Childhood adversity and empathy in eating disorders: Exploring transdiagnostic profiles and socio-emotional functioning

Background: Adverse childhood experiences (ACEs), including abuse and neglect, have been associated with difficulties in developing empathy. People with eating disorders (EDs) often report higher rates of ACE and display empathy-related impairments, which may contribute to maladaptive interpersonal functioning. Objective: This study explored the associations between childhood adversities and empathy-related outcomes in individuals with ED compared to a general population sample (GP). Participants and setting: Participants included 210 people with EDs (94 anorexia nervosa restrictive, 34 binge-purge anorexia nervosa, 36 bulimia nervosa, 36 binge-eating disorder, 24 OSFED) from national ED clinics and 151 participants from the GP. Methods: Participants completed the Childhood Trauma Questionnaire (CTQ) and the Empathy Quotient (EQ). Multivariate analyzes evaluated group differences and associations between specific forms of childhood adversity and subdomains of EQ: cognitive empathy (CE), emotional reactivity (ER) and social skills (SS). Results: ACEs were more prevalent in the ED group (56 %) than in the GP (33 %, chi 2 = 31.81, p < 0.001). Emotional abuse and neglect were associated with a lower ER and SS, and physical neglect was associated with a reduction in CE and ER. No significant effects for physical or sexual abuse. Group membership alone was not associated with empathy outcomes. Cluster analysis identified two profiles: one with high trauma exposure and lower empathy, and another with lower trauma and more preserved socio-emotional functioning. Conclusion: Findings highlight the specific impact of emotional forms of childhood adversity on empathy in EDs and support trauma-informed, individualized interventions based on socioemotional profiles.