Eating disorders (EDs), which encompass conditions such as anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED), represent a significant public health concern due to their profound physical, psychological, and social consequences (1–3). These disorders are marked by persistent disturbances in eating behavior, accompanied by distressing thoughts and emotions related to food, body weight, and shape (1). In line with the biopsychosocial model, this complex etiology underscores the importance of considering social and environmental factors, alongside biological and psychological influences, in understanding and addressing EDs (4). Among environmental factors, childhood traumas have emerged as a critical area of focus, given their long-lasting impact on mental health (5, 6). Recent studies report varying prevalence rates of EDs, with lifetime prevalence ranging from 2.2% for men to 8.4% for women (7, 8). These rates vary by region, with higher point prevalence observed in America (4.6%) and Asia (3.5%) compared to Europe (2.2%), suggesting that eating disorders are highly prevalent worldwide, particularly among women, and that the incidence of these disorders has been increasing over time. The distribution of ED varies widely, with AN typically being more prevalent in clinical settings, particularly in inpatient facilities, while BN and BED are often more common in outpatient or community samples (9). The prevalence of each diagnosis is also influenced by factors such as gender, age, and geographical region (10).

Traumatic childhood experiences, including physical, emotional, and sexual abuse, as well as neglect and household dysfunction, have been extensively documented as significant risk factors for the development of various psychological disorders (11, 12). These early adversities disrupt the normal developmental trajectory, leading to maladaptive coping mechanisms and alterations in neurobiological stress response systems (13). Research has consistently shown that individuals with a history of childhood trauma are at a heightened risk for developing eating disorders, as these individuals may turn to disordered eating behaviors as a means to exert control, manage negative emotions, or dissociate from traumatic memories (14). Recently, various studies have suggested the possible presence of an echophenotype in individuals with eating disorders who have a history of trauma, indicating more severe clinical conditions and physical changes that constitute a different and specific manifestation of the disorder (15, 16).

Social support, a key element in the biopsychosocial model, plays a crucial role in mental health by providing emotional resources that help individuals manage stress and adversity (17). Supportive relationships can buffer the impact of trauma, fostering resilience and promoting healthier coping strategies (18, 19). Conversely, a lack of social support or experiences of social isolation can heighten vulnerability to psychological distress, intensifying the risk of developing or worsening symptoms of mental health conditions, including eating disorders (18, 20).

Loneliness and social isolation also play critical roles in eating disorders across diagnostic categories. Social isolation, defined as a lack of meaningful social interactions, is a frequent experience among individuals with eating disorders and can heighten the sense of disconnection from others (21). This is particularly relevant given that social withdrawal is common in ED populations, where shame and stigma surrounding eating behaviors may lead to avoidance of social situations (22, 23). Such isolation exacerbates feelings of loneliness—a perceived deficit in social connections—and has been associated with the maintenance and severity of eating disorder symptoms across various diagnoses, including AN, BN, and BED (24–26). In addition to the effects of childhood trauma, the role of loneliness as a mediation feature has gained increasing attention in the context of mental health outcomes, in different disorders and different contexts (27–29). Individuals who have experienced childhood trauma often report higher levels of loneliness, stemming from difficulties in forming and maintaining secure attachments and trusting relationships (30). This chronic sense of isolation and social disconnection can exacerbate the psychological distress associated with eating disorders, creating a vicious cycle that reinforces maladaptive eating behaviors (31). Furthermore, loneliness has recently been identified as a potential factor that may contribute to the worsening of physical conditions in people with eating disorders, calling for further investigations (24).

The intersection of childhood trauma, loneliness, and eating disorder psychopathology represents a compelling area for investigation. While the link between childhood trauma and EDs has been well-established (32), the mediating role of loneliness in this relationship remains underexplored. Understanding how loneliness mediates this relationship can provide crucial insights into the underlying mechanisms that contribute to the development and persistence of eating disorders. This knowledge can inform the design of targeted therapeutic interventions aimed at alleviating loneliness, thus potentially mitigating the impact of childhood trauma on the symptoms of eating disorders.

This study aims to explore the mediating effect of loneliness in the relationship between traumatic childhood experiences and eating disorder psychopathology. By employing a mediation analysis approach, we seek to elucidate the pathways through which early adverse experiences influence EDs symptoms, highlighting the critical role of loneliness. Our findings are expected to contribute to the growing body of literature regarding the etiology of eating disorders and offer practical implications for enhancing treatment strategies to address loneliness in individuals with a history of childhood trauma.

The sample consisted of 206 women (89.4%) and 24 men (10.6%). The mean age was 26.58 ± 11.82 years, with a mean BMI of 22.53 ± 12.02 kg/m², and an average duration of the disorder of 6.90 ± 8.02 years. Diagnoses within the sample included 99 individuals with restrictive anorexia nervosa (42.8%), 34 with binge-purge anorexia nervosa (14.7%), 36 with bulimia nervosa (15.3%), 47 with binge eating disorder (20.0%), and 14 with other specified feeding and eating disorders (6.2%). Most participants lived with their parents (n = 165, 71.7%), while fewer lived alone (n = 35, 15.2%) or with a partner (n = 30, 13.0%). Regarding employment status, the majority reported having a stable occupation (n = 84, 36.5%), a significant proportion were unemployed (n = 84, 36.5%), and 56 were students (24.3%). EDEQ global score was 4.12 ± 1.31, CTQ global score was 44.12 ± 17.97, and UCLA Loneliness score was 49.00 ± 12.16. See Table 1 for details.

The present study explored the mediating effect of loneliness on the relationship between traumatic childhood experiences and eating disorder psychopathology. The findings reveal that loneliness significantly mediates the relationship between childhood trauma and the severity of eating disorder symptoms. This has profound clinical implications, as it provides insights into the underlying mechanisms that contribute to the development and persistence of eating disorders and suggests avenues for targeted therapeutic interventions. Previous research has established a link between childhood trauma and eating disorders (4, 12), but the mediating role of loneliness has been underexplored. Our findings extend this understanding by demonstrating that loneliness significantly mediates this relationship.

This study addresses a critical gap in the literature by examining the mediating role of loneliness, providing a more nuanced understanding of how early adverse experiences can lead to disordered eating behaviors through the intermediary of social isolation. Indeed, loneliness is pointed out as a crucial element in the pathway from childhood trauma to eating disorder symptoms. This finding aligns with the theoretical framework that traumatic childhood experiences disrupt normal developmental trajectories, leading to maladaptive coping mechanisms and alterations in neurobiological stress response systems (39, 40). From a clinical perspective, this underscores the importance of addressing loneliness in therapeutic settings to disrupt this pathway. Otherwise, interventions might be not useful for the improvement of patients’ health.

Moreover, the mediating role of loneliness suggests that interventions aimed at reducing feelings of isolation and enhancing social connections could be effective in treating individuals with eating disorders who have a history of childhood trauma. In this perspective, Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT), which focus on improving social skills and building meaningful relationships, may be particularly beneficial (41–44). Also, specific remediation therapy interventions like Cognitive Remediation and Emotional Skills Training (CREST) might be considered an effective add-on treatment with these specific goals due to their efficacy in implementing specific interpersonal features (45).

The results corroborate recent studies that have identified loneliness as a significant factor in the worsening of physical and psychological conditions, including eating disorders (24, 31, 46). By empirically demonstrating the mediating role of loneliness, this study reinforces the importance of social connections in mental health and eating disorder psychopathology specifically (47, 48). We found evidence of partial mediation, supporting the idea that childhood maltreatment and loneliness have both combined and independent effects. However, the partial nature of these relationships suggests opportunities for future research to explore additional mediators and moderators. Factors such as resilience, social support, and coping strategies could be examined to provide a more comprehensive understanding of the complex interplay between childhood trauma, loneliness, and eating disorders. Longitudinal studies could also investigate the temporal dynamics of these relationships, offering further insights into causality and optimal intervention timing.

Finally, the findings emphasize the need for personalized treatment plans that take into account the patient’s history of childhood trauma and current levels of loneliness (49). Clinicians should consider incorporating assessments for loneliness and trauma history into their diagnostic process to identify patients who may benefit from targeted interventions aimed at improving social connections. This tailored approach can lead to more effective treatment outcomes. Indeed, there is growing evidence that both loneliness and traumatic events have specific disruptive effects on life trajectories, increasing both psychological and physical symptoms (50). From a preventive perspective, early interventions targeting loneliness in children who have experienced trauma have been reported to be effective in reducing the long-lasting negative effects on physical and mental health (51–53). This approach could also reduce the risk of developing eating disorders later in life (54, 55). School-based programs and family interventions that promote healthy attachment and social support could play a crucial role in preventing the onset of eating disorders among at-risk populations (55–57).

This study prioritized mediation analysis to explore the mechanisms underlying the relationships between childhood trauma, loneliness, and ED symptoms. The decision not to examine moderation was guided by our aim to identify potential indirect pathways rather than the interaction effects or conditions that might influence these relationships (58). However, investigating moderation could offer valuable insights into how individual differences or contextual factors, such as gender, cultural background, or severity of symptoms, might shape these associations (59)-all aspects that ED research needs (60). Future research should consider incorporating moderation analyses to provide a more comprehensive understanding of the complexity of these interactions.

This study underscores the significant mediating role of loneliness in the relationship between traumatic childhood experiences and eating disorder psychopathology. These findings highlight the importance of addressing loneliness in therapeutic interventions to mitigate the impact of childhood trauma on eating disorder symptoms. By advancing the understanding of the underlying mechanisms and suggesting targeted therapeutic approaches, this study contributes to the development of more effective and personalized treatment strategies. Additionally, it fills a critical gap in the literature and sets the stage for future research to further elucidate the complex relationships between childhood trauma, loneliness, and eating disorders.