Childhood sexual abuse in pediatric-onset anorexia Nervosa: a systematic review

Abstract

Background Childhood sexual abuse (CSA) is a pervasive and underreported form of trauma strongly associated with psychiatric morbidity. While numerous studies in adult populations have demonstrated a significant association between trauma exposure and eating disorders, particularly anorexia nervosa (AN), limited evidence exists regarding this relationship in the pediatric population. Understanding how CSA relates to early-onset AN is essential for improving diagnostic accuracy and guiding trauma-informed treatment. Aim of the study was to explore the relationship between CSA and the onset of anorexia nervosa in individuals under 18 years of age, providing a more comprehensive assessment of trauma exposure as a contributing factor to AN development. Methods A systematic review was conducted in accordance with PRISMA guidelines. PubMed and Embase were searched for studies including empirical data, participants under age 18, and assessed sexual abuse in relation to AN. Data were extracted from eligible studies and synthesized narratively. Results Across multiple clinical and questionnaire-based studies, adolescents with AN exhibited notably higher rates of CSA compared to peers without eating disorders. CSA was associated with depressive symptoms, emotional dysregulation, impaired self-esteem, fear of life, and relational difficulties. Evidence also indicated subtype differences, with binge-eating/purging AN showing stronger association with CSA than restrictive AN. The relationship between CSA and AN appears mediated by emotional and interpersonal factors rather than being directly causal. Conclusions CSA contributes significantly to psychological vulnerability in adolescents with AN. Trauma exposure influences mood, relational functioning, and coping mechanisms, all of which shape AN onset and severity. Systematic trauma assessment should be integrated into pediatric eating disorder evaluations, and treatment should incorporate trauma-informed and emotion-focused interventions to support holistic recovery.