{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T07:16:40Z","timestamp":1788419800592,"version":"build-2803163510"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Childhood sexual abuse (CSA) is a pervasive and underreported form of trauma strongly associated with psychiatric morbidity. While numerous studies in adult populations have demonstrated a significant association between trauma exposure and eating disorders, particularly anorexia nervosa (AN), limited evidence exists regarding this relationship in the pediatric population. Understanding how CSA relates to early-onset AN is essential for improving diagnostic accuracy and guiding trauma-informed treatment. Aim of the study was to explore the relationship between CSA and the onset of anorexia nervosa in individuals under 18 years of age, providing a more comprehensive assessment of trauma exposure as a contributing factor to AN development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review was conducted in accordance with PRISMA guidelines. PubMed and Embase were searched for studies including empirical data, participants under age 18, and assessed sexual abuse in relation to AN. Data were extracted from eligible studies and synthesized narratively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across multiple clinical and questionnaire-based studies, adolescents with AN exhibited notably higher rates of CSA compared to peers without eating disorders. CSA was associated with depressive symptoms, emotional dysregulation, impaired self-esteem, fear of life, and relational difficulties. Evidence also indicated subtype differences, with binge-eating\/purging AN showing stronger association with CSA than restrictive AN. The relationship between CSA and AN appears mediated by emotional and interpersonal factors rather than being directly causal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CSA contributes significantly to psychological vulnerability in adolescents with AN. Trauma exposure influences mood, relational functioning, and coping mechanisms, all of which shape AN onset and severity. Systematic trauma assessment should be integrated into pediatric eating disorder evaluations, and treatment should incorporate trauma-informed and emotion-focused interventions to support holistic recovery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1886855","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:42:56Z","timestamp":1788417776000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Childhood sexual abuse in pediatric-onset anorexia Nervosa: a systematic review"],"prefix":"10.3389","volume":"14","author":[{"given":"Elena","family":"Bozzola","sequence":"first","affiliation":[{"name":"Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia","family":"Cirillo","sequence":"additional","affiliation":[{"name":"Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Spina","sequence":"additional","affiliation":[{"name":"Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Rosaria","family":"Marchili","sequence":"additional","affiliation":[{"name":"Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"B1","year":"2026"},{"key":"B2","doi-asserted-by":"publisher","first-page":"236","DOI":"10.2174\/2210676608666180112123154","article-title":"Eating disorders and abuse","volume":"7","author":"Dancyger","year":"2017","journal-title":"Adolesc Psychiatry"},{"key":"B3","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1016\/j.chiabu.2005.09.004","article-title":"The impact of childhood sexual abuse in anorexia nervosa","volume":"30","author":"Carter","year":"2006","journal-title":"Child Abuse Negl"},{"key":"B4","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/j.comppsych.2006.03.004","article-title":"Sexual abuse and eating disorder symptoms: the mediator role of body dissatisfaction","volume":"47","author":"Preti","year":"2006","journal-title":"Compr Psychiatry"},{"key":"B5","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1016\/S0140-6736(20)30059-3","article-title":"Eating disorders","volume":"395","author":"Treasure","year":"2020","journal-title":"Lancet"},{"key":"B6","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1001\/archgenpsychiatry.2011.74","article-title":"Mortality rates in patients with anorexia nervosa: a meta-analysis of 36 studies","volume":"68","author":"Arcelus","year":"2011","journal-title":"Arch Gen Psychiatry"},{"key":"B7","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1016\/j.appet.2018.06.034","article-title":"The relationship between trauma and weight status among adolescents in eating disorder treatment","volume":"129","author":"Hicks White","year":"2018","journal-title":"Appetite"},{"key":"B8","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1002\/erv.3000","article-title":"Pathways between childhood maltreatment and life satisfaction in adolescents with eating disorders: a network analysis","volume":"31","author":"Monteleone","year":"","journal-title":"Eur Eat Disord Rev"},{"key":"B9","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1159\/000328580","article-title":"Etiological role of childhood emotional trauma and neglect in adolescent anorexia nervosa: a cross-sectional questionnaire analysis","volume":"45","author":"Jaite","year":"2012","journal-title":"Psychopathology"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1066","DOI":"10.1097\/NMD.0000000000000055","article-title":"Attitudes toward life and death and suicidality among inpatient female adolescents with eating disorders","volume":"201","author":"Stein","year":"2013","journal-title":"J Nerv Ment Dis"},{"key":"B11","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1007\/s00103-007-0242-6","article-title":"Eating disorders in children and adolescents. 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