Association of childhood psychological trauma with eating disorders in undergraduate medical students.

AIM: The aim of the study was to study the association of childhood psychological trauma with eating disorders (EDs) and to assess and compare the relationship with food, concerns about weight gain, and restrictive or compensatory practices in male and female undergraduate medical students.
MATERIALS AND METHODS: A cross-sectional, analytical study was performed in a Tertiary Care Medical College and Research Hospital in a suburban area of India. After obtaining ethical clearance, 100 final-year undergraduate students were included in the study with their informed consent. Self-made questionnaire, Childhood Trauma Questionnaire, Stirling ED Scale with Disordered Eating Attitude Scale were used. Spearman's correlation coefficient (Rho) was calculated.
RESULTS: There was a significant correlation of history of childhood psychological trauma in the form of emotional abuse, emotional neglect or physical abuse and physical neglect with higher prevalence of disordered eating behaviors and relationship with food, concern about weight gain, and compensatory practices. No significant relationship was found in a history of sexual abuse.
CONCLUSION: The importance of a healthy psychosocial upbringing and nurturing by parents to prevent development of psychiatric comorbidities is an important finding in this study. Copyright:

Eating disorders (ED), as their name suggests, are characterized by disturbances in feeding and eating behaviors that significantly interfere with the daily life of the individual. The psychopathology manifests primarily in disordered behaviors but can also present with disturbance of thoughts, attitudes, and emotions. They are a complex, multifactorial convergence of biological, familial, psychosocial, and psychological variables and differ in etiology, clinical presentation; treatment needs and prognosis. They are spread across all demographic strata of the society with an increasing incidence in India.

Lifetime prevalence for Anorexia Nervosa ranges between 2% and 4%and Bulimia to 2% and 6%. A significant prevalence of ED symptoms and disordered eating attitudes and behaviors (16.9%) was reported by a study in EDs among medical students, and a significant correlation between distorted eating attitudes was found.[1] In the past decade, researchers have contemplated the possibility of childhood abuse and trauma, especially sexual abuse, represent powerful predecessors of the EDs, including anorexia nervosa, bulimia nervosa, and binge eating. Some studies examining other forms of trauma in the histories of EDs have also reported high rates of physical abuse, psychological abuse, witnessing of intra-familial violence, and other adverse events.[23] One study found that 45% of the patients with EDs had a history of sexual abuse other forms of childhood psychological trauma.[4] In another study, it was discovered that relative to a noneating-disordered comparison group, eating-disordered men reported higher rates of being beaten in childhood (36% vs. 8%), mother-child abuse (32% vs. 4%), and sexual abuse (20% vs. 0%).[5] It is evident; childhood trauma has a bearing on the development of eating psychopathology (defined as the psychological traits clinically relevant in individuals with EDs, anxiety, depression, and posttraumatic stress disorder). Keeping in view of the paucity of research on ED in Indian doctor population, and their impact on the mental health, it was hoped this study would bridge the gap. In view of the paucity of Indian studies, the present study was undertaken to study association of childhood psychological trauma with EDs in undergraduate medical students.

MATERIALS AND METHODS

This cross-sectional, analytical study was conducted among MBBS students studying in a Tertiary Care Medical College and Research Centre in the western part of Maharashtra. Period of study was January 2020–August 2020. Clearance for the ethical aspects of the study was obtained from the Institutional Ethics Committee before the start of the study. All subjects gave written informed consent.

Sample size

The sample size was calculated using the Fisher's formula.

Formula:

Description:

n = required sample size

t = confidence level at 95% (standard value of 1.96)

p = estimated prevalence of eating disorders in India (6%)

m = margin of error at 5% (standard value of 0.05)

Calculation:

n = 138 ~ 140

Sample size was calculated to be approximately ~140

Sample

All students from final-year MBBS were approached for inclusion in the study. They were explained the purpose of the study and written informed consent was obtained from them. Due to the physical unavailability of undergraduate students during the COVID-19 pandemic, a total of 100 students were interviewed for participation in the study.

Inclusion criteria

All the students studying in MBBS who were willing to participate in the study were included.

Exclusion criteria

Students with a past history of any psychiatric or EDs

Those with history of head injury, seizures, metabolic disorders, history of drug abuse or on psychotropic medications, and history of having had electroconvulsive therapy in the past 6 months.

Study tool

All subjects fulfilling the above eligibility criteria were assessed by using following tools.

Self-made questionnaire

The self-made questionnaire included demographic details such as age, religion, education, occupation, marital status, family income, and number of children. It consisted of a questionnaire containing 13 questions along with some demographic information based on general eating habits and physical health.

Childhood Trauma Questionnaire

Childhood Trauma Questionnaire (CTQ) is a standardized, retrospective 28-item self-report inventory that measures the severity of different types of childhood trauma divided into five subscales – emotional abuse and neglect, physical abuse and neglect, sexual abuse. The measure also includes a three item minimization/denial scale indicating the potential underreporting of maltreatment.[6]

Stirling Eating Disorder Scale

The Stirling Eating Disorder Scale (SEDS) is an 80-item, 8-scale measure for use with ED patients. The scale is for use with both primary EDs and patients showing dietary aspects of both diagnoses.[7] As a self-report measure, with a true/false response format, the SEDS is easily and quickly administered. The SEDS assess eight components: anorexic dietary behavior, anorexic dietary cognitions, bulimic dietary behavior, bulimic dietary cognitions, high perceived external control, low assertiveness, low self-esteem (LSE), and self-directed hostility (SDH). Studies have indicated that it is acceptable in terms of internal consistency, reliability, group validity, and concurrent validity. Results indicated that there were no significant sex differences on any of the eight scales.

Disordered Eating Attitude Scale

The Disordered Eating Attitude Scale (DEAS) is a 25-item questionnaire that assesses the individual's eating attitudes. This index consists of questions grouped into seven subscales: Relationship with food, concern with food and weight gain, restrictive and compensatory behaviors, food refusal, meanings of eating, positive feelings about eating, and idea of normal eating. Higher scores are indicative of worse attitudes.[8]

Statistical analysis

Data were processed using the Statistical Package for the Social Sciences - version 16.0 (SPSS-16). Descriptive statistics were used to calculate U- and Z-score of the sample. The level of significance kept at P < 0.05 (two-tailed).

RESULTS

The sample of medical students included in present study comprised 43 males and 57 females. Majority (97%) belonged to 20–25-year age group and remaining 3% were more than 25 years old. Height, weight, and body mass index (BMI) were significantly more in male medical students [Table 1]. In the present study, 22% of students fell under the overweight or obese category, more commonly seen in male medical students. Substance use in the form of alcohol or cigarette smoking was also significantly more frequent in males. Males consumed alcohol more often and more amount in each session. 54% medical students reported to eat more while they were stressed or feeling low, out of which more than half were females. However, there were no differences between boys and girls [Table 2]. Females, also reported to eat more or follow a binge-eating pattern after consumption of alcohol, than males. The relationship with food also varied with the weight and BMI of students, along with greater compensatory practices as the BMI increased. It was noted that the male medical students felt more insecure about their appearance, frequently looked in the mirror. Similarly, males also experienced higher gastric irritability and upset stomachs as compared to female students [Table 3].

Table 1

Demographic and clinical characteristics of medical students

Characteristics	Mean	SD	t-test (df)	Significance (two-tailed)	95% CI of the difference
					Lower	Upper
Age
Female	22.6842	1.26995	1.684 (98)	0.095	−0.07219	0.88247
Male	22.2791	1.07627
Height
Female	157.0526	6.99086	−13.258 (98)	0.000	−21.62306	−15.99261
Male	175.8605	7.06629
Weight
Female	57.1053	11.06423	−8.981 (98)	0.000	−23.94992	−15.28142
Male	76.7209	10.46838
BMI
Female	23.0381	4.22507	−2.129 (98)	0.036	−3.21538	−0.11266
Male	24.7021	3.33903

SD – Standard deviation; CI – Confidence interval; BMI – Body mass index

Table 2

Weight and habits of the medical students (n=100)

Characteristics	Frequency, n (%)	Males	Females	Chi square test	P
BMI
<18.5 (underweight)	6 (6)	1	5	8.286	0.041 (S)
18.5-24.9 (normal)	72 (72)	27	45
25-29.9 (overweight)	16 (16)	11	5
>30 (obese)	6 (6)	4	2
Habits
Alcohol	65 (65)	38	27	18.113	0.00002 (S)
Cigarette smoking	22 (22)	19	3	21.639	0.00001 (S)
Overeating
Watching a movie	37 (37)	17	20	1.934	0.584 (NS)
Stressed	47 (47)	22	25
Excited	9 (9)	2	7
Feeling low or depressed	7 (7)	3	4

BMI – Body mass index; S – Significant; NS – Not significant

Table 3

Scores of male and female medical students on the self-made questionnaire and history of physical and sexual abuse

Questions	Females		Males		Mann-Whitney U-test	P
	Mean	SD	Mean	SD
Experience hair loss/dry skin	1.421	0.498	1.348	0.482	1137.000	0.466
Partner must have perfect physique	1.666	0.475	1.674	0.474	1216.000	0.935
Frequently eat alone	1.666	0.607	1.604	0.583	1164.500	0.632
Frequently look in mirror	2.491	0.782	2.767	0.611	996.000	0.035
Frequent GI disorders	1.614	0.491	1.814	0.450	991.500	0.044
Teased because of size	1.684	0.735	1.604	0.583	1184.000	0.745
Consume alcohol	4.017	1.231	3.558	1.240	922.000	0.026
How much alcohol at one time	3.491	1.627	2.907	1.508	944.500	0.044
feeling of inadequacy/lack of control	1.596	0.494	1.581	0.499	1207.000	0.880
Trouble in personal relationships	1.543	0.502	1.488	0.505	1157.500	0.584
Difficulty in expressing emotions	1.649	0.481	1.604	0.494	1171.000	0.650
History of physical abuse	1.894	0.309	1.953	0.213	1153.500	0.286
History of sexual abuse	1.947	0.225	2.000	0.000	1161.000	0.129

SD – Standard deviation; GI – Gastrointestinal

On the SEDS, a significant difference in the self-esteem and assertiveness was found in the medical students, females reporting lower self-esteem and low assertiveness [Table 4]. There was a significant difference in eating attitudes in male and female medical students with higher concern about weight gain and compensatory practices found in females more than males; without major variation in BMI [Figure 1]. On the DEAS subscales, the scores were similar, and no significant differences were noted between male and female medical students [Table 5]. According to the CTQ, 25% of students had a history of emotional abuse and 43% experienced psychological trauma in the form of emotional neglect. Only 2% reported to have a history of sexual abuse during childhood. On comparison, incidence of emotional abuse and emotional neglect was higher in males than females whereas physical abuse and physical neglect was more commonly seen in females. However, none of the differences were statistically significant [Table 6]. There was a significant correlation of SDH in students with a history of emotional abuse, emotional neglect, physical abuse, and physical neglect but not with sexual abuse during childhood. No such finding was detected in the reduction of self-esteem or low assertiveness in students. A significant correlation was also noted between low assertiveness and self-esteem, along with BMI and SDH [Table 7]. A multiple regression was run to predict LSE scores from perceived external control, bulimic dietary condition, low assertiveness, feelings toward eating, total score on DEAS, feelings of inadequacy, and lack of control and LSE. These variables statistically significantly predicted LSE scores, F (6, 93) =32.297, P < 0.000, R2 = 0.676. All variables added statistically significantly to the prediction, P < 0.05 [Table 8].

Table 4

Scores of male and female medical students on the sterling eating attitude scale

SEAS subscales	Females		Males		Mann-Whitney U test	P
	Mean	SD	Mean	SD
ADB	11.982	6.031	13.044	6.443	1134.000	0.524
ADC	14.675	8.287	20.974	12.1	871.000	0.014
BDB	20.164	6.372	23.932	7.479	910.000	0.028
BDC	18.143	7.531	21.118	9.020	989.500	0.100
PEC	14.921	6.481	17.600	7.843	950.500	0.055
LA	15.080	7.004	18.014	6.856	920.500	0.034
LSE	13.664	6.461	17.360	7.553	925.500	0.037
SDH	17.240	6.189	19.065	7.065	1052.000	0.227

ADB – Anorexic dietary behaviour; ADC – Anorexic dietary cognitions; BDB – Bulimic dietary behaviour; BDC – Bulimic dietary cognitions; PEC – Perceived external control; LA – Low assertiveness; LSE – Low self-esteem; SDH – Self-directed hostility; SD – Standard deviation; SEAS – Stirling eating disorder scale

Figure 1

Concerns about weight gain and compensatory practices in male and female medical students

Table 5

Scores of male and female medical students on the Disordered Eating Attitude Scale

DEAS subscales	Females		Males		Mann-Whitney U test	P
	Mean	SD	Mean	SD
Relationship with food	32.210	11.242	33.744	11.503	1149.000	0.592
Concerns about food and weight gain	12.508	4.02724	12.581	4.147	1212.500	0.927
Restrictive and compensatory practices	9.719	5.16082	10.697	5.031	1108.500	0.403
Feelings toward eating	7.210	4.16935	8.302	4.426	1056.000	0.217
Idea of normal eating	33.017	11.576	33.907	12.023	1202.000	0.868
Grand total	88.456	25.988	95.70	27.136	1044.500	0.208

DEAS – Disordered Eating Attitude Scale; SD – Standard deviation

Table 6

Scores of male and female medical students on the childhood trauma questionnaire

CTQ	Females		Males		Mann-Whitney U test	P
	Mean	SD	Mean	SD
Emotional abuse	9.5700	4.73383	11.2821	5.53434	996.000	0.092
Emotional neglect	6.5500	3.40640	8.0000	5.04715	1109.500	0.376
Sexual abuse	5.6900	2.17746	5.7436	1.39015	1078.000	0.149
Physical abuse	19.2900	4.81642	17.4872	5.66091	1006.000	0.107
Physical neglect	11.6842	1.03782	11.4615	1.09655	1135.000	0.480

CTQ – Childhood trauma questionnaire; SD – Standard deviation

Table 7

Correlations: Spearman’s rho

	Age	Sex	BMI	ADB	ADC	BDB	BDC	PEC	LA	LSE	SDH	DEAS	EA	EN	SA	PA	PN
Age
CC	1.00	−0.20*	0.01	−0.10	−0.19	−0.202*	−0.133	−0.359**	−0.19*	−0.213*	−0.11	−0.256*	0.068	0.054	0.093	−0.07	−0.090
Significant		0.04	0.92	0.32	0.06	0.044	0.188	0.000	0.050	0.033	0.264	0.010	0.499	0.595	0.355	0.460	0.375
Sex
CC	−0.20*	1.00	0.23*	0.04	0.25*	0.231*	0.143	0.185	0.22*	0.194	0.119	0.141	0.194	0.110	0.156	−0.18	−0.09
Significant	0.04		0.021	0.70	0.01	0.021	0.155	0.066	0.026	0.053	0.237	0.163	0.053	0.277	0.121	0.063	0.339
BMI
CC	0.01	0.23*	1.00	0.23*	0.21*	0.320**	0.228*	0.216*	0.21*	0.317**	0.129	0.173	0.20*	0.02	0.40**	−0.20*	−0.119
Significant	0.92	0.02		0.02	0.03	0.001	0.023	0.031	0.035	0.001	0.200	0.085	0.041	0.796	0.000	0.038	0.236
ADB
CC	−0.10	0.03	0.23*	1.00	0.36**	0.43**	0.39**	0.44**	0.47**	0.42**	0.37**	−0.02	−0.09	0.00	−0.03	0.09	0.07
Significant	0.31	0.70	0.02		0.00	0.000	0.000	0.000	0.000	0.000	0.000	0.844	0.330	0.999	0.737	0.350	0.468
ADC
CC	−0.18	0.25*	0.21*	0.36**	1.00	0.537**	0.618**	0.629**	0.36**	0.52**	0.30**	0.057	0.112	0.040	0.144	−0.11	−0.087
Significant	0.05	0.01	0.03	0.00		0.000	0.000	0.000	0.000	0.000	0.002	0.575	0.269	0.694	0.153	0.264	0.392
BDB
CC	−0.20*	0.23*	0.32**	0.43**	0.53**	1.000	0.441**	0.507**	0.38**	0.439**	0.37**	0.156	0.059	0.065	0.111	−0.06	−0.043
Significant	0.04	0.02	0.00	0.00	0.00		0.000	0.000	0.000	0.000	0.000	0.121	0.558	0.522	0.272	0.547	0.674
BDC
CC	−0.13	0.14	0.22*	0.393**	0.61**	0.441**	1.000	0.490**	0.30**	0.596**	0.35**	0.052	0.072	0.074	0.086	−0.07	−0.053
Significant	0.18	0.16	0.02	0.000	0.00	0.000		0.000	0.002	0.000	0.000	0.606	0.475	0.464	0.394	0.471	0.600
PEC
CC	−0.35**	0.19	0.21*	0.44**	0.62**	0.507**	0.490**	1.00	0.56**	0.700**	0.52**	0.143	0.122	−0.01	0.134	−0.12	−0.071
Significant	0.00	0.07	0.03	0.00	0.00	0.000	0.000		0.000	0.000	0.000	0.155	0.227	0.917	0.183	0.221	0.484
LA
CC	−0.19*	0.22*	0.21*	0.47**	0.36**	0.386**	0.304**	0.563**	1.00	0.597**	0.41**	0.063	0.035	0.01	0.05	−0.03	0.020
Significant	0.05	0.03	0.03	0.00	0.00	0.000	0.002	0.000		0.000	0.000	0.533	0.729	0.948	0.610	0.753	0.846
LSE
CC	−0.21*	0.19	0.31**	0.42**	0.52**	0.43**	0.59**	0.70**	0.59**	1.000	0.39**	0.146	0.123	0.038	0.155	−0.12	−0.097
Significant	0.03	0.053	0.00	0.00	0.00	0.000	0.000	0.000	0.000		0.000	0.146	0.223	0.705	0.124	0.212	0.338
SDH
CC	−0.11	0.12	0.12	0.37**	0.30**	0.369**	0.353**	0.529**	0.41**	0.399**	1.00	0.11	0.23*	0.21*	0.10	−0.23*	−0.234*
Significant	0.26	0.24	0.20	0.00	0.00	0.000	0.000	0.000	0.000	0.000		0.248	0.020	0.030	0.296	0.020	0.019
DEAS
CC	−0.25*	0.14	0.17	−0.02	0.05	0.156	0.052	0.143	0.063	0.146	0.117	1.000	0.179	0.021	0.142	−0.18	−0.142
Significant	0.01	0.16	0.08	0.84	0.57	0.121	0.606	0.155	0.533	0.146	0.248		0.075	0.840	0.160	0.074	0.158
EA
CC	0.06	0.19	0.20*	−0.09	0.11	0.059	0.072	0.122	0.035	0.123	0.23*	0.179	1.00	0.61**	0.63**	−0.99**	−0.90**
Significant	0.49	0.053	0.041	0.33	0.26	0.558	0.475	0.227	0.729	0.223	0.020	0.075		0.000	0.000	0.000	0.000
EN
CC	0.05	0.110	0.02	0.000	0.040	0.065	0.074	−0.011	0.007	0.038	0.21*	0.021	0.61**	1.00	0.126	−0.60**	−0.809**
Significant	0.59	0.277	0.79	0.999	0.694	0.522	0.464	0.917	0.948	0.705	0.030	0.840	0.000		0.212	0.000	0.000
SA
CC	0.09	0.156	0.40**	−0.034	0.144	0.111	0.086	0.134	0.052	0.155	0.106	0.142	0.63**	0.126	1.00	−0.63**	−0.405**
Significant	0.35	0.121	0.00	0.737	0.153	0.272	0.394	0.183	0.610	0.124	0.296	0.160	0.000	0.212		0.000	0.000
PA
CC	−0.07	−0.18	−0.20*	0.095	−0.113	−0.061	−0.073	−0.124	−0.03	−0.126	−0.23*	−0.180	−0.99**	−0.60**	−0.63**	1.00	0.911**
Significant	0.46	0.063	0.038	0.350	0.264	0.547	0.471	0.221	0.753	0.212	0.020	0.074	0.000	0.000	0.000		0.000
PN
CC	−0.09	−0.09	−0.12	0.073	−0.08	−0.04	−0.05	−0.07	0.02	−0.09	−0.23*	−0.14	−0.90**	−0.81**	−0.41**	0.91**	1.00
Significant	0.37	0.339	0.236	0.468	0.392	0.674	0.600	0.484	0.846	0.338	0.019	0.158	0.000	0.000	0.000	0.000

* and **; * Significant; ** Highly significant. CC – Correlation coefficient; BMI – Body mass index; ADB – Anorexic dietary behaviour; ADC – Anorexic dietary cognitions; BDB – Bulimic dietary behaviour; BDC – Bulimic dietary cognitions; PEC – Perceived external control; LA – Low assertiveness; LSE – Low self-esteem; SDH – Self-directed hostility; DEAS – Disordered Eating Attitude Scale; EA – Emotional abuse; EN – Emotional neglect; SA – Sexual abuse; PA –Physical abuse; PN – Physical neglect

Table 8

Multivariate logistic regression analysis to find predictors of low self-esteem: Coefficientsa

Model 6	Unstandardized coefficients		Standardized coefficients	t	Significant	95% CI for B		Collinearity statistics
	B	SE	Beta			Lower bound	Upper bound	Tolerance	VIF
Constant	−2.487	2.321		−1.071	0.287	−7.096	2.122
PEC	0.310	0.083	0.312	3.738	0.000	0.146	0.475	0.501	1.994
BDC	0.216	0.062	0.251	3.491	0.001	0.093	0.339	0.676	1.480
LA	0.306	0.077	0.302	3.986	0.000	0.154	0.458	0.608	1.644
DEAS total	0.115	0.026	0.426	4.452	0.000	0.063	0.166	0.381	2.622
FTE	−0.504	0.156	−0.303	−3.229	0.002	−0.815	−0.194	0.397	2.522
FILC	−1.927	0.870	−0.133	−2.215	0.029	−3.654	−0.200	0.966	1.035

aDependent variable: LSE. PEC – Perceived external control; BDC – Bulimic dietary conditions; LA – Low assertiveness; FTE – Feelings towards eating; DEAS total – Total score on Disordered Eating Attitude Scale; FILC – Feelings of inadequacy and lack of control, LSE: Low self-esteem, SE: Standard error, CI: Confidence interval, VIF – Variance inflation factor

DISCUSSION

Although the fast pace and stress of medical school has affected students' eating habits and their relationship with food, concerns about appearance and restrictive eating patterns were found to be higher in female students than males [Figure 1]. A research conducted in Pennsylvania, to study the changes in food intake in response to stress in females and males, eating behavior during the specific stressful experience for females, correlated significantly with disinhibition followed by eating more than usual, which is in concordance to our findings.[9] Nelson et al. studied a University population for alcohol-related eating behaviors, where they found that 81% of female students ate more after drinking, as seen in this study.[10] Several studies have confirmed the importance of weight and BMI in young adults and its association with self-esteem and assertive behavior. As noted in our results, a highly significant deterioration in self-esteem was noted as the BMI went up the scale.

According to an earlier study, two out of every three children were physically abused during childhood, and every second child reported to be facing emotional abuse, which was consistent with our findings.[11] Similarly, in a survey done in college students of Pondicherry, there were significant statistical differences in the proportions of emotional abuse, based on gender (females were name-called and neglected twice as much as males).[12] Several studies have described the association of EDs with a history of childhood abuse in a significant number of individuals. One study reported that up to half of the patients with EDs had a history of childhood abuse or trauma,[13] while another study found that 48% of the patients admitted for anorexia nervosa reported a history of sexual abuse during their childhood.[14] Women with a history of both childhood physical and sexual abuse were three times more vulnerable to develop ED-like symptoms.[15]

In a study of 489 women in undergraduate courses, it was found that childhood emotional abuse, but not childhood physical or sexual abuse, contributed to adult ED symptoms.[2] In partial agreement with the above, the present study also showed substantial association of childhood emotional and physical abuse or neglect with EDs in medical students, regardless of their gender, but sexual abuse was not related to symptoms of ED [Table 7]. The linkage of childhood sexual abuse with ED was not supported in our study which is in agreement with few earlier studies.[16] Development of negative self-worth in adulthood in correlation with disordered eating practices shines light upon the importance of a healthy psychosocial upbringing and nurturing by parents to prevent development of psychiatric comorbidities.

Limitations of the study

Due to the pandemic and lack of availability of students on campus, live interviews could not be conducted and sample size had to be reduced. Authenticity of the data could not be reviewed due to the above reason.

CONCLUSION

There is a higher prevalence of disordered eating behaviors and relationship with food, concern about weight gain, and compensatory practices found in females more than males, without major variation in their BMI. There was a positive correlation between the presence of childhood psychological trauma in the form of emotional or physical abuse or neglect with development of ED cognition in adulthood in medical students. Medical students with a history of childhood psychological trauma also showed SDH associated with disordered eating habits.

Scope for future research

Taking into consideration the paucity of data in disordered eating behaviors in our country, and the westernization movement leading to more access to fast foods, more studies need to be undertaken in this area. If research is carried out in younger age groups (15–18 years), the progression to ED level can be minimized.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.