physical maltreatment, and parental emotional neglect) and eating disorder symptoms. A convenience sample of college women (N = 246, M age = 19.62, SD = 2.41) completed measures of maltreatment (Parent-Child Conflict Tactics Scales and the Parental Bonding Instrument), limbic system dysfunction (Limbic System Questionnaire), and eating pathology (Eating Disorder Examination Questionnaire). We hypothesized that there would be an indirect effect of each type of childhood maltreatment on eating disorder symptoms via limbic system irritability. Results generally supported the hypotheses. Examination of the individual paths that defined the indirect effect indicated that higher reported childhood maltreatment was associated with greater limbic irritability symptoms, and higher limbic irritability symptomatology was related to higher total eating disorder scores. There were no significant direct effects for any of the proposed models. Findings are in line with research supporting the role of limbic system dysfunction as a possible pathway in the maltreatment-eating disorder link. Given that limbic system dysfunction may underlie behavioral symptoms of eating disorders, efforts targeting limbic system dysfunction associated with child maltreatment might best be undertaken at an early developmental stage, although interventions for college women struggling with eating disorders are also crucial.

Keywords

childhood maltreatment limbic dysfunction eating disorders

Childhood maltreatment is defined as any act by a caregiver that results in harm, potential for harm, or threat of harm to a child, regardless of the caregiver’s intent (Gilbert et al., 2009).¹ Maltreatment can be subdivided into four major categories: neglect (including emotional neglect, which was a particular focus of this study), physical abuse, emotional or psychological abuse, and sexual abuse (Mills et al., 2014). According to the U.S. Department of Health and Human Services (2015), roughly 683,000 children were victims of maltreatment in the United States and Puerto Rico in 2013, with children under the age of one having the highest abuse rate; furthermore, estimates put reported cases as much as 10 times below the true number of child maltreatment incidents.

Several studies have found links between different forms of childhood maltreatment and eating psychopathology and weight problems later in adolescence and adulthood (e.g., Caslini et al., 2016; Danese & Tan, 2014; Johnson et al., 2002; Kim & Cicchetti, 2010; Molendijk et al., 2017). Two recent meta-analytic studies concluded that childhood sexual abuse, childhood physical abuse, and childhood emotional abuse were related to different types of eating disorder diagnoses in clinical samples (Caslini et al., 2016; Molendijk et al., 2017). Research on nonclinical samples has similarly shown that various types of childhood maltreatment are correlated directly and indirectly with disordered eating symptoms (e.g., Burns et al., 2012; Kennedy et al., 2007; Kent et al., 1999; Mazzeo & Espelage, 2002; Rind et al., 1998). Although a connection between childhood maltreatment and eating disorder symptoms has been established, less is known about neurological mechanisms that might underlie this relationship. However, there is some suggestion in the literature that the limbic system—which is comprised mainly of the hippocampus (involved in consolidating memory), the amygdala (involved in fear and anger processing), and the hypothalamus (which regulates cortisol and stress responses)—may be a key brain region involved in the link between childhood maltreatment and the development of eating disorders. In an extensive review of research related to their hypothesis that maltreatment acts as a stressor producing extensive physiological and neurohumoral reactions influencing developing brains in ways that can contribute to later psychiatric symptoms in genetically susceptible individuals, Teicher and Samson (2016) found, for example, considerable evidence for an increased amygdala response to emotional faces, particularly those seen as threatening, as well as alterations in the adult hippocampus, in individuals maltreated during childhood. Research has also shown that limbic system dysfunction, which has been linked consistently to the experience of childhood trauma and stress (e.g., Ashy et al., 2020; Choi et al., 2009), predicts eating disorders (e.g., Chowdhury et al., 2003; Dackis et al., 2012; Edmiston et al., 2011; Lipsman et al., 2015; Teicher et al., 2003).

There are a number of strands of evidence that support the possibility of a mediating role for limbic system involvement in the childhood maltreatment/eating disorder relationship: (a) evidence that limbic irritability mediates the relationship between childhood maltreatment and psychiatric symptoms such as depression (Ashy et al., 2020; Dackis et al., 2012); (b) evidence that childhood maltreatment is associated with neurotoxic effects within limbic regions that may lead to limbic system dysfunction, specifically limbic irritability (Andersen et al., 2002; Ashy et al., 2020; Choi et al., 2009; Teicher et al., 2010); and (c) evidence of functional and potentially structural changes in neuroanatomy such as abnormal blood flow to certain brain regions, including parts of the limbic system, in patients with eating disorders such as bulimia and anorexia nervosa (Chowdhury et al., 2003; Lask et al., 2005; Yoshizawa et al., 2009).

In sum, limbic system dysfunction is associated with childhood trauma and maltreatment (e.g., Ashy et al., 2020; Choi et al., 2009) as well as with eating disorders (e.g., Lask et al., 2005; Yoshizawa et al., 2009). However, to our knowledge, no studies have examined limbic system dysfunction as a mediator between different forms of maltreatment and eating disorder symptoms. Researchers have found evidence to support the role of the limbic system as a mediator in the relationship between maltreatment and more general indices of psychopathology (Ashy et al., 2020), but eating disorders have not been specifically considered (e.g., Dackis et al., 2012). This study was designed to address this gap in the literature.

Specifically, in this study, we explored whether limbic system dysfunction, as measured by self-reported limbic irritability symptoms—including perceptual and somatic distortions, motor automatism, brief hallucinatory events, and dissociative symptoms (Dackis et al., 2012)— mediated the relationships between various forms of parental maltreatment and disordered eating symptoms in a nonclinical sample of college women. We chose to focus exclusively on college women because late adolescence and early adulthood represents a high-risk time-period for the development of unhealthy weight control behaviors and heightened body image concerns among young women, which increases their vulnerability to clinical and subclinical eating disorders (Ata et al., 2007; Stice & Bearman, 2001). Most research suggests that eating pathology emerges most commonly between the ages of 16 and 18 (Taylor et al., 2006). We considered three forms of maltreatment (parental physical maltreatment, parental psychological maltreatment, and parental emotional neglect) and examined them separately in relation to limbic irritability and eating pathology. We hypothesized that each type of maltreatment would exert a significant indirect effect on eating disorder symptoms via limbic irritability symptoms.

Method

Participants

The sample consisted of 246 females (M age = 19.62, SD = 2.41). The ethnicity of the sample was 44.1% White, 26.6% Asian-American, 9% Hispanic, 8.1% African American, and 12.2% other ethnicities. (These percentages do not add up to 100 because not every participant provided data.) The majority of participants self-reported that they were either from an upper-middle class (40.8%) or middle-class family (38%), while 14% reported a lower-middle class socioeconomic status. Participation requirements included being at least 18 years of age and a native English speaker. The majority of participants were recruited from general psychology classes at a large urban university in the Northeast (n = 176). Additional participants were recruited from an online job board for undergraduates at the same institution (n = 65) or from Craigslist (n = 5). Upon completion of the study, participants received either course credit or a US$25 gift card.

Procedure

This study was completed as a part of a larger experiment investigating the association of cortisol with childhood maltreatment and other variables, such as parental bonding and adult attachment style. Participants first engaged in informed consent procedures during which they were assured they could refrain from participating in any procedures and from answering any questions that made them uncomfortable. The entire session lasted approximately 90 min, during which the participants individually underwent a modified version of the Trier Social Stress Test (TSST), had their height and weight taken for body mass index (BMI) calculation, provided one hair sample and three saliva samples for cortisol measurements, and completed a paper-and-pencil questionnaire packet including the measures analyzed for this study. At the end of the procedure, each participant was given a debriefing, including a written copy of the debriefing form providing information regarding available counseling services. None of the participants reported being stressed by any of the survey measures.

We complied with all state laws, federal laws, and the American Psychological Association guidelines. The university’s Institutional Review Board reviewed and approved all study procedures and materials. Data were collected anonymously and all participants gave permission for their responses to be analyzed for research purposes.

Measures

Psychological and physical maltreatment

Psychological and physical maltreatment were evaluated using subscales from the Parent-Child Conflict Tactics Scales (CTSPC) (Straus & Hamby, 1997), a questionnaire that measures the frequency of conflict-tactics employed by the participant’s parents during the self-described “worst year” of childhood. The psychological maltreatment subscale contained five items and the physical maltreatment subscale contained nine items. Each item was rated separately for mothers and fathers using a 7-point scale (0—never happened; 1—once in worst year; 2—twice in worst year; 3—3–5 times in worst year; 4—6–10 times in worst year; 5—11–20 times in worst year; 6—more than 20 times in worst year; and 7—not in worst year, but did happen at another time). Thus, there were 10 items assessing psychological maltreatment and 18 items assessing physical maltreatment. Based on an instruction manual developed by Straus (2004), we calculated an annual frequency score separately for psychological maltreatment and physical maltreatment. All items were recoded such that 7 became 0, 3 became 4 (the midpoint of the 3–5 range), 4 became 8 (the midpoint of the 6–10 range), 5 became 15 (the midpoint of the 11–20 range), and 6 became 25. (Because 6 represents the highest end of the scale and reflects experiencing a behavior more than 20 times in a year, there is no clear “midpoint” to choose in this instance. However, we followed Straus’ recommendation and coded 6 to 25, which he referred to as an assumed midpoint.) The response values of 1 and 2 remained the same. Then, we summed responses for mothers and fathers for each subscale to create a total parental psychological maltreatment score and a total parental physical maltreatment score. Scores could range from 0 to 250 for the psychological maltreatment subscale and from 0 to 450 for the physical maltreatment subscale. Past studies (e.g., El-Sheikh & Elmore-Staton, 2004; Miller-Perrin et al., 2009; Slep & O’Leary, 2005) have shown good reliability and validity for this measure. Cronbach’s α was .83 for parental psychological maltreatment and .87 for parental physical maltreatment.

Parental emotional neglect

The 12-item “care” subscale of the Parental Bonding Instrument (G. Parker et al., 1979) was used to measure parental emotional neglect. Participants rated their level of agreement with each statement on a scale from 1 (very likely) to 4 (very unlikely), separately for mother and fathers. We summed the ratings across mothers and fathers to calculate a total parental emotional neglect score, with higher scores reflecting greater emotional neglect. Scores could range from 24 to 96. Previous research has established adequate evidence of reliability and validity for this measure (Bulik et al., 2000; G. Parker, 1989; Wilhelm et al., 2005). Cronbach’s α was .93 for parental emotional neglect.

Limbic system dysfunction

The Limbic System Checklist (LSCL-33; Teicher et al., 1993), which showed good reliability and validity in past research (e.g., Andersen et al., 2002; Dinn et al., 2002; Teicher et al., 2006), was used to measure the lifetime frequency with which participants have experienced symptoms of limbic irritability. It is a 33-item questionnaire that measures overall temporolimbic functioning and specific forms of limbic system dysfunction through subscales of (a) paroxysmal somatic disturbances (e.g., “Headache,” “Sensation of something crawling under your skin”), (b) sensory disturbances (brief hallucinations and visual disturbances, for example, “Hearing a voice repeating a sentence or phrase”), (c) behavioral disturbances (automatisms, for example, “Twitching or jerking of the arms or legs”), and (d) dissociative disturbances (e.g., “The sensation that a familiar person or place has become unfamiliar, changed, different, or almost as if you had never experienced it before”). Items are rated on a 4-point scale (0 = Never, 1 = Rarely, 2 = Sometimes, 4 = Often). Total scores are calculated by adding responses across items. Higher scores indicate greater limbic system dysfunction and could range from 0 to 132. Cronbach’s α was .89 for this measure.

Eating disorder symptoms

Eating disorder symptoms (Fairburn & Cooper, 1993) were evaluated using the EDE-Q6, a 28-item questionnaire that measures the frequency of particular eating behaviors over the past 4 weeks. The measure includes four main subscales, including dietary restraint (e.g., “Have you been deliberately trying to limit the amount of food you eat to influence your shape and weight (whether or not you have succeeded)?”), eating concerns (e.g., “Has thinking about food, eating, or calories made it very difficult to concentrate on things you are interested in (for example, working, following a conversation, or reading)?”), shape concerns (e.g., “Have you had a definite fear that you might gain weight?), and weight concerns (e.g., “Has thinking about shape or weight made it very difficult to concentrate on things you are interested in (for example, working following a conversion, or reading)?). Participants rated items on a 7-point scale ranging from 0 (never) to 6 (often). Responses were summed across the four subcategories to form a total eating disorder symptom score. Scores for this measure could range from 0 to 168. The EDE-Q6 has shown good test–retest reliability in both males and females (Almenara et al., 2017; K. Parker et al., 2015; Rose et al., 2013). Cronbach’s α was .93 for this measure.

Statistical Analyses

We first examined whether demographic variables, including age, socioeconomic status, and race, were related to any of our key variables. Next, we examined the mediating role of limbic system dysfunction between the different types of childhood maltreatment and total eating disorder scores. We tested for mediation using Hayes’ (2012) PROCESS macro developed for SPSS. PROCESS produces 95% bias-corrected confidence intervals for the indirect effect using a bootstrapping procedure. Bootstrapping is a nonparametric resampling technique that does not make assumptions about the distribution of the sample. We set the number of bootstrap resamples to 5,000 for each mediational model. The indirect effect is considered significant when the confidence interval does not contain 0.

Results

Preliminary Analyses and Correlation Results

Table 1 displays the means, ranges, and standard deviations for all study variables. Zero order correlations among variables are presented in Table 2. Limbic irritability was positively correlated with all three types of childhood maltreatment as well as with eating disorder symptoms. Psychological maltreatment was the only form of parental maltreatment that was significantly related to eating disorder symptoms. Because age was significantly correlated with eating disorder symptoms, (r = −.15, p = .04), we added it into each mediational model as a covariate.

Table 1.

Descriptive Statistics for Maltreatment Types, Limbic Dysfunction, and Eating Pathology (N = 246).

Variables	M	SD	Range
Parental psychological maltreatment	42.58	43.58	0–250
Parental physical maltreatment	14.06	32.79	0–278
Parental emotional neglect	44.02	13.98	24–93
Total limbic dysfunction	57.04	11.43	33–97
Total eating disorder symptoms	25.96	13.33	0–85

Table 2.

Correlations Among Childhood Maltreatment, Limbic System Dysfunction, and Eating Pathology (N = 246).

Variables	1	2	3	4	5
1. Parental psychological maltreatment	—
2. Parental physical maltreatment	.59***	—
3. Parental emotional neglect	.38***	.25***	—
4. Total limbic dysfunction	.40***	.27***	.23***	—
5. Total eating disorder symptoms	.16*	.10	.02	.31***	—

p < .05. ***p < .001.

The Mediating Role of Limbic System Dysfunction

In all three models examining the mediating role of limbic system dysfunction between the different types of childhood maltreatment and total eating disorder scores, higher reported childhood maltreatment was associated with greater limbic irritability symptoms, and higher limbic irritability symptoms were related to higher total eating disorder scores. Examination of the confidence intervals indicated that each type of childhood maltreatment had a significant indirect effect on disordered eating symptoms through limbic irritability (see Table 3). There was no evidence of an association between maltreatment types and eating disorder symptoms independent of limbic system irritability.

Table 3.

Indirect Effects of Maltreatment Types on Eating Pathology Via Limbic Irritability Controlling for Age (5,000 Bootstrap Samples).

IV	MV	Effect of IV on MV (a)	Effect of MV on DV (b)	Direct Effect (c′)	Indirect Effect (a × b)
Psychological maltreatment	Limbic system dysfunction	0.13***(SE = 0.02)	0.56***(SE = 0.14)	0.03(SE = 0.04)	0.07* [0.04, 0.12](SE = 0.02)
Physical maltreatment	Limbic system dysfunction	0.11***(SE = 0.02)	0.66***(SE = 0.14)	0.02(SE = 0.05)	0.07* [0.03, 0.13](SE = 0.03)
Emotional neglect	Limbic system dysfunction	0.24***(SE = 0.06)	0.65***(SE = 0.13)	−0.11(SE = 0.13)	0.15* [0.07, 0.28](SE = 0.05)

Note. IV = independent variable; MV = mediating variable; DV = dependent variable; SE = standard error.

p < .05. ***p < .001.

Discussion

To consider the implications of our findings, it is important to view them within their ecological context. The sample consisted primarily of fairly privileged and well-functioning young women attending an expensive private university. Perhaps not surprisingly, their self-reported overall exposure to physical maltreatment by parents in childhood was quite low; however, the participants reported rather high levels of emotional neglect (M = 44 out of a possible range of 24 to 96), which, like physical and psychological parental aggression, was positively correlated with limbic system dysfunction in our sample. Thus, it may not be just severe physical aggression or absence of economic well-being that can be harmful for neurodevelopment in ways that can be identified in young women.

The positive correlations of physical maltreatment, psychological maltreatment, and emotional neglect with limbic system dysfunction have important implications for the types of clinical services that could be useful to college women; specifically, even students from well-to-do backgrounds may be suffering from the negative effects of childhood maltreatment by parents, including emotional neglect, in ways that may not necessarily be fully amenable to, or require, traditional psychotherapy. One potentially effective approach to dealing with those negative effects would be a focus on strengthening resilience, which has been found to moderate the relationship between childhood maltreatment and psychiatric symptoms in young adults (Ashy et al., 2020) and to mediate the relationships of maternal maltreatment, paternal psychological maltreatment, and paternal emotional neglect with perceived stress in females (Hong et al., 2018).

Our mediation results generally complement and extend the findings of past studies showing that child maltreatment exerts an indirect effect on mental health outcomes via limbic irritability (e.g., Ashy et al., 2020; Dackis et al., 2012). Limbic system irritability significantly mediated the relationship between parental physical and psychological maltreatment, and eating disorder symptoms as well as between parental emotional neglect and eating disorder symptoms. It is noteworthy that for both parental physical maltreatment and parental emotional neglect, limbic irritability specifically explained the association between these aspects of childhood maltreatment and disordered eating symptoms in adulthood. Screening for limbic system dysfunction as well as psychological maltreatment and emotional neglect may provide additional useful information for interventions tailored to the particular experiences and outcomes of a substantial group of undergraduate women. One intervention program specifically designed to improve mental health and well-being in college students actually begins by introducing students to their “emotional brain”—specifically, the limbic system—and then providing guidance regarding dealing with threats to mental health (Morton et al., 2020).

To our knowledge, this is the first study to date that has explicitly tested limbic irritability as an intervening variable between different types of childhood maltreatment and subsequent eating pathology in a nonclinical sample of young women. Previous research provided support for a relationship between childhood trauma and eating pathology (e.g., Caslini et al., 2016; Molendijk et al., 2017), but the psychoneurological underpinnings accounting for this association had not been thoroughly examined. Our study also helps to fill a gap identified by Perry (2008), who argued that the developmental effects of emotional neglect are less well studied than effects of other forms of trauma.

Given growing evidence that child maltreatment, including emotional maltreatment and emotional neglect, can affect neurophysiological development, McCullough and Mathura (2019) have recommended a Neuro-Physiological Psychotherapy (NPP) approach for treating the effects of maltreatment in children. For example, to counteract the negative effects of maltreatment on the “limbic brain,” they recommend sensory/somatic activities, mindfulness activities, and “developmental re-parenting” to increase maltreated children’s ability to relate securely to others and, on a neurophysiological level, to build limbic-prefrontal cortex connections in those children. Their experiment evaluation of the effectiveness of their NPP model had promising results in regard to reducing a range of mental health symptoms in maltreated children; whether it would be useful in reducing the likelihood of eating disorders in children who have been maltreated would be a useful goal of future research.

There are a number of important limitations that warrant caution in interpreting our results. Of particular concern is the cross-sectional and correlational design, which leaves us uncertain about the causal order of the variables. Although we tested for reverse causality, and for two of the models found no support for reverse mediation, longitudinal work would be necessary to confirm that limbic dysfunction acts as a mechanism through which childhood trauma contributes to eating pathology. This would be especially important in the case of psychological maltreatment as we found evidence that both limbic irritability and eating disorder symptoms were plausible mechanisms based on these data. Longitudinal designs would also reduce problems with retrospective reports of childhood maltreatment, which raise concerns about possible reporting biases that may occur for any number of reasons (e.g., forgetting, response bias, current emotional state).

In addition, because we did not ask participants to report on other traumatic events they may have experienced inside or outside the home, we could not account for the potential contribution of other life stressors that may have exerted negative effects on brain functioning and later eating disorders. This would be an important issue for researchers to consider in future work. Moreover, although we assessed limbic irritability with a validated self-report measure, additional studies using direct assessments of the brain through imaging techniques and physiological instruments would provide more definitive support for the role of limbic dysfunction. Finally, we recruited a nonclinical convenience sample of college women from primarily middle-class backgrounds. Thus, it is unclear whether our findings would generalize to older women, men of different age groups, or to those from different socioeconomic backgrounds.

There is a clear need for greater attention to the effects of childhood maltreatment on men’s development and mental health functioning. In their recent review and meta-analysis of childhood maltreatment and its relation to the presence and severity of eating disorders, Molendijk et al. (2017) pointed out that the majority of studies recruited samples comprised primarily of women. Although the focus on women is not terribly surprising given the documented rates of eating disorders and subclinical eating disorder symptoms are higher in women (e.g., Lewinsohn et al., 2002), some research suggests that the gender difference may not be as large as previously described (Striegel-Moore et al., 2009). Moreover, there are some forms of eating disturbances (e.g., binge eating) that seem to be equally common in men and women (e.g., Striegel et al., 2011).

Central to a neurodevelopmental perspective is the contention that the brain mediates all aspects of emotion and behavior (Perry, 2008). Thus, it is crucial to continue investigating childhood experiences that can disrupt normal brain development. Of particular interest are developments and responses in the limbic system of infants and young children, whose brains are more malleable and thereby more sensitive to negative experiences, including emotional neglect (De Bellis, 2005). These neural abnormalities likely reflect adaptation to the adverse contexts in which the child is developing, such as the need to remain vigilant in a risky home environment. However, due to sensitive periods for neural development, these patterns of atypical neural functioning are retained long after the child has left the adverse context, with implications for adult mental health (Rutter et al., 2004). Thus, timely intervention efforts may be key to ameliorating neurological damage stemming from early child maltreatment. Our findings add to the existing literature establishing that child maltreatment is associated with limbic abnormalities, which has been proposed to help explain associations between child maltreatment and adult psychiatric disorders (McCrory et al., 2010). Our results suggest that, even in a relatively privileged and low-risk sample, physical maltreatment and emotional neglect in adulthood contribute to long-term limbic irritability and ultimately increase risk for disordered eating.

Footnotes

Authors’ Note

Majed Ashy is now affiliated with Mental Health Consulting, Education, and Strategic Planning, Jeddah, Saudi Arabia.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported in part by Clara Mayo Memorial Fellowship.

ORCID iD

Andrea E. Mercurio

Note

Author Biographies

Andrea E. Mercurio, PhD, is a senior lecturer in the Department of Psychological and Brain Sciences at Boston University. Her research focuses on the social and psychological factors that negatively affect young women’s body image. She is interested in understanding how we can promote healthy body image in women through the use of technology and social media.

Fang Hong’s, PhD, research focuses on the role of childhood maltreatment and emotion regulation strategies in later psychological health and stress psychophysiology, such as behavioral responses, psychological responses, and physiological responses. She is also interested in the extent to which culture can exert an influence on emotion recognition.

Carolyn Amir, BA, is a post-baccalaureate research fellow at the National Institutes of Health studying the effects of psychological processes on pain perception. She majored in psychology at Boston University, where she conducted research on the relationship between childhood maltreatment and adult outcomes, as well as the effects of brain stimulation.

Amanda R. Tarullo, PhD, is an associate professor of Psychological and Brain Sciences at Boston University. Her research focuses on how early experiences get “under the skin,” shaping the psychophysiological, emotional, and cognitive development of children who experience early life stress.

Anna Samkavitz, BA, is a second-year Mental Health Counseling student at Boston College. She received her BA in psychology from Boston University. Her research interests include the impacts of stress, the treatment of trauma, and the development of mental health issues across the lifespan.

Majed Ashy, PhD, earned his degree from Boston University and did postdoctoral work in psychiatric research at the Developmental Bio-Psychiatry Program (DBPRP) at MacLean Hospital at Harvard University Medical School, and at the Mind, Brain, and Education Program at Harvard Graduate School of Education. He studies childhood experiences, neurological development, mental health, psychosomatic medicine, psychoneuroimmunology, cultural psychology, and political psychology.

Kathleen Malley-Morrison, EdD, is a professor emerita from the Department of Psychological and Brain Sciences at Boston University. Her major research program focuses on family violence, particularly child maltreatment, and its predictors and correlates. She also does work in the area of cognitions regarding war and peace, and violence and nonviolence.

References

Almenara

C. A.

Aimé

Maïano

Ejova

Guèvremont

Bournival

Ricard

M. M.

(2017). Weight stigmatization and disordered eating in obese women: The mediating effects of self-esteem and fear of negative appearance evaluation. European Review of Applied Psychology, 67(3), 155–162. https://doi.org/10.1016/j.erap.2017.02.004

Andersen

C. M.

Teicher

M. H.

Polcari

Renshaw

P. F.

(2002). Abnormal T2 relaxation time in the cerebellar vermis of adults sexually abused in childhood: Potential role of the vermis in stress-enhanced risk for drug abuse. Psychoneuroendocrinology, 27(1), 231–244. https://doi.org/10.1016/S0306-4530(01)00047-6

Ashy

Gutowski

Samkavitz

Malley-Morrison

(2020). Childhood maltreatment, limbic dysfunction, resilience, and psychiatric symptoms. Journal of Interpersonal Violence, 35, 462–452. https://doi.org/10.1177/0886260516683174

Ata

R. N.

Ludden

A. B.

Lally

M. M.

(2007). The effects of gender and family, friend, and media influences on eating behaviors and body image during adolescence. Journal of Youth and Adolescence, 36, 1024–1037. https://doi.org/10.1007/s10964-006-9159-x

Bulik

C. M.

Sullivan

P. F.

Fear

J. L.

Pickering

(2000). Outcome of anorexia nervosa: Eating attitudes, personality, and parental bonding. International Journal of Eating Disorders, 28(2), 139–147. https://doi.org/10.1002/1098-108X(200009)28:2<139::AID-EAT2>3.0.CO;2-G

Burns

E. E.

Fischer

Jackson

J. L.

Harding

H. G.

(2012). Deficits in emotion regulation mediate the relationship between childhood abuse and later eating disorder symptoms. Child Abuse & Neglect, 36(1), 32–39. https://doi.org/10.1016/j.chiabu.2011.08.005

Caslini

Bartoli

Crocamo

Dakanalis

Clerici

Carrà

(2016). Disentangling the association between child abuse and eating disorders: A systematic review and meta-analysis. Psychosomatic Medicine, 78(1), 79–90. https://doi.org/10.1097/PSY.0000000000000233

Choi

Jeong

Rohan

M. L.

Polcari

A. M.

Teicher

M. H.

(2009). Preliminary evidence for white matter tract abnormalities in young adults exposed to parental verbal abuse. Biological Psychiatry, 65(3), 227–234. https://doi.org/10.1016/j.biopsych.2008.06.022

Chowdhury

Gordon

Lask

Watkins

Watt

Christie

(2003). Early-onset anorexia nervosa: Is there evidence of limbic system imbalance? International Journal of Eating Disorders, 33(4), 388–396. https://doi.org/10.1002/eat.10155

10.

Dackis

M. N.

Rogosch

F. A.

Oshri

Cicchetti

(2012). The role of limbic system irritability in linking history of childhood maltreatment and psychiatric outcomes in low-income, high-risk women: Moderation by FK506 binding protein 5 haplotype. Development and Psychopathology, 24(4), 1237–1252. https://doi.org/10.1017/S0954579412000673

11.

Danese

Tan

(2014). Childhood maltreatment and obesity: Systematic review and meta-analysis. Molecular Psychiatry, 19(5), 544–554. https://doi.org/10.1038/mp.2013.54

12.

De Bellis

M. D.

(2005). The psychobiology of neglect. Child Maltreatment, 10(2), 150–172. https://doi.org/10.1177/1077559505275116

13.

Dinn

W. M.

Harris

C. L.

Aycicegi

Greene

Andover

M. S.

(2002). Positive and negative schizotypy in a student sample: Neurocognitive and clinical correlates. Schizophrenia Research, 56(1–2), 171–185. https://doi.org/10.1016/S0920-9964(01)00230-4

14.

Edmiston

E. E.

Wang

Mazure

C. M.

Guiney

Sinha

Mayes

L. C.

Blumberg

H. P.

(2011). Corticostriatal-limbic gray matter morphology in adolescents with self-reported exposure to childhood maltreatment. Archives of Pediatrics & Adolescent Medicine, 165, 1069–1077. https://doi.org/10.1001/archpediatrics.2011.565

15.

El-Sheikh

Elmore-Staton

(2004). The link between marital conflict and child adjustment: Parent-child conflict and perceived attachments as mediators, potentiators, and mitigators of risk. Development and Psychopathology, 16(3), 631–648. https://doi.org/10.1017/S0954579404004705

16.

Fairburn

C. G.

Cooper

(1993). The eating disorder examination. In Fairburn

C. G.

Wilson

G. T.

(Eds.), Binge eating: Nature, assessment, and treatment (12th ed., pp. 317–360). Guilford Press.

17.

Gilbert

Widom

C. S.

Browne

Fergusson

Webb

Janson

(2009). Burden and consequences of child maltreatment in high-income countries. The Lancet, 373 (9657), 68–81. https://doi.org/10.1016/S0140-6736(08)61706-7

18.

Hayes

A. F.

(2012). PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling. http://www.afhayes.com/public/process2012.pdf

19.

Hines

D. A.

Malley-Morrison

Dutton

L. B.

(2012). Family violence in the United States: Defining, understanding, and combating abuse. Sage.

20.

Hong

Tarullo

Mercurio

A. E.

Liu

Cai

Malley-Morrison

(2018). Childhood maltreatment and perceived stress in young adults: The role of emotion regulation strategies, self-efficacy, and resilience. Child Abuse & Neglect, 86, 136–146. https://doi.org/10.1016/j.chiabu.2018.09.014

21.

Johnson

J. G.

Cohen

Kasen

Brook

J. S.

(2002). Childhood adversities associated with risk for eating disorders or weight problems during adolescence or early adulthood. American Journal of Psychiatry, 159(3), 394–400. https://doi.org/10.1176/appi.ajp.159.3.394

22.

Kennedy

M. A.

Samra

Gorzalka

B. B.

(2007). The role of childhood emotional abuse in disordered eating. Journal of Emotional Abuse, 7(1), 17–36. https://doi.org/10.1300/J135v07n01-02

23.

Kent

Waller

Dagnan

(1999). A greater role of emotional than physical or sexual abuse in predicting disordered eating attitudes: The role of mediating variables. International Journal of Eating Disorders, 25(2), 159–167. https://doi.org/10.1002/(SICI)1098-108X(199903)25:2<159::AID-EAT5>3.0.CO;2-F

24.

Kim

Cicchetti

(2010). Longitudinal pathways linking child maltreatment, emotion regulation, peer relations, and psychopathology. Journal of Child Psychology and Psychiatry, 51(6), 706–716. https://doi.org/10.1111/j.1469-7610.2009.02202.x

25.

Lask

Gordon

Christie

Frampton

Chowdhury

Watkins

(2005). Functional neuroimaging in early-onset anorexia nervosa. International Journal of Eating Disorders, 37(Suppl. 1), S49–S51. https://doi.org/10.1002/eat.20117

26.

Lewinsohn

P. M.

Seeley

J. R.

Moerk

K. C.

Striegel-Moore

R. H.

(2002). Gender differences in eating disorder symptoms in young adults. International Journal of Eating Disorders, 32(4), 426–440. https://doi.org/10.1002/eat.10103

27.

Lipsman

Woodside

D. B.

Lozano

A. M.

(2015). Neurocircuitry of limbic dysfunction in anorexia nervosa. Cortex, 62, 109–118. https://doi.org/10.1016/j.cortex.2014.02.020

28.

Mazzeo

S. E.

Espelage

D. L.

(2002). Association between childhood physical and emotional abuse and disordered eating behaviors in female undergraduates: An investigation of the mediating role of alexithymia and depression. Journal of Counseling Psychology, 49(1), 86–100. https://doi.org/10.1037/0022-0167.49.1.86

29.

McCrory

De Brito

S. A.

Viding

(2010). Research review: The neurobiology and genetics of maltreatment and adversity. Journal of Child Psychology and Psychiatry, 51, 1079–1095.

30.

McCullough

Mathura

(2019). Physiological psychotherapy (NPP) treatment group and a control group for children adopted from care: Support for a neurodevelopmentally informed approach to therapeutic intervention with maltreated children. Child Abuse & Neglect, 92, 77–84.

31.

Miller-Perrin

C. L.

Perrin

R. D.

Kocur

J. L.

(2009). Parental physical and psychological aggression: Psychological symptoms in young adults. Child Abuse & Neglect, 33(1), 1–11. https://doi.org/10.1016/j.chiabu.2008.12.001

32.

Mills

Newman

Cossar

Murray

(2014). Emotional maltreatment and disordered eating in adolescents: Testing the mediating role of emotion regulation. Child Abuse & Neglect, 39, 156–166. https://doi.org/10.1016/j.chiabu.2014.05.011

33.

Molendijk

M. L.

Hoek

H. W.

Brewerton

T. D.

Elzinga

B. M.

(2017). Childhood maltreatment and eating disorder pathology: A systematic review and dose-response meta-analysis. Psychological Medicine, 47(8), 1402–1416. https://doi.org/10.1017/S0033291716003561

34.

Morton

D. P.

Hinze

Craig

Herman

Kent

Beamish

Renfrew

Przybylko

(2020). A multimodal intervention for improving the mental health and emotional well-being of college students. American Journal of Lifestyle Medicine, 14(2), 216–224. https://doi.org/10.1177/1559827617733941

35.

Parker

(1989). The parental bonding instrument: Psychometric properties reviewed. Psychiatric Developments, 7(4), 317–335.

36.

Parker

Tupling

Brown

L. B.

(1979). A parental bonding instrument. British Journal of Medical Psychology, 52(1), 1–10. https://doi.org/10.1111/j.2044-8341.1979.tb02487.x

37.

Parker

Mitchell

O’Brien

Brennan

(2015). Psychometric evaluation of disordered eating measures in bariatric surgery patients. Eating Behaviors, 19, 39–48. https://doi.org/10.1016/j.eatbeh.2015.05.007

38.

Perry

B. D.

(2008). Child maltreatment: A neurodevelopmental perspective on the role of trauma and neglect in psychopathology. In Beauchaine

T. P.

Hinshaw

S. P.

(Eds.), Child and adolescent psychopathology (pp. 93–128). Wiley.

39.

Rind

Tromovitch

Bauserman

(1998). A meta-analytic examination of assumed properties of child sexual abuse using college samples. Psychological Bulletin, 124(1), 22–53. https://doi.org/10.1037/0033-2909.124.1.22

40.

Rose

J. S.

Vaewsorn

Rosselli-Navarra

Wilson

G. T.

Weissman

R. S.

(2013). Test-retest reliability of the eating disorder examination-questionnaire (EDE-Q) in a college sample. Journal of Eating Disorders, 1(1), Article 42. https://doi.org/10.1186/2050-2974-1-42

41.

Rutter

O’Conner

T. G.

& English and Romanian Adoptees Study Team. (2004). Are there biological programming effects for psychological development? Findings from a study of Romanian adoptees. Developmental Psychology, 40, 81–94.

42.

Slep

M. S.

O’Leary

S. G.

(2005). Parent and partner violence in families with young children: Rates, patterns, and connections. Journal of Consulting and Clinical Psychology, 73(3), 435–444. https://doi.org/10.1037/0022-006X.73.3.435

43.

Stice

Bearman

S. K.

(2001). Body-image and eating disturbances prospectively predict increases in depressive symptoms in adolescent girls: A growth curve analysis. Developmental Psychology, 37(5), 597–607. https://doi.org/10.1037/0012-1649.37.5.597

44.

Straus

M. A.

(2004). Manual for scoring the CTS2 and CTSPC. Family Research Laboratory, University of New Hampshire.

45.

Straus

M. A.

Hamby

S. L.

(1997). Measuring physical and psychological maltreatment of children with the conflict tactics scale. In Kantor

G. K.

Jasinski

J. L.

(Eds.), Out of the darkness: Contemporary perspectives on family violence (pp. 119–135). SAGE.

46.

Striegel

R. H.

Bedrosian

Wang

Schwartz

(2011). Why men should be included in research on binge eating: Results from a comparison of psychosocial impairment in men and women. International Journal of Eating Disorders, 45(2), 233–240. https://doi.org10.1002/eat.20962

47.

Striegel-Moore

R. H.

Rosselli

Perrin

Debar

Wilson

G. T.

May

Kraemer

H. C.

(2009). Gender difference in the prevalence of eating disorder symptoms. International Journal of Eating Disorders, 42(5), 471–474. https://doi.org10.1002/eat.20625

48.

Taylor

C. B.

Bryson

Luce

K. H.

Cunning

Doyle

A. C.

Abascal

L. B.

Wilfley

D. E.

(2006). Prevention of eating disorders in at-risk college-age women. Archives of General Psychiatry, 63(8), 881–888. https://doi.org/10.1001/archpsyc.63.8.881

49.

Teicher

M. H.

Andersen

S. L.

Polcari

Andersen

C. M.

Navalta

C. P.

Kim

D. M.

(2003). The neurobiological consequences of early stress and childhood maltreatment. Neuroscience & Biobehavioral Reviews, 27(1), 33–44. https://doi.org/10.1016/S0149-7634(03)00007-1

50.

Teicher

M. H.

Glod

C. A.

Surrey

Swett

(1993). Early childhood abuse and limbic system ratings in adult psychiatric outpatients. The Journal of Neuropsychiatry and Clinical Neurosciences, 5(3), 301–306. https://doi.org/10.1176/jnp.5.3.301

51.

Teicher

M. H.

Samson

J. A.

(2016). Annual Research Review: Enduring neurobiological effects of childhood abuse and neglect. Journal of Child Psychology and Psychiatry, 57(3), 241–266. https://doi.org10.1111/jcpp.12507

52.

Teicher

M. H.

Samson

J. A.

Polcari

McGreenery

C. E.

(2006). Sticks, stones, and hurtful words: Relative effects of various forms of childhood maltreatment. American Journal of Psychiatry, 163(6), 993–1000. https://doi.org/10.1176/ajp.2006.163.6.993

53.

Teicher

M. H.

Samson

J. A.

Sheu

Polcari

McGreenery

C. E.

(2010). Hurtful words: Association of exposure to peer verbal abuse with elevated psychiatric symptom scores and corpus callosum abnormalities. American Journal of Psychiatry, 167(12), 1464–1471. https://doi.org/10.1176/appi.ajp.2010.10010030

54.

U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2015). Child maltreatment. http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment

55.

Wilhelm

Niven

Parker

Hadzi-Pavlovic

(2005). The stability of the parental bonding instrument over a 20-year period. Psychological Medicine, 35(3), 387–393. https://doi.org/10.1017/S0033291704003538

56.

Yoshizawa

Tashiro

Fukudo

Yanai

Utsumi

Kano

Adachi

(2009). Increased brain histamine H1 receptor binding in patients with anorexia nervosa. Biological Psychiatry, 65(4), 329–335. https://doi.org/10.1016/j.biopsych.2008.08.012