The prevalence of abuse/neglect in our sample of women is similar to other reports of abuse/neglect using the CTQ. Walker and colleagues (29
) examined 1225 women members of a health maintenance organization and found that 43% reported some history of abuse/neglect (versus 36% in our sample), with the following prevalence rates for subtypes: emotional abuse = 24% (versus 20%), physical abuse = 14% (versus 17%), sexual abuse = 18% (versus 14%), emotional neglect = 21% (versus 6%), and physical neglect = 12% (versus 15%). A study assessing over 9000 women from a health maintenance organization reported a slightly higher pattern of prevalence using items from validated measures other than the CTQ, 27% endorsed physical abuse, 25% endorsed sexual abuse, and 13% endorsed emotional abuse (47
The present study tested for an association between reports of childhood abuse/neglect and adulthood central adiposity and obesity in Black and White women. It found that women who reported any childhood abuse/neglect had higher central adiposity and obesity in adulthood than women who reported no abuse/neglect. These findings are consistent with the literature connecting childhood abuse to central adiposity and obesity (16
), but improved upon the empirical evidence by using a validated and reliable measure of childhood abuse/neglect.
Our study also showed that the specific subtypes of abuse that related to adiposity were physical and sexual abuse, as opposed to neglect or emotional abuse. Physical and sexual abuse may be more severe childhood stressors than other forms of abuse or neglect. In addition, questions assessing physical and sexual abuse in the CTQ may require less subjective evaluation than questions pertaining to emotional abuse and neglect (“I was punished with a belt, a board, a cord, or some other hard object” versus “I felt that someone in my family hated me”). There is some research indicating that recall for childhood experience is poorest for subjective perceptions and best for concrete events and behaviors (49
Childhood abuse/neglect was not associated with changes in central adiposity or obesity across the 8 years of follow-up in the full sample. However, among women with baseline BMI < 30, a history of any abuse/neglect was related to greater increases in WC over eight years. This is the first study to report on the relationship between childhood abuse/neglect and changes in central adiposity. Normal-weight and overweight women who experienced emotional abuse, physical abuse, sexual abuse, or physical neglect had greater increases in central adiposity compared to non-abused women. The null effect for emotional neglect may be related to low power with only 14 women reporting neglect in this BMI category. The findings suggest that most forms of victimization early in life are related to increases in central adiposity over time, particularly for normal-weight and overweight women.
The results for obese women were unexpected, in that obese women reporting physical or sexual abuse had smaller increases or decreases in central adiposity. Although these findings are not readily understood, research by Wiederman et al. (50
) offers one possible explanation. They found that sexually abused obese women displayed less weight fluctuation relative to non-abused obese women, whereas sexually abused normal-weight women displayed greater weight fluctuation compared to their non-abused normal-weight peers. Perhaps central adiposity is also less variable in abused obese women.
This is the first study to test whether negative emotions mediated the relationship between childhood abuse/neglect and adiposity. Trait Anger was a significant mediator in cross-sectional relationships between childhood abuse/neglect and central adiposity and obesity. Perspectives from developmental psychopathology suggest that abused/neglected children demonstrate problems with emotion regulation, which is the way affect is redirected, controlled, modulated, and modified to enable the individual to function adaptively in emotionally arousing situations (definition in 51). Maltreated children experience more negative emotions, specifically anger, fear, and aggression, when with peers and adults. Furthermore, abused/neglected children are hypervigilant and sensitized to witnessing aggressive stimuli (see review in 48). Previous literature has suggested that anger is a particularly detrimental emotion that influences the development of central adiposity, more so than depression, anxiety, and cynicism both in adults (52
) and in adolescents (20
This study was also the first to test whether reproductive hormones (testosterone, estradiol, FSH, FAI, FEI, and SHBG) mediated between childhood abuse/neglect and central adiposity and obesity. Only SHBG significantly attenuated the cross-sectional relationships between childhood abuse/neglect and central adiposity and obesity. SHBG is produced by the liver cells and is a carrier protein, binding to testosterone and estradiol and inhibiting their function. Hence, lower levels of SHBG would be associated with higher levels of unbound, bioavailable testosterone and estrogen. Previous studies have suggested that lower levels of SHBG in middle-aged premenopausal women were associated with greater central adiposity and obesity (53
). It is noteworthy that our tests of mediation were not driven solely by associations between SHBG and adiposity; exploratory analyses showed that any abuse/neglect predicted SHBG, even after controlling for central adiposity (β = -.12, p
= .03) or obesity (β = -.11, p
= .04). Our findings are the first to show that childhood abuse and neglect are related to levels of SHBG in mid-life.
Several studies show that childhood abuse/neglect is related to alcohol abuse in adulthood, particularly for women, as noted in a review by Widom and Hiller-Sturmhöfel (55
). The authors suggest that abused children and adolescents may rely on alcohol to help cope with negative emotions or hyperarousal. Another possibility is that the childhood abuse may lead to antisocial behavior, one form being alcohol abuse or dependence (55
). Moderate to high intake of alcohol has been shown to be related to high central adiposity later in life (56
). However, in our study, a history of alcohol abuse/dependence only tended to mediate the association between childhood abuse and central adiposity.
Although the data indicates non-significant mediating effects for negative health behaviors, we cannot disqualify the potential importance of negative health behaviors. Low physical activity and an unhealthy dietary pattern were significantly correlated to central adiposity and obesity, but these negative health behaviors were not related to a history of abuse/neglect. In addition, the low frequency of current smokers in this sample (16.1%) may have precluded significant associations.
It is possible that a physiological mechanism, other than reproductive hormones, may be linking abuse/neglect history to body fat distribution. Childhood abuse/neglect may affect body fat distribution by directly activating the hypothalamic-pituitary-adrenal (HPA) axis, which releases the hormone cortisol. Visceral adipose tissue is particularly sensitive to circulating cortisol due to increased blood flow and glucocorticoid receptors (57
), and cortisol promotes differentiation of preadipocytes into adipocyte cells and stimulates lipogenesis (58
). Elevated cortisol secretion has been documented in samples of sexually and physically abused children and adolescents (59
). Other research has suggested that autoimmune processes may also be important; Dube and colleagues (62
) recently reported that cumulative childhood traumatic stress (including emotional, physical, and sexual abuse) was associated with hospitalization for autoimmune diseases. We did not have comprehensive neuroendocrine or immunity measures in the present study so we cannot evaluate these mechanisms.
There are several limitations to the current study. Although a history of childhood abuse/neglect was associated with central adiposity and obesity in midlife, the causal nature of these associations cannot be established. The extent to which our findings are generalizable to younger or older women or to men cannot be determined. Additionally, a retrospective measure of childhood abuse and neglect has limitations because recall of temporally distant and emotionally painful events has the potential for distortion, possibly because of repression, denial, or current mood at time of recall (63
). However, studies that use legal records to classify children as abused may misclassify cases that never reach the criminal justice system as “not abused,” thus biasing results toward the null (64
). Children identified by the legal system as being abused not only receive intervention, but in most situations the abuse usually stops, suggesting that identified children may not be representative of all abused children (65
). Parental or caretaker reports would also be unsuitable alternatives, given the social and legal implications of self-identification as a child abuser.
Given the challenges with retrospective and prospective reports of childhood abuse/neglect, a strength of the present study is its use of a well-validated and reliable assessment of multiple forms of abuse and neglect. The Childhood Trauma Questionnaire has been evaluated in psychiatric and normal populations, corroborated with clinician interviews, and standardized for appropriate cut-off scores to minimize false-positives or false-negatives. Results from this questionnaire indicated that 36% of the women in our sample were abused or neglected, which may appear to be high, but rates of maltreatment within each subtype of abuse/neglect generally fall into the ranges recently reviewed by Gilbert et al. (1
). Another strength of the present study is its longitudinal design and diverse sample. The longitudinal design aids researchers in understanding the progression of health outcomes and their risk factors. Previous research between childhood abuse/neglect and obesity has not explored whether race was associated with outcomes. Our sample was 34% Black, which allowed us to investigate whether race influenced outcomes, and improved the generalizability of our findings.
In conclusion, results from the present study showed that childhood abuse and neglect were associated with adulthood adiposity. This study also clarified possible mechanisms between early-life victimization and adulthood health. Children who are abused may be sensitized to experiencing anger, particularly in interpersonal interactions with heightened perceived threat, and over time these frequent expressions of anger may have a toxic effect on adiposity. Additionally, abuse and neglect were associated with dysregulated physiology, specifically lower SHBG, and this carrier protein was linked to increased adiposity.