Childhood Adversities Associated With Risk For Eating Disorders or Weight Problems

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Article

Childhood Adversities Associated With Risk


for Eating Disorders or Weight Problems
During Adolescence or Early Adulthood
Jeffrey G. Johnson, Ph.D.
Patricia Cohen, Ph.D.
Stephanie Kasen, Ph.D.
Judith S. Brook, Ph.D.

Objective: A community-based prospective longitudinal study was conducted to


investigate the association between childhood adversities and problems with eating or weight during adolescence and
early adulthood.
Method: A community-based sample of
782 mothers and their offspring were interviewed during the childhood, adolescence, and early adulthood of the offspring. Childhood maltreatment, eating
problems, environmental risk factors,
temperament, maladaptive parental behavior, and parental psychopathology
were assessed during childhood and adolescence. Eating disorders and problems
with eating or weight in the offspring
were assessed during adolescence and
early adulthood.
Results: A wide range of childhood adversities were associated with elevated
risk for eating disorders and problems
with eating or weight during adolescence
and early adulthood after the effects of

age, childhood eating problems, difficult


childhood temperament, parental psychopathology, and co-occurring childhood adversities were controlled statistically. Numerous unique associations were
found between specific childhood adversities and specific types of problems with
eating or weight, and different patterns of
association were obtained among the
male and female subjects. Maladaptive
paternal behavior was uniquely associated with risk for eating disorders in offspring after the effects of maladaptive
maternal behavior, childhood maltreatment, and other co-occurring childhood
adversities were controlled statistically.
Conclusions: Childhood adversities may
contribute to greater risk for the development of eating disorders and problems
with eating and weight that persist into
early adulthood. Maladaptive paternal
behavior may play a particularly important role in the development of eating
disorders in offspring.
(Am J Psychiatry 2002; 159:394400)

revious research has suggested that childhood adversities may contribute to the development of eating disorders. Individuals with eating disorders are more likely than
those without eating disorders to report a history of childhood maltreatment (13), other chronic or episodic childhood adversities (47), and problematic relationships with
their parents (1, 813). These findings have enabled researchers to generate hypotheses about the role of childhood adversities in the development of eating disorders
(14). However, nearly all of the studies that have examined
the association between childhood adversities and eating
disorders have been cross-sectional case-control investigations. It is problematic to make inferences about risks
associated with the onset of eating disorders among individuals in the general population on the basis of cross-sectional studies of patients with eating disorders.
To investigate potential risk factors that may contribute
to the development of eating disorders, prospective longitudinal research with a sizable community-based sample
is necessary. Potential risk factors must be assessed before

394

the development of the eating disorders. Covariates such


as childhood eating problems and childhood temperament that may account for the association between the
risk factors and the eating disorders must be controlled
statistically. Our review of the literature indicates that no
investigation of the association between a wide range of
childhood adversities and offspring risk for the development of eating disorders that we located met all of these
methodological criteria.
In the study reported here, data from the Children in the
Community Study, a prospective longitudinal investigation, were used to examine whether maladaptive parental
behavior, childhood abuse and neglect, other childhood
adversities, and socioeconomic variables were associated
with elevated risk for the development of problems with
eating or weight during adolescence or early adulthood.
Statistical procedures were used to control for the effects
of offspring age, childhood temperament, childhood eating problems, parental psychopathology, and co-occurring childhood adversities.
Am J Psychiatry 159:3, March 2002

JOHNSON, COHEN, KASEN, ET AL.

Method

search has supported the reliability and validity of these 10 indices of childhood temperament (21).

Sample and Procedure

Parental psychiatric symptoms. Interview items used to assess maternal psychiatric symptoms in 1975, 1983, and 1985
1986 were obtained from the Disorganizing Poverty Interview, the
California Psychological Inventory (22), the Hopkins Symptom
Checklist (23), and instruments that assessed maternal alienation
(24), rebelliousness (25), and other maladaptive traits (26, 27). Paternal alcohol abuse, drug abuse, and antisocial behavior were assessed during the 1975, 1983, and 19851986 interviews by using
the Disorganizing Poverty Interview. In addition, lifetime histories of parental anxiety, depressive, disruptive, and substance use
disorders were assessed during the 19911993 maternal interview
by using items adapted from the New York High Risk Study Family
Interview (28). Additional data were provided by the interviewers
observations of the mothers behavior during the interview. Parental eating disorders were not assessed. Data regarding age at
onset permitted identification of maternal and paternal psychiatric disorders that were evident by 19851986. Computerized diagnostic algorithms were developed by using the items from these
instruments to assess the DSM-IV diagnostic criteria for maternal
personality disorders, paternal antisocial personality disorder,
and maternal and paternal anxiety, depressive, disruptive, and
substance use disorders.

The current analyses were conducted with data from 782 families for whom information was available on childhood adversities and problems with eating or weight during adolescence or
early adulthood. These families are a subset of 976 randomly
sampled families from two upstate New York counties. The
mothers were interviewed in 1975, 1983, 19851986, and 1991
1993 (15, 16). One randomly selected child from each family was
interviewed in 1983, 19851986, and 19911993. The sample was
generally representative of families in the northeastern United
States with regard to socioeconomic status and most demographic variables; the sample reflected the region in having high
proportions of Catholic (54%) and white (91%) participants (16).
The mean age of the 397 male and 385 female offspring in the
sample was 6 years (SD=3) in 1975, 14 years (SD=3) in 1983, 16
years (SD=3) in 19851986, and 22 years (SD=3) in 19911993.
Study procedures were approved according to appropriate institutional guidelines. Written informed consent was obtained after the interview procedures were fully explained. The youths
and their mothers were interviewed separately, and both interviewers were blind to the responses of the other informant. Additional methodological information is available from previous
reports (15, 16).

Assessment
Offspring psychiatric disorders and childhood temperament. The parent and youth versions of the Diagnostic Interview Schedule for Children (17) were administered in 1983,
19851986, and 19911993 to assess offspring psychiatric disorders. Both the parents and the youths were interviewed because
the use of multiple informants tends to increase the reliability
and validity of psychiatric diagnoses (18, 19). A symptom was
considered present if it was reported by either informant. Previous research has indicated that the reliability and validity of
the Diagnostic Interview Schedule for Children as employed in
the present study are comparable to those of other structured
interviews (20).
Diagnostic Interview Schedule for Children items assessed
the diagnostic criteria for eating disorders, as well as a wide
range of specific eating and weight problems. Computer algorithms were subsequently developed to determine whether individuals met the DSM-IV criteria for eating disorders. A diagnosis of eating disorder not otherwise specified (e.g., anorexia
without amenorrhea, binge eating disorder) was made if clinically significant eating disorder symptoms were present but the
full criteria for anorexia nervosa, binge eating disorder, or bulimia nervosa were not met. Participants were defined as obese
if their weight was 150% of normal body weight and 2 standard deviations above the sample mean. Participants were defined as having low body weight if their weight was 90% of normal body weight and 2 standard deviations below the sample
mean. Neither obesity nor low body weight was considered an
eating disorder unless the individual had symptoms that met
the DSM-IV criteria for an eating disorder. Additional data were
drawn from the interviewers observations of the childs behavior during the interview.
Ten dimensions of difficult childhood temperament were assessed by using the Disorganizing Poverty Interview (15) during
the 1975 maternal interviews: 1) clumsiness-distractibility,
2) nonpersistence-noncompliance, 3) anger, 4) aggression to
peers, 5) problem behavior, 6) temper tantrums, 7) hyperactivity,
8) crying-demanding, 9) fearful withdrawal, and 10) moodiness.
Children with severe problems in one or more of these domains
were identified as having a difficult temperament. Previous reAm J Psychiatry 159:3, March 2002

Maladaptive parental behavior. The Disorganizing Poverty


Interview and the measures of parental child-rearing attitudes
and behaviors that were administered during the maternal interviews were used to assess maternal enforcement of rules, the
presence of loud arguments between the parents, maternal educational aspirations for the child, maternal possessiveness, maternal use of guilt to control the child, maternal difficulty controlling anger toward the child, parental cigarette smoking, paternal
assistance to the childs mother, paternal role fulfillment, and maternal verbal abuse (15, 2931). Measures that assessed parental
affection toward the child, time spent with the child, and communication with the child were administered in the maternal and
offspring interviews in 1983 and 19851986 (15, 29, 30). Interview
items used to assess maternal punishment and offspring identification with the parents were administered during the maternal
and offspring interviews in 1975, 1983, and 19851986 (29, 30).
Parental home maintenance and maternal behavior during the
interview were assessed on the basis of interviewers observations. Previous research has supported the construct validity of
the measures that were used to assess parental behavior (15, 16,
2935). The scales and items assessing each type of parental behavior across the three interviews (1975, 1983, and 19851986)
were dichotomized empirically at the maladaptive end of the
scale to identify statistically deviant parental behaviors. To ensure
adequate statistical power, parental behavior was defined as deviant if such behavior was at least one standard deviation from the
sample mean.
Childhood maltreatment. Youths who had been referred to
state agencies, investigated by childhood protective service agencies, and confirmed as being abused or neglected were identified
from a central registry. Information about these individuals was
abstracted from the registry by a member of the study team. Selfreports of childhood maltreatment were obtained from the offspring in 19911993. Official and self-reports were not available
for offspring who were under age 18 in 19911993 or who had
moved out of the state. Maternal interview items that were used
to assess childhood neglect were obtained from the Disorganizing Poverty Interview on the basis of correspondence with the
items in the cognitive, emotional, physical, and supervision neglect subscales of the Neglect Scale (36). Childhood neglect was
considered present if scores were 2 standard deviations above

395

LONGITUDINAL STUDY OF EATING DISORDERS


TABLE 1. Prevalence of Problems With Eating or Weight During Adolescence or Early Adulthood in 782 Offspring in a Community Sample of Familiesa
Prevalence in Female
Offspring (N=385)
Eating or Weight Problem
Adherence to a strict diet to lose weight
Eating alone to conceal unusual eating behavior
Fasting for 24 hours or longer to lose weight
Recurrent eating binges
Recurrent fluctuations 10 pounds in body weight
Self-induced vomiting
Use of medication to lose weight
Eating disorders
Anorexia nervosa
Bulimia nervosa
Eating disorder not otherwise specifiedc
Anorexia nervosa without amenorrhea
Binge eating disorder
Any eating disorder

Prevalence in Male
Offspring (N=397)

Analysis

N
102
27
79
38
72
20
59

%
26
7
21
10
19
5
15

N
34
8
24
13
70
5
7

%
9
2
6
3
18
1
2

Odds Ratiob
3.85
3.67
4.01
3.23
1.07
4.30
10.08

95% CI
2.535.85
1.648.18
2.486.49
1.706.17
0.751.55
1.6011.56
4.5422.38

0
8
35
9
8
43

0
2
9
2
2
11

1
2
6
0
1
9

<1
1
2
0
<1
2

4.19
6.52

8.40
5.42

0.8819.86
2.7115.68

1.0567.51
2.6011.28

A subset of 976 randomly sampled families in two upstate New York counties. Mothers were interviewed in 1975, 1983, 19851986, and
19911993. One randomly selected child from each family was interviewed in 1983, 19851986, and 19911993. Interviewers used a variety
of instruments assessing childhood maltreatment, eating problems, environmental risk factors, temperament, maladaptive parental behavior, and parental psychopathology.
b Odds ratios represent comparisons between male and female offspring.
c Of the 41 subjects with eating disorder not otherwise specified, nine had anorexia nervosa without amenorrhea, nine had binge eating disorder, and 23 had other forms of eating disorder not otherwise specified (e.g., self-induced vomiting after eating small amounts of food).

the sample mean and if there was clear evidence of parental neglect (e.g., failure to vaccinate the child).

Results

Other childhood adversities and socioeconomic variables.

Descriptive Statistics

The Disorganizing Poverty Interview was used to assess the following childhood adversities in 1975, 1983, and 19851986: death
of a parent, disabling parental accident or illness, living in an unsafe neighborhood, low level of parental education, parental separation or divorce, peer aggression, low family income, school violence, the presence of a crime victim in the household, and
upbringing by a single parent. Family income was transformed to
percentage of the current U.S. poverty levels in 1975, 1983, and
19851986. Poverty was defined as mean income below 100% of
the U.S. poverty levels. Low level of parental education was defined as less than a high school education for one or both parents.
Adversities were considered present if reported at any of the three
assessments. Numerous studies have supported the reliability
and validity of the Disorganizing Poverty Interview (15, 16).

Data Analytic Procedure


Analyses of contingency tables were conducted to investigate
the associations between childhood adversities and eating or
weight problems during adolescence or early adulthood. An alpha level of 0.01 was adopted to reduce the likelihood of type I error. Logistic and multiple regression analyses were conducted to
investigate whether these associations remained significant after
the effects of age, difficult childhood temperament, eating problems during childhood, parental psychopathology, and co-occurring childhood adversities were controlled. Logistic regression
analyses were conducted to investigate whether overall levels of
maladaptive maternal and paternal behavior were associated
with eating disorders in offspring during adolescence or early
adulthood after the effects of co-occurring childhood adversities
were controlled. Multiple regression analyses were conducted to
investigate whether the overall levels of maladaptive maternal
and paternal behavior were associated with the total number of
offspring problems with eating or weight during adolescence or
early adulthood after the effects of co-occurring childhood adversities were controlled.

396

Fifty-two youths (6.6%) received a diagnosis of an eating


disorder during adolescence or early adulthood. The
frequencies of specific problems with eating or weight
during adolescence or early adulthood are presented in
Table 1. The frequencies of childhood adversities that were
uniquely associated with eating or weight problems are
presented in Table 2 and Table 3.

Childhood Adversities and Eating Disorders


Individuals who experienced physical neglect or sexual
abuse during childhood were at elevated risk for eating
disorders and for several types of eating or weight problems during adolescence or early adulthood (Table 2). Low
paternal affection toward the child, low paternal communication with the child, low paternal time spent with the
child, poverty, and low parental education were each associated with one or more types of eating or weight problems in the offspring during adolescence or early adulthood. These associations remained significant after the
effects of age, difficult temperament, childhood eating
problems, and parental psychiatric disorders were controlled statistically.
Because there was some temporal overlap between the
assessment of childhood maltreatment and adolescent
eating and weight problems, we also investigated the association between childhood adversities and problems with
eating or weight during early adulthood. Low paternal
time spent with the child (odds ratio=1.55, 95% confidence interval [CI]=1.062.26), low paternal affection
(odds ratio=1.78, 95% CI=1.242.53), sexual abuse (odds
ratio=3.32, 95% CI=1.407.82), and physical neglect (odds
Am J Psychiatry 159:3, March 2002

JOHNSON, COHEN, KASEN, ET AL.


TABLE 2. Prevalence of Eating or Weight Problems During Adolescence or Early Adulthood Associated With Childhood
Adversity in Offspring in a Community Sample of Familiesa
Offspring Without Childhood Adversity Offspring With Childhood Adversity
Eating or Weight Problem
and Type of Childhood Adversity
Eating disorder
Physical neglect
Sexual abuse
Fasting for at least 24 hours
Low paternal affection
Low paternal communication
Obesity
Low parental education
Physical neglect
Poverty
Recurrent fluctuations in weight
Physical neglect
Sexual abuse
Strict dieting
Physical neglect
Sexual abuse
Use of medication to lose weight
Low paternal affection
Low paternal communication
Low paternal time spent with child
Self-induced vomiting
Physical neglect
Sexual abuse

Prevalence of Problem

Prevalence of Problem

Analysis

Total N

Odds Ratiob

95% CI

711
644

48
44

7
7

24
22

6
6

25
27

4.82
5.11

1.8212.73
1.9113.72

586
625

63
68

11
11

196
157

40
35

20
22

2.13
2.35

1.383.29
1.493.69

562
711
707

19
38
36

3
5
5

220
24
75

29
5
12

13
21
16

4.34
4.66
3.55

2.387.92
1.6513.16
1.767.17

711
644

117
120

16
19

24
22

10
9

42
41

3.63
3.02

1.588.36
1.267.24

711
644

120
111

17
17

24
22

9
11

38
50

2.96
4.80

1.266.91
2.0311.35

586
625
620

39
43
43

7
7
7

196
157
162

27
23
23

14
15
14

2.24
2.32
2.22

1.333.77
1.353.99
1.303.81

711
644

21
21

3
3

24
22

4
4

17
18

6.57
6.59

2.0620.92
2.0521.19

Total N

A subset of 976 randomly sampled families in two upstate New York counties. Mothers were interviewed in 1975, 1983, 19851986, and
19911993. One randomly selected child from each family was interviewed in 1983, 19851986, and 19911993. Interviewers used a variety
of instruments assessing childhood maltreatment, eating problems, environmental risk factors, temperament, maladaptive parental behavior, and parental psychopathology.
b Each odds ratio was significant when an alpha level of 0.01 was used, and each remained significant after the effects of offspring age, sex,
difficult childhood temperament, childhood eating problems, parental psychiatric disorders, and co-occurring childhood adversities were
controlled statistically.
FIGURE 1. Association of Maladaptive Maternal and Paternal Behavior With Prevalence of Eating Disorders During
Adolescence or Early Adulthood in 782 Offspring in a Community Sample of Familiesa
13
Eating Disorder Prevalence During
Adolescence or Early Adulthood (%)

ratio=4.58, 95% CI=1.9910.46) were associated with elevated risk for problems with eating or weight during early
adulthood. The index of maladaptive paternal behavior
was associated with eating or weight problems during
early adulthood (r=0.10, df=781, p=0.004). The index of
maladaptive maternal behavior was not associated with
eating or weight problems during early adulthood.

Maladaptive Maternal and Paternal Behavior


As Figure 1 shows, youths who experienced three or
more kinds of maladaptive paternal behavior were approximately three times as likely as youths who did not experience any maladaptive paternal behaviors to have eating disorders during adolescence or early adulthood (2=
9.49, df=2, p=0.009). The overall association between maladaptive maternal behavior and offspring risk for eating
disorders was not statistically significant. The continuous
index of maladaptive paternal behaviors remained significantly associated with offspring risk for eating disorders
after the effects of co-occurring childhood adversities
were controlled statistically.
The association between maladaptive paternal behaviors and offspring eating disorders was partly mediated by
low offspring identification with the father. Youths who
did not identify with their father were at elevated risk for
eating disorders after the effect of maladaptive paternal
behavior was controlled statistically (adjusted odds ratio=
2.70, 95% CI=1.126.49). The association between malAm J Psychiatry 159:3, March 2002

12
11

Paternal behavior
Maternal behavior

10
9
8
7
6
5
4
3
2
1
0
0

1 or 2

Number of Types of Maladaptive Behavior


a

A subset of 976 randomly sampled families in two upstate New


York counties. Mothers were interviewed in 1975, 1983, 1985
1986, and 19911993. One randomly selected child from each family was interviewed in 1983, 19851986, and 19911993.

adaptive paternal behavior and offspring eating disorders


did not remain significant after the effect of low offspring
identification with the father was controlled statistically.

397

LONGITUDINAL STUDY OF EATING DISORDERS


TABLE 3. Prevalence of Eating or Weight Problems During Adolescence or Early Adulthood Associated With Childhood
Adversity in Female Offspring in a Community Sample of Familiesa
Offspring Without Childhood Adversity Offspring With Childhood Adversity
Eating or Weight Problem
and Type of Childhood Adversity
Eating disorder
Low paternal assistance to mother
Fasting for at least 24 hours
Inadequate parental supervision
Obesity
Harsh maternal punishment
Loud arguments between parents
Low parental education
Physical neglect
Poor parental maintenance of home
Poverty
Strict dieting
Inadequate parental supervision
Use of medication to lose weight
High peer aggression
Low paternal affection
Self-induced vomiting
Sexual abuse
Low body weight
Physical abuse

Prevalence of Problem

Prevalence of Problem

Analysis

Total N

Total N

Odds Ratiob

95% CI

313

28

72

15

21

2.68

1.355.33

368

71

19

17

47

3.72

1.399.98

347
319
286
356
354
344

13
9
7
14
11
12

4
3
2
4
3
3

38
66
99
14
31
41

6
10
12
3
8
7

16
15
12
21
26
17

4.82
6.15
5.50
6.66
10.85
5.70

1.7113.54
2.3915.82
2.0914.40
1.6726.59
3.9729.59
2.1015.43

368

92

25

17

10

59

4.29

1.5911.58

367
288

52
35

14
12

18
97

7
24

39
25

3.85
2.38

1.4310.40
1.324.25

325

16

17

24

5.94

1.7420.29

319

13

24

17

4.71

1.4115.76

A subset of 976 randomly sampled families in two upstate New York counties. Mothers were interviewed in 1975, 1983, 19851986, and
19911993. One randomly selected child from each family was interviewed in 1983, 19851986, and 19911993. Interviewers used a variety
of instruments assessing childhood maltreatment, eating problems, environmental risk factors, temperament, maladaptive parental behavior, and parental psychopathology.
b Each odds ratio was significant when an alpha level of 0.01 was used, and each remained significant after controlling for offspring age, difficult childhood temperament, childhood eating problems, parental psychiatric disorders, and co-occurring childhood adversities.

The index of maladaptive paternal behaviors was significantly correlated with the total number of eating or weight
problems during adolescence or early adulthood among
the male (r=0.12, df=396, p=0.01) and female (r=0.10, df=
384, p=0.04) offspring. The index of maladaptive maternal
behaviors was not significantly correlated with the total
number of eating or weight problems during adolescence
or early adulthood in either subsample. This pattern of
findings was obtained regardless of whether the mother or
the youth provided the data regarding parental behavior.
Maladaptive paternal behaviors remained significantly associated with the total number of offspring problems with
eating or weight after the effects of co-occurring childhood
adversities were controlled statistically (t=2.89, df=777, p=
0.004).
The indices of maladaptive maternal behaviors, types of
childhood maltreatment, and other childhood adversities
and socioeconomic variables were not independently associated with offspring risk for eating disorders after the effects of co-occurring childhood adversities were controlled
statistically. However, the index of types of childhood maltreatment was independently associated with strict dieting
(odds ratio=1.60, 95% CI=1.162.20), recurrent fluctuations
in weight (odds ratio=1.58, 95% CI=1.152.16), and vomiting (odds ratio=1.89, 95% CI=1.083.29), and the index of
other adversities was independently associated with obesity during adolescence or early adulthood (odds ratio=
1.23, 95% CI=1.061.43).

398

Eating Problems Among Male


and Female Offspring
Significant associations between childhood adversities
and problems with eating or weight during adolescence
or early adulthood among the female offspring are presented in Table 3. The effects of the covariates were controlled. In the male subsample, low parental education
was associated with elevated risk for obesity (odds ratio=
3.60, 95% CI=1.667.79), and physical neglect during
childhood was associated with elevated risk for use of
medication to lose weight (odds ratio=17.50, 95% CI=
2.94104.12) and self-induced vomiting (odds ratio=
29.33, 95% CI=4.29200.39) during adolescence or early
adulthood. These associations remained significant after
Fishers exact tests were conducted and after the effects of
the covariates were controlled statistically.

Discussion
The present findings advance our understanding of the
association between childhood adversities and risk for
eating disorders in several respects. First, our findings indicate that a wide range of childhood adversities tend to
be associated with elevated risk for problems with eating
or weight during adolescence or early adulthood after the
effects of childhood eating problems, difficult childhood
temperament, parental psychopathology, and co-occurring childhood adversities are controlled statistically. Further, the findings suggest that there may be unique associations between specific childhood adversities and specific
Am J Psychiatry 159:3, March 2002

JOHNSON, COHEN, KASEN, ET AL.

problems with eating or weight and that there may be different patterns of association between adversities and
problems with eating or weight among males and females
in the general population.
The present findings suggest that maladaptive paternal
behavior may play a more important role than maladaptive maternal behavior in the development of eating disorders in offspring. Most of the theoretical literature in this
area has focused on the mother-child relationship (3741).
However, our findings are consistent with previous research suggesting that low paternal affection (8), care (9),
and empathy (12) and high paternal control (8), unfriendliness (14), overprotectiveness (11), and seductiveness (10)
are associated with the development of eating disorders in
offspring. Although the fathers were not interviewed in the
present study, the findings are not likely to be attributable
to reporting bias on the part of the informants. First, the
overall rate of maladaptive paternal behavior was not
higher than that of maladaptive maternal behavior. Second, the same pattern of findings was obtained with data
for paternal behavior that were obtained during the maternal and offspring interviews. Third, maladaptive paternal behavior was not more strongly associated with offspring risk for other psychiatric disorders than was
maladaptive maternal behavior (34). Our findings also
suggest that low paternal identification may partially mediate the association between maladaptive paternal behavior and eating disorders in offspring. It will be of interest for future research to fu rther investiga te the
mechanisms that underlie this association.
The present findings are consistent with previous crosssectional research suggesting that childhood maltreatment (13) and maladaptive parental behavior (813, 42)
may contribute to the development of eating disorders
and that many types of childhood adversities may be associated with risk for problems with eating or weight (47,
43). Because the present findings are based on prospective
longitudinal data, they provide more compelling support
for these hypotheses. Moreover, our findings support the
hypothesis that the causes of eating disorders tend to be
heterogeneous and multifactorial (44). However, because
previous research has provided inconsistent findings
about the nature of the association between childhood adversities and the development of weight problems, it will
be important for future research to investigate this association more extensively.
The limitations of the present study merit consideration. There were not enough cases to permit analyses of
the relationships between childhood adversities and specific eating disorders. Therefore, we have reported associations between childhood adversities and several different
types of eating and weight problems. To have enough statistical power to conduct separate analyses with the female and male subsamples, data on eating and weight
problems during adolescence and early adulthood were
pooled, and there was some overlap in the periods during
Am J Psychiatry 159:3, March 2002

which some of the risk factors and outcomes were assessed. To address this concern, we have reported associations between childhood adversities and problems with
eating or weight during early adulthood. Despite these
limitations, the present findings provide a detailed, systematic, and methodologically rigorous contribution to
the literature.
Received Feb. 6, 2001; revisions received May 18 and July 26, 2001;
accepted Aug. 15, 2001. From Columbia University and the New York
State Psychiatric Institute; and Mount Sinai School of Medicine, New
York. Address reprint requests to Dr. Johnson, Box 60, New York State
Psychiatric Institute, 1051 Riverside Dr., New York, NY, 10032;
jjohnso@pi.cpmc.columbia.edu (e-mail).

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