The research team recruited 332 adults with a mean age of 34.85 years, who completed a battery of validated online questionnaires. Participants reported on their history of childhood sexual abuse, their symptoms of complex PTSD as measured by the International Trauma Questionnaire, their binge eating severity on the Binge Eating Scale, their night eating behaviors on the Night Eating Questionnaire, and their general emotional distress on the Brief Symptom Inventory-18, which captures depression, anxiety, and somatization. A Satisfaction with Life Scale rounded out the survey, allowing the researchers to situate eating pathology within a broader picture of well-being. The sample was predominantly female, predominantly Jewish, and non-clinical, meaning participants were recruited from the community rather than from treatment settings.

Complex PTSD is a diagnostic construct that extends beyond the classic features of post-traumatic stress disorder. In addition to re-experiencing, avoidance, and a persistent sense of threat, CPTSD encompasses disturbances in self-organization: profound difficulties with emotion regulation, a negative self-concept, and problems in relationships. These additional features are thought to arise particularly after prolonged or repeated interpersonal trauma, such as childhood sexual abuse, which betrays the child’s trust in caregivers or familiar adults and disrupts the development of a stable sense of self. The researchers hypothesized that this broader trauma syndrome, rather than trauma exposure alone, would be the proximal driver of disordered eating, and that the emotional distress dimensions of depression, anxiety, and somatization would carry the signal from trauma to eating behavior.

The statistical engine of the study was structural equation modeling, a technique that allows researchers to test an entire network of hypothesized relationships simultaneously rather than examining correlations one pair at a time. The fitted model showed excellent fit to the data, with a comparative fit index of 0.99, a root mean square error of approximation of 0.079, and a standardized root mean square residual of 0.05, values that fall within or near conventional thresholds for a well-fitting model. Within that model, childhood sexual abuse strongly predicted CPTSD symptoms, with a standardized path coefficient of 0.39, indicating a substantial association. CPTSD, in turn, was linked to both binge eating and night eating symptoms, but the routes connecting them diverged in ways the authors had not fully anticipated.

The pathway to night eating syndrome ran almost entirely through anxiety. Night eating syndrome is characterized by recurrent episodes of eating after the evening meal or during the night, often with full awareness and frequently without the compensatory behaviors seen in bulimia. In the model, anxiety fully mediated the path from CPTSD to night eating, with a standardized indirect effect of 0.45 that was highly significant. In practical terms, this suggests that among people with complex trauma symptoms, it is the anxious arousal, the chronic vigilance and worry that often accompany trauma, that appears to channel distress into nighttime eating, rather than depressed mood or bodily complaints. Full mediation means that once anxiety was accounted for, the direct link between CPTSD and night eating was no longer statistically meaningful.

The road to binge eating was different. Somatization, the propensity to manifest emotional pain as headaches, gastrointestinal complaints, fatigue, and other physical symptoms, partially mediated the association between CPTSD and binge eating, with a standardized coefficient of 0.20. Partial mediation implies that somatization carries part of the relationship, but that a direct path from CPTSD to binge eating also remains. This pattern is consistent with theoretical accounts in which binge eating functions as a bodily regulation strategy, a way of numbing or soothing distress that is experienced physically rather than verbally. For survivors whose trauma is somatically encoded, the drive to eat may be less about anxious rumination and more about quieting a body that has learned to hold its pain in flesh rather than words.

Perhaps the most surprising result concerned depression. CPTSD and depression were almost inseparable in the data, with a path coefficient of 0.82, one of the strongest associations in the entire model. Yet depression did not significantly mediate either the pathway to binge eating or the pathway to night eating. The authors highlight this dissociation as a key contribution of the study. It suggests that although depression is a near-constant companion of complex trauma, it may be a relatively nonspecific one, whereas anxiety and somatization carry more diagnostic information about which form of disordered eating a survivor is most likely to develop. If replicated, this specificity could sharpen clinical assessment: a trauma survivor presenting with high anxiety might be screened for night eating, while one reporting prominent physical symptoms might be evaluated for binge eating.

The authors are careful to frame these findings as preliminary rather than definitive, and their cautions deserve emphasis. The study used a cross-sectional design, meaning all data were collected at a single point in time, so the direction of the pathways is a statistical inference rather than a demonstrated causal sequence. Childhood sexual abuse was measured by retrospective self-report, which can be affected by memory and disclosure biases. Participants were not clinically diagnosed; eating pathology was assessed by questionnaire symptom scales rather than structured diagnostic interviews. And the sample, drawn largely from Jewish female adults online, limits generalizability to men, other populations, and clinical settings. The model fit statistics, while good, describe how well the hypothesized network matches the observed correlations, not proof that the mechanisms operate as drawn.

Even with those limits, the study opens a promising line of investigation. It positions binge eating and night eating not as isolated problems with food, but as potential expressions of a wider trauma-related syndrome in which the body becomes the site of regulation and repair. The plain-language summary accompanying the paper makes this point directly: in people with a history of childhood sexual abuse, disordered eating may be connected with broader trauma-related difficulties, not only with eating itself. Understanding anxiety, somatization, and complex PTSD may therefore be essential when assessing these eating problems, rather than focusing on eating behavior alone.

The clinical implications, if future research confirms them, could be significant. Screening for CPTSD in patients with binge eating or night eating symptoms, and conversely screening for disordered eating in trauma services, could help identify people whose difficulties currently fall between diagnostic categories. Treatments that target anxious arousal or somatic distress, alongside established eating disorder interventions, might prove more effective for trauma survivors than approaches aimed solely at food and weight. The research team, which also included Maya Levy, Iris Shachar Lavie, and Rachel Bachner-Melman of Ruppin Academic Center and Inbal Brenner of Lev-Hasharon Mental Health Center and Tel Aviv University, notes that their results provide a preliminary basis for further investigation of the trauma-related and psychological factors associated with binge- and night-eating symptoms. Longitudinal studies following survivors over time, and clinical samples with formal diagnoses, will be needed to test whether the two divergent pathways mapped here hold up as genuine mechanisms, and whether treating the anxiety behind night eating, or the bodily distress behind binge eating, can interrupt the trajectory from childhood trauma to adult eating disorder.

Subject of Research: Pathways linking childhood sexual abuse, complex PTSD, and disordered eating through anxiety and somatization

Article Title: Childhood sexual abuse and disordered eating: distinct pathways linking complex PTSD with binge eating disorder and night eating syndrome

Article References: Lev-Ari, L., Levy, M., Lavie, I. S., Bachner-Melman, R., & Brenner, I. (2026). Childhood sexual abuse and disordered eating: distinct pathways linking complex PTSD with binge eating disorder and night eating syndrome. Journal of Eating Disorders. https://doi.org/10.1186/s40337-026-01784-7

Image Credits: AI Generated

DOI: 10.1186/s40337-026-01784-7

Keywords: childhood sexual abuse, complex PTSD, binge eating disorder, night eating syndrome, anxiety, somatization, depression, trauma, eating disorders, structural equation modeling, emotional distress, mental health