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. Author manuscript; available in PMC: 2023 Jul 1.
Published in final edited form as: Eat Disord. 2021 Mar 18;30(4):355–369. doi: 10.1080/10640266.2020.1864588

Relationships Between Childhood Abuse and Eating Pathology Among Individuals with Binge-Eating Disorder: Examining the Moderating Roles of Self-Discrepancy and Self-Directed Style

Skylar L Borg a, Lauren M Schaefer a,*, Vivienne M Hazzard a, Nicola Herting a,b, Carol B Peterson c, Ross D Crosby a,d, Scott J Crow c,e, Scott G Engel a,d, Stephen A Wonderlich a,d
PMCID: PMC8448781  NIHMSID: NIHMS1657716  PMID: 33734931

Abstract

Childhood maltreatment appears to increase risk for eating disorders (EDs). The current study examined potential moderating factors (i.e., self-discrepancy and negative self-directed style), which may increase or decrease the impact of maltreatment (i.e., emotional abuse, physical abuse, sexual abuse) on later ED symptoms. One hundred seven men and women with binge-eating disorder (BED) completed semi-structured interviews and questionnaires assessing childhood maltreatment, self-discrepancy, negative self-directed style, and ED pathology. Linear regression was used to examine the moderating role of self-discrepancy and negative self-directed style in the associations between each type of abuse and level of ED severity. Actual:ought self-discrepancy (i.e., the difference between one’s self and who one believes they ought to be) moderated the relationships between ED pathology and emotional abuse (β = .26 p = .007), as well as physical abuse (β = .23, p = .02). Results suggest that the relationship between childhood abuse (i.e., emotional abuse, physical abuse) and ED pathology may be stronger for those with higher levels of actual:ought self-discrepancy. Further clarification of the relationships between actual:ought self-discrepancy and distinct forms of childhood abuse is needed, as well as intervention studies examining whether targeting actual:ought self-discrepancy provides additional benefit for trauma-exposed individuals with BED.

Keywords: eating disorders, binge-eating disorder, maltreatment, abuse, integrative cognitive-affective therapy

Binge-eating disorder (BED) is characterized by persistent episodes of binge eating (i.e., overeating accompanied by a sense of having lost control over one’s eating), which are marked by psychological distress. Unlike bulimia nervosa, which also involves recurrent binge-eating episodes, individuals with BED do not engage in regular, inappropriate compensatory behaviors (American Psychiatric Association, 2013). BED is associated with psychosocial impairment, as well as significant psychiatric and medical comorbidity (Grilo, White, & Masheb, 2009; Hudson, Hiripi, Pope, & Kessler, 2007), and affects approximately 3.5% of women and 2.0% of men, making it more common than anorexia nervosa (a disorder primarily characterized by insufficient dietary intake resulting in low weight) and bulimia nervosa (Hudson et al., 2007). Existing treatments for BED have demonstrated suboptimal effectiveness (Linardon, 2018); thus, identifying underlying risk and maintenance processes that contribute to the onset and persistence of BED is crucial for improving interventions for this disorder.

Elevated rates of childhood maltreatment (e.g., abuse and neglect) have been observed across the eating disorders (EDs) with particularly high rates among individuals with binge-eating (BE) pathology, suggesting that childhood maltreatment may operate as a risk factor for EDs such as BED (Caslini et al., 2016; Kong & Bernstein, 2009; Molendijk, Joek, Brewerton, & Elzinga, 2017). Further, a history of childhood maltreatment is associated with earlier onset of the ED, as well as poorer clinical course and outcomes (Caslini et al., 2016; Molendijk et al., 2017), emphasizing the clinical importance of childhood maltreatment in this population. While most research has examined the broad association between childhood maltreatment assessed as a singular construct and BE, a growing body of work has examined the association between specific forms of childhood maltreatment (e.g., emotional abuse, physical abuse, sexual abuse) and BE pathology. These studies have demonstrated relationships between various forms of childhood maltreatment and BE, with particularly strong associations observed between emotional abuse and BE (Caslini et al., 2016; Molendijk et al., 2017). However, not all individuals who experience maltreatment in childhood go on to develop eating disturbances, suggesting the likely presence of moderating factors that may amplify or ameliorate trauma-related risk for subsequent eating disturbance. Therefore, clarification of factors that modify the impact of childhood maltreatment on ED pathology may illuminate potentially meaningful treatment targets for trauma-exposed individuals.

The Integrative Cognitive Affective Therapy (ICAT) model of binge-eating pathology, which highlights the interplay between historical interpersonal experiences (e.g., childhood maltreatment) and an individual’s intrapsychic characteristics, suggests that disturbances in self-evaluation and self-regulation may increase risk for ED behaviors, particularly among individuals reporting a history of painful interpersonal experiences (Wonderlich et al., 2015). Specifically, the model posits that increased self-discrepancy and negative self-directed style may both serve as proximal risk factors for ED pathology, including BE. Self-discrepancy refers to the perceived difference between one’s actual self (i.e., the attributes that an individual believes he/she possesses) and one’s standards for self-evaluation, referred to as “self-guides” (Higgins, 1987). Two self-guides have been posited. The ideal self-guide defines the personal characteristics that an individual would ideally like to possess (e.g., the individual’s aspirations). The difference between a person’s perception of who they actually are (i.e., one’s actual self) and their ideal self is referred to as actual:ideal self-discrepancy. Alternatively, the ought self-guide defines the characteristics that the individual believes are their responsibility to possess (e.g., the individual’s obligations). The difference between an individual’s perceived self and ought self is referred to as actual:ought self-discrepancy. According to the ICAT model, individuals who experience greater self-discrepancy (i.e., those who feel that they are not who they should be [high actual:ought self-discrepancy] or who they would like to be [high actual:ideal self-discrepancy]), may experience increased negative emotionality (e.g., low mood or anxiety), which may prompt engagement in ED behaviors intended to regulate aversive emotional states. Consistent with the ICAT model, both actual:ideal and actual:ought self-discrepancy have been found to be associated with ED psychopathology. Notably, however, actual:ought self-discrepancy has been specifically linked with BE pathology, including BED, whereas actual:ideal self-discrepancy appears to be more strongly associated with dietary restriction and anorexia nervosa (Mason et al., 2016a, 2016b, 2019). Importantly, the development of self-guides (i.e., ought self, ideal self) is thought to be primarily shaped during early life experiences in the context of caretaker-child interactions and relationships (Manian, Papadakis, Strauman, & Essex, 2006; Manian, Strauman, & Denney, 1998). Therefore, some individuals with a history of childhood maltreatment, may be particularly vulnerable to developing maladaptive self-guides, contributing to greater actual:ought and actual:ideal discrepancy (Brewin & Vallance, 1997; Classen, Field, Atkinson, & Spiegel, 1998; Manian et al., 2006; Manian, Strauman & Denney, 1998; Mason et al., 2019). Further, it is possible that among trauma-exposed individuals, increased levels of self-discrepancy may amplify ED risk or correspond with higher levels of ED severity.

Similarly, the ICAT model proposes another self-oriented factor that is thought to increase risk for BE, namely self-directed behavior. The theory specifies that individuals who exhibit more negative self-directed style, as evidenced by increased maladaptive thoughts, feelings, and actions toward oneself (i.e., self-blame, self-criticism, and self-neglect) will be at increased risk for negative affective states, which would in turn promote BE pathology. Consistent with ICAT theory, growing evidence supports a relationship between negative self-directed style and BE pathology (Mason et al., 2016b). In addition, research indicates that childhood maltreatment raises risk for negative self-directed attitudes (e.g., self-blame), which then moderate the relationship between experiences of childhood maltreatment and later self-destructive behaviors (Swannell et al., 2012). Similarly, it is possible that self-directed style may moderate the impact of abuse exposure in childhood on ED pathology. Specifically, individuals with a history of childhood abuse and a more negative self-directed style may experience increased BE pathology.

In sum, research indicates that there are plausible relationships between childhood maltreatment, self-discrepancy and negative self-directed style, and BE pathology. Further, ICAT theory suggests that increased self-discrepancy and negative self-directed style may amplify risk for ED pathology, particularly among individuals with histories of childhood maltreatment (Wonderlich et al., 2015); however, limited work has directly examined this proposition. Therefore, the aims of the proposed study are (a) to examine the relationships between ED pathology, childhood abuse (i.e., emotional abuse, physical abuse, sexual abuse), self-discrepancy (actual:ought, actual:ideal), and negative self-directed style, and (b) to examine the extent to which disturbances in self-discrepancy and negative self-directed style moderate the relationships between childhood abuse and ED pathology among individuals with BED. It is hypothesized that the relationships between childhood abuse and ED pathology will be stronger among individuals who demonstrate greater actual:ideal self-discrepancy, greater actual:ought self-discrepancy, and more negative self-directed style.

Method

Participants

One hundred twelve men and women diagnosed with DSM-5 BED were enrolled in a randomized treatment trial for BED (Peterson et al., 2020). Study participants were required to be between the ages of 18 to 65 years old and meet criteria for DSM-5 BED (American Psychiatric Association, 2013). Participants were excluded from the trial for the following reasons: (a) unable to read English, (b) BMI less than 21, (c) lifetime history of psychotic symptoms or bipolar disorder, (d) substance use disorder within six months of enrollment, (e) medical instability, (f) acute suicidality, (g) purging behavior (e.g., self-induced vomiting, misuse of laxatives or diuretics) more than once per month for the previous three months, (h) current diagnosis of BN, (i) medical condition impacting eating or weight (e.g., thyroid condition), (j) history of gastric bypass surgery, (k) currently pregnant or lactating, (l) currently receiving weight loss or eating disorder treatment, (m) use of medication impacting eating or weight (e.g., stimulants), or (n) psychotropic medication changes in the 6 weeks prior to enrollment. In the current analysis, five individuals were excluded due to missing data on age (n = 2) and childhood trauma (n = 3) variables, resulting in a final analytic sample of 107 participants for the present study. This analytic sample comprised 18 cisgender males (16.8%), 88 cisgender females (82.2%), and one individual who identified as transgender male to female (0.9%). Participants ranged in age from 18 to 64 years (M = 39.7, SD = 13.5) with a mean body mass index (BMI; kg/m2) of 35.1 (SD = 8.8). The majority of participants were Caucasian (92.5%), in a partnered relationship (70.1%), and had achieved at least a bachelor’s degree (63.6%). Lifetime rates of DSM-IV Axis I disorders were 57.0% for mood disorders, 37.4% for anxiety disorders, and 39.3% for substance dependence.

Structured Interviews

Trained assessors administered semi-structured interviews to assess for eating pathology and other psychiatric diagnoses. Clinical interviewers were trained in initial didactic sessions, supervised by a licensed psychologist, and met regularly for consensus discussions regarding scoring and diagnoses.

Eating Disorder Examination Interview (EDE).

The EDE Version 16.0 (Fairburn & Cooper, 1993; Fairburn, 2008) was used to assess ED symptoms and determine the DSM-5 diagnosis of BED (American Psychiatric Association, 2013). The EDE has demonstrated good reliability and validity in previous studies (Berg, Peterson, Frazier, & Crow, 2012). In the present study, interrater reliability for current BED diagnosis was assessed for a random subset of participants (n = 21, 19%) with 100% agreement. The current study utilized the EDE Global score as an index of the respondent’s overall level of ED severity, with higher scores indicating more severe ED psychopathology. Cronbach’s alpha for the Global score in the current sample was .80.

Structured Clinical Interview for DSM-IV Axis I Disorders, Patient Version (SCID-I/P).1

The SCID-I/P (First, Spitzer, Gibbon, & Williams, 1995) modules assessing mood, psychotic, substance, anxiety, eating, adjustment, and somatoform disorders were administered to assess comorbid psychiatric diagnoses for study sample description. The SCID has demonstrated good interrater reliability and validity in prior research (Lobbestael et al., 2011; Ventura, Liberman, Green, & Minz, 1998).

Self-Report Measures

Short Form of the Childhood Trauma Questionnaire (CTQ-SF).

The CTQ-SF (Bernstein et al., 2003) is a 28-item self-report measure of abuse and neglect experienced during childhood. Respondents indicate the frequency of specific traumatic experiences on a Likert-type scale, with selections ranging from 0 (never) to 5 (very often). The current study utilized three CTQ-SF subscales assessing Physical Abuse, Sexual Abuse, and Emotional Abuse, with higher subscale scores indicating greater levels of abuse.2 CTQ-SF scores have demonstrated good reliability and validity in previous studies (Bernstein, et al., 2003; Spinhoven, et al., 2014). In the current sample, Cronbach’s alpha for the CTQ-SF subscales ranged from .80 (Physical Abuse) to .90 (Sexual Abuse).

Computerized-SELVES (C-SELVES).

The C-SELVES (Shah & Higgins, 2001) is an idiographic measure of self-discrepancy (i.e., actual:ideal self-discrepancy, actual:ought self-discrepancy), which is adapted from the SELVES Questionnaire (Higgins, Shah, & Friedman, 1997; Higgins, Klein, & Strauman, 1985). In the C-SELVES, individuals are asked to generate two lists of adjectives describing the person they would ideally like to be (i.e., ideal self), and the person they believe they ought to be (i.e., ought self). Participants are then asked to indicate the degree to which they believe each attribute describes them using Likert-type scale ranging from 1 (not at all) to 7 (extremely), with higher actual:ought self-discrepancy and actual:ideal self-discrepancy scale scores indicting greater levels of self-discrepancy. Past research using the SELVES has demonstrated good reliability, convergent validity, and discriminant validity of actual:ought self-discrepancy and actual:ideal self-discrepancy subscale scores (Wonderlich et al., 2008; Strauman & Higgins, 1987, Strauman & Higgins, 1988; Lesser et al., 2020). Cronbach’s alphas in the current sample were .74 for actual-ideal self-discrepancy and .70 for actual-ought self-discrepancy.

Structural Analysis of Social Behavior-Intrex Questionnaire (SASB-Intrex).

The SASB-Intrex (Benjamin, 2000) is a self-report measure that is used to assess self-directed style (e.g., the tendency to use positive or negative coping mechanisms directed toward oneself). The current study utilized 12 items from the Intrex specific to negative self-directed style (i.e., assessing the tendency to engage in self-blame, self-neglect, and self-attack). Items are rated on a Likert-type scale ranging from 1 (never or not at all) to 100 (always or perfectly). Higher scale scores indicate more negative self-directed style. This method of assessing negative self-directed style has demonstrated good reliability and validity in previous research (Wonderlich et al., 2008). Cronbach’s alpha for the negative self-directed style subscale was .88 in the present sample.

Procedure

The current study utilizes data from the baseline assessment visit of a randomized controlled treatment trial for BED (Peterson et al., 2020). Participants were recruited from eating disorder clinics, community advertisements, and social media postings at two sites (Fargo, ND; Minneapolis, MN). Eligible individuals attended the baseline assessment visit, during which they received further information about the study, provided informed consent, and completed semi-structured clinical interviews (EDE, SCID-I/P) and self-report measures. Participants were compensated with $150 after study completion. Institutional review board approval for the study was obtained at each site.

Statistical Analyses

Included participants provided complete data on all of the examined variables. Visual inspection of histogram and quantile-quantile (Q-Q) plots, as well as a non-significant Shapiro-Wilk test (p = .44) for EDE global scores, indicated no substantial departures from normality. Bivariate correlations between all examined variables were estimated. Correlations of .10 were considered small, .30 were considered medium, and .50 were considered large (Cohen, 1988). Next, nine separate hierarchical linear regression models were used to test the hypothesized moderator models. For each regression model, main effects for one form of abuse (e.g., sexual abuse) and one proposed moderator (e.g., actual:ought self-discrepancy) were entered as statistical predictors of ED severity (i.e., EDE Global scores) in Step 1. Next, their interaction (e.g., sexual abuse*actual:ought self-discrepancy), was entered in Step 2. Age and gender were entered as covariates in each model. Interaction terms, which were the primary effect of interest, were created by multiplying together the centered, continuous childhood maltreatment variable and the centered, continuous moderator as recommended by Frazier, Tix, and Barron (2004). Change in R2 at Step 2 was used as the measure of effect size with change in R2 values of .02, .15, and .35 indicating small, medium, and large effects, respectively (Cohen, 1992).

Results

Descriptive Statistics

Means, standard deviations, and correlations for all study variables are presented in Table 1. Although not statistically significant, actual:ought self-discrepancy, actual:ideal self-discrepancy, and negative self-directed style exhibited small positive correlations with ED pathology. However, childhood maltreatment variables (i.e., emotional abuse, physical abuse, sexual abuse) did not demonstrate bivariate associations with ED pathology.

Table 1.

Means, Standard Deviations, and Correlations Among all Examined Variables

Mean (SD) 1 2 3 4 5 6
1. Physical Abuse 6.36 (2.59) –
2. Emotional Abuse 9.79 (4.88) .57*** –
3. Sexual Abuse 6.18 (2.63) .39*** .35*** –
4. Negative Self-Directed Style 4.08 (1.97) .17 .29** .16 –
5. Actual:Ought Self-Discrepancy 6.92 (1.40) −.04 .21* .07 .33** –
6. Actual:Ideal Self-Discrepancy 7.51 (1.67) .02 .10 −.04 .29** .35*** –
7. Eating Disorder Pathology 2.66 (0.84) −.05 −.03 .01 .19 .19 .16
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Note. SD = Standard deviation. Physical abuse = Childhood Trauma Questionnaire – Physical Abuse subscale; Emotional Abuse = Childhood Trauma Questionnaire – Emotional Abuse subscale; Sexual Abuse = Childhood Trauma Questionnaire – Sexual Abuse subscale; Negative Self-Directed Style = Structural Analysis of Social Behavior-Intrex Questionnaire – Negative Self-Directed Style subscale; Actual:Ought Self-Discrepancy = Computerized-SELVES – Actual:Ought Self-Discrepancy subscale; Actual:Ideal Self-Discrepancy = Computerized-SELVES – Actual:Ideal Self-Discrepancy subscale; Eating Disorder Pathology = Eating Disorder Examination Global Score.

*

p < .05.

**

p < .01.

***

p < .001.

Regression Analyses

In the regression models, there was a significant interaction between emotional abuse and actual:ought self-discrepancy ( β = .26 p = .007). Change in R2 at Step 2 was .07, indicating a small moderating effect. As shown in Figure 1a, individuals who had experienced higher levels of emotional abuse and who reported higher actual:ought self-discrepancy evidenced higher levels of ED pathology than those who had higher levels of emotional abuse and lower actual:ought self-discrepancy.

Figure 1.

Figure 1.

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The interaction between emotional abuse and actual:ought self-discrepancy (Panel A), and the interaction between physical abuse and actual:ought self-discrepancy (Panel B).

Similarly, there was a significant interaction between physical abuse and actual:ought self-discrepancy (β = .23, p = .02). Change in R2 at Step 2 was .05, indicating a small moderating effect. As shown in Figure 1b, individuals who had experienced higher levels of physical abuse and who reported higher actual:ought self-discrepancy evidenced higher levels of ED pathology than those who had higher levels of physical abuse and lower actual:ought self-discrepancy.

No significant interactions emerged for the other examined models (p-values all > .05). The full results for all nine regression models are presented as Supplemental Material.

Discussion

The purpose of this study was to examine the relationships between childhood abuse, self-discrepancy, negative self-directed style, and ED pathology, as well as the extent to which disturbances in self-evaluation and self-regulation (i.e., actual:ideal self-discrepancy, actual:ought self-discrepancy, negative self-directed style) moderate the relationships between childhood abuse and ED pathology among individuals with BED. Overall, findings from the current study suggest that the relationships between emotional and physical abuse in childhood and ED severity in adulthood are moderated by actual-ought self-discrepancy, such that individuals with a history of emotional or physical abuse, along with greater discrepancies between who they believe they are actually and who they believe they ought to be, exhibited the greatest levels of ED pathology.

In the current clinical sample, we did not observe simple associations between emotional, physical, or sexual abuse and ED pathology. While this appears to stand in contrast to meta-analytic work demonstrating relationships between childhood abuse and EDs (Caslini et al., 2016; Molendijk et al., 2017), our finding is consistent with results from other studies demonstrating non-significant relationships between childhood abuse and EDE global scores among individuals with BED (Becker & Grilo, 2011). Taken together, these results may suggest that childhood abuse is most directly related to the presence or absence of BED pathology, rather than its severity. This interpretation coalesces with evidence from prior reviews indicating a relationship between early abuse and later ED diagnoses, but not necessarily the severity of the eating disturbance (Wonderlich, Brewerton, Jocic, Dansky, & Abbott, 1997).

However, findings from the current study suggest that the impact of childhood abuse on BED severity may be moderated by other factors, including beliefs about the self. The finding that increased self-discrepancy and emotional abuse were synergistically associated with ED symptoms is consistent with the etiological theory underlying the ICAT model (Wonderlich et al., 2015), and coalesces with growing evidence indicating that emotional abuse may be strongly implicated in the development of ED pathology (Caslini et al., 2016; Molendijk et al., 2017). It is notable that actual:ought self-discrepancy exhibited a significant moderating effect, while actual:ideal did not. These results align with previous empirical work indicating that actual:ought self-discrepancy may be more strongly implicated in BE pathology, whereas actual:ideal self-discrepancy may be more commonly associated with restrictive EDs like anorexia nervosa (Mason et al., 2016a). In considering the processes underlying these relationships, it is possible that some individuals who experience frequent criticism, verbal attacks, or ridicule as a child may come to believe that they are not meeting the basic or minimum standards for how they ought to behave or who they should be. This sense of not being good enough might then contribute to negative affective states, which might trigger BE episodes, consistent with the ICAT model (Wonderlich et al., 2015) and other affect regulation theories of ED pathology (Heatherton & Baumeister, 1991). While findings from the current study are consistent with this hypothesized developmental and maintenance process, mediational approaches using longitudinal data would be needed to directly test the hypothesized temporal relationships.

Similarly, physical abuse did not exhibit a significant bivariate association with ED pathology in the current study; however, this relationship was found to differ according to actual:ought self-discrepancy levels. Analogous to the hypothesized process underlying relationships between emotional abuse and ED pathology, it is possible that individuals who experienced a history of physical abuse as a child (e.g., being hit by a parent or guardian as a severe form of punishment), may develop a belief that they are not worthy of being protected or are not as good as they should be (i.e., actual:ought self-discrepancy), which might contribute to negative affect and ultimately to ED behaviors intended to relieve or distract from those unpleasant emotions.

There are a number of notable strengths to the current study, which include the utilization of a large clinical sample of individuals with a confirmed diagnosis of BED and the ability to examine different forms of abuse in relation to hypothesized moderators/outcomes. In addition, this study used validated measures to assess the constructs of interest and tested a theoretical model of ED development. Although our results add to the existing literature, some limitations should be noted. The demographic characteristics of the sample were limited, suggesting the need to test the hypothesized relationships among more diverse samples in future research, including non-treatment seeking individuals. Further, there was an exclusive focus on individuals with BED, and future work may seek to examine how these relationships replicate or diverge among individuals with other EDs such as bulimia nervosa and anorexia nervosa. Finally, the cross-sectional design limits our ability to draw firm conclusions regarding temporality and causality, highlighting the need for longitudinal research.

Although continued work is needed to confirm the hypothesized developmental and maintenance processes underlying the observed relationships, findings from the current study suggest possible implications for clinical practice. Specifically, results suggest that actual:ought self-discrepancy may play an important role in promoting ED pathology, particularly among individuals who experienced emotional or physical abuse in childhood. Therefore, treatments that directly target this form of negative self-evaluation may be especially beneficial for individuals reporting abuse histories. ICAT provides specific intervention techniques for addressing self-evaluation deficits, including actual:ought self-discrepancy, among patients with eating pathology. For example, ICAT guides therapists to explore the historical origins of their patient’s personal standards (e.g., actual:ought self-guide), which may have developed in the context of childhood abuse. Next, therapists help the patient to examine the pros and cons of continuing to pursue these standards, including consideration of the ways in which strict self-standards may contribute to experiences of negative affect and ED behaviors. Finally, therapists are guided to support patients in identifying more adaptive self-standards, which would theoretically contribute to reduced negative affect and use of ED behaviors. Although ICAT-BED has demonstrated good efficacy among individuals with BED (Peterson et al., 2020), further work is needed to examine whether ICAT may be particularly beneficial among individuals with child abuse histories.

Conclusion

Results from the present study demonstrate that individuals who report higher levels of emotional abuse or physical abuse in childhood and higher levels of actual:ought self-discrepancy in adulthood, evidence greater ED pathology. These findings strengthen our understanding of the complex relationship between childhood maltreatment and ED pathology, and underscore the importance of considering moderating factors (i.e., actual:ought self-discrepancy) which may serve to dampen or increase the impact of early abusive experiences on later problems in adulthood. Results also highlight the utility of the ICAT model in guiding research efforts to explore the relationship between maltreatment experiences, self-perceptions, and EDs. Future research should seek to identify additional moderating or mediating variables which, if effectively targeted, would have the potential to improve current intervention approaches for EDs, including BED.

Supplementary Material

1

Clinical Implications.

  • Actual:ought self-discrepancy and emotional abuse interact to predict ED pathology

  • Actual:ought self-discrepancy and physical abuse interact to predict ED pathology

  • Self-discrepancy may promote ED pathology among abused individuals

  • Targeting self-discrepancy in ED treatment may benefit those with abuse histories

Acknowledgments

This research was supported by the National Institute of Mental Health (grant numbers R34 MH099040–01A1, R34 MH098995, and T32 MH082761).

Footnotes

1

The SCID for DSM-5 was not available at the time of study implementation, therefore comorbid psychopathology was assessed using the SCID for DSM-IV. Reliability data for SCID diagnoses in the current sample are not available.

2

The CTQ includes additional subscales assessing emotional neglect and physical neglect, however, these subscales have demonstrated strong correlations with the emotional and physical abuse subscales in clinical and community samples (Bernstein et al., 2003). Therefore, the neglect subscales were not examined in the current study in order to reduce the number of predictors and constrain the overall alpha.

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