Multiple Mediation of the Association between Childhood Emotional Abuse and Adult Obesity by Anxiety and Bulimia

Bulimia is the most primitive reason for overweight and obesity. The extended literature has indicated that childhood emotional abuse has a close relationship with adverse mood states, bulimia, and obesity. To comprehensively understand the potential links among these factors, we evaluated a multiple mediation model in which anxiety/depression and bulimia were mediators between childhood emotional abuse and body mass index (BMI). A set of self-report questionnaires, including the Childhood Trauma Questionnaire (CTQ), Beck Anxiety Inventory [1], Beck Depression Inventory (BDI), and Eating Disorder Inventory (EDI), was sent out. Clinical data from 37 obese patients (age: 29.65 ± 5.35, body mass index (BMI): 37.59 ± 6.34) and 37 demographically well-matched healthy people with normal body weight (age: 31.35 ± 10.84, BMI: 22.16 ± 3.69) were included in the investigation. We first performed an independent t test to compare all scales or subscale scores between the two groups. Then, we conducted Pearson correlation analysis to test every two variables’ pairwise correlation. Finally, multiple mediation analysis was performed with BMI as the outcome variable, childhood emotional abuse as the predictive variable, and “anxiety → bulimia”/“depression → bulimia” as the mediating variables. The results show that the obese group reported higher childhood emotional abuse ( t =  2.157, p  = 0.034), worse mood state (anxiety: t =  5.466, p  < 0.001; depression: t =  2.220, p  = 0.030), and higher bulimia ( t =  3.400, p  = 0.001) than the healthy control group. Positive correlations were found in every pairwise combination of BMI, childhood emotional abuse, anxiety, and bulimia. Multiple mediation analyses indicate that childhood emotional abuse is positively linked to BMI ( β  = 1.312, 95% CI = 0.482–2.141). The “anxiety → bulimia” model is attested to play multiple mediating roles in the relationship between childhood emotional abuse and obesity (indirect effect = 0.739, 95% CI = 0.261–1.608, 56.33% of the total effect). These findings confirm that childhood emotional abuse contributes to adulthood obesity through the multiple mediating effects of anxiety and bulimia. The present study adds another potential model to facilitate our understanding of the eating psychopathology of obesity.