Childhood abuse and disordered eating behaviors in female college students: how does depression and anxiety come from?

Childhood abuse and disordered eating behaviors in female college students: how does depression and anxiety come from? - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Search Log in Dashboard Publications Account settings Log out Search… Search NCBI Primary site navigation Search Logged in as: Dashboard Publications Account settings Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide PERMALINK Copy As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Eat Weight Disord . 2026 Mar 24;31(1):32. doi: 10.1007/s40519-026-01846-4 Search in PMC Search in PubMed View in NLM Catalog Add to search Childhood abuse and disordered eating behaviors in female college students: how does depression and anxiety come from? Huizi Li Huizi Li 1 School of Medicine, Nanjing University of Chinese Medicine, Nanjing, China Find articles by Huizi Li 1, # , Wenyue Han Wenyue Han 2 Changzhou Vocational Institute of Textile and Garment, Changzhou, China Find articles by Wenyue Han 2, # , Shaoshan Zhuang Shaoshan Zhuang 1 School of Medicine, Nanjing University of Chinese Medicine, Nanjing, China Find articles by Shaoshan Zhuang 1 , Jialong Xu Jialong Xu 1 School of Medicine, Nanjing University of Chinese Medicine, Nanjing, China Find articles by Jialong Xu 1 , YueYi Sun YueYi Sun 3 School of Elderly Care Services and Management, Nanjing University of Chinese Medicine, Nanjing, China Find articles by YueYi Sun 3, ✉ , Zheng Zheng Zheng Zheng 1 School of Medicine, Nanjing University of Chinese Medicine, Nanjing, China Find articles by Zheng Zheng 1, ✉ Author information Article notes Copyright and License information 1 School of Medicine, Nanjing University of Chinese Medicine, Nanjing, China 2 Changzhou Vocational Institute of Textile and Garment, Changzhou, China 3 School of Elderly Care Services and Management, Nanjing University of Chinese Medicine, Nanjing, China ✉ Corresponding author. # Contributed equally. Received 2024 Feb 15; Accepted 2026 Mar 17; Issue date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13083386  PMID: 41874866 Abstract Purpose This study examines the relationship among childhood abuse, disordered eating behaviors, depression, and anxiety in female college students. It also investigates the mediating role of disordered eating in the relationship between childhood abuse and depression, as well as anxiety. Methods 832 female college students were evaluated with the Hospital Anxiety and Depression Scale (HADS), Eating Disorder Inventory (EDI) and Personal Report of Childhood Abuse (PRCA). Results Depression and anxiety was significantly positively correlated with childhood abuse, physical abuse, emotional abuse, sexual abuse and neglect, and was significantly positively correlated with disordered eating. Disordered eating was significantly positively correlated with childhood maltreatment, physical maltreatment, emotional maltreatment and neglect. Disordered eating mediated the relationship between childhood abuse and depression, as well as between childhood abuse and anxiety. Conclusion Childhood abuse is positively associated with depression and anxiety, both directly and indirectly through the mediating effect of disordered eating. This provides a new perspective for interventions aimed at alleviating the symptoms of depression and anxiety in individuals with a history of childhood abuse. Keywords: Childhood abuse, Disordered eating, Depression, Anxiety Introduction Childhood abuse (CA) refers to harm inflicted by a caregiver or another individual during childhood, whether actual or potential. Behaviors such as emotional abuse, physical abuse, sexual abuse, and neglect are specific manifestations of it [ 1 ]. In the United States, approximately 38.1% of children are estimated to have encountered childhood abuse, including 18.1% who have experienced physical abuse, 23.9% who have experienced emotional abuse, and 18.4% who have been neglected [ 2 ]. The proportion of female victims is significantly higher than that of male victims [ 3 ]. The incidence of experiencing childhood abuse among undergrads in China is approximately 64% [ 4 ]. Childhood abuse can have detrimental effects on adolescent development, leading to internalizing and externalizing mental disorders in adolescence and adulthood [ 5 ], as well as substance abuse, unsafe sexual behaviors, sleep disturbances [ 6 ] and emotional disorders [ 7 ]. It is noteworthy that these consequences are not restricted to adolescence and may persist into adulthood. Depression and anxiety are common mental health concerns among contemporary college students. College students often feel anxiety or depression on account of the demands of academic work, social activities, and job hunting. Approximately 32% of undergraduates worldwide experience symptoms of depression and anxiety [ 8 ]. In China, approximately 6.9% of the population experiences depression at some point in their lifetime. Females are more likely to be affected, accounting for around 65% of cases [ 9 ]. The prevalence of depression among undergraduates can reach as high as 23.8% [ 10 ]. Among the Chinese undergraduate population, the incidence of anxiety disorders is approximately 21.51%. Medical students, in particular, have a high detection rate of anxiety disorders, reaching 30.8% [ 11 ]. As academic years progress, anxiety becomes more prevalent. Depression and anxiety can have numerous negative effects on undergrads, accordingly, it is essential to figure out the factors that lead to their development. Childhood abuse is widely recognized as a remarkable predictor of adulthood depression as well as anxiety [ 12 ]. Studies have laid out a significant association between adulthood depression, anxiety and childhood abuse [ 13 , 14 ], however, there are varying conclusions among researchers regarding the mechanism. Hou et al. conducted a study and discovered a greatly connection between childhood abuse and depression. This association may be mediated through passive automatic thoughts [ 15 ]. Schierholz suggests that incidences of childhood abuse are linked to multiple depressive symptoms [ 16 ]. Emotional dysregulation and disruption of close relationships jointly mediate the bonds between the depressive seriousness and childhood abuse experiences [ 16 ]. Li et al. investigated the connection between adulthood depression, anxiety and childhood abuse, focusing on malicious jealousy, and found that malicious jealousy exacerbates the implications of childhood abuse on both anxiety and depression [ 1 ]. Within the framework of emotion regulation theory, it is posited that childhood maltreatment impedes the acquisition of adaptive regulatory skills, thereby fostering enduring emotional management deficits [ 17 ]. Gross [ 18 ] further identifies emotional dysregulation as a critical antecedent to multiple psychopathologies, notably anxiety and depression. For individuals with trauma histories, the inability to effectively modulate negative affect—exacerbated by factors such as insufficient social support—significantly escalates the vulnerability to adult mental health disorders. Consequently, elucidating these underlying pathways is paramount for developing targeted clinical interventions. Disordered eating behavior (DEB) is often an early indicator of eating disorder [ 19 ], which is a prevalent issue on university campuses [ 20 ]. Obsessive focus on weight or body shape, overeating, binge eating, purging behaviors, and dieting behaviors are among the manifestations of eating disorders [ 21 ]. These behaviors vary in severity, and more severe consequences may lead to more serious clinical eating disorders [ 22 ]. Previous studies have confirmed that disordered eating behavior is closely related to anxiety and depression [ 23 , 24 ]. Additionally, disordered eating behavior has a longitudinal bidirectional effect on depression and anxiety [ 25 ]. Surveys have shown that more than 70% of adults diagnosed with an eating disorder also suffer from anxiety or depressive disorders [ 26 ]. Jung et al. found that eating disorder was frequently accompanied by a higher incidence of anxiety disorders, particularly when they manifest as binge eating behaviors [ 27 ]. Some researchers discovered that childhood abuse is significantly linked to atypical eating habits in adulthood [ 28 – 30 ]. Miskinyte et al. discovered that female college students who had underwent childhood abuse were inclined to arise abnormal eating behaviors, such as food restriction, than those who had not subjected to childhood abuse [ 31 ]. In a study carried out by Burns et al., it was discovered that childhood emotional abuse was a greatly predictive factor of disordered eating behaviors, specifically binge eating behavior, than childhood sexual or emotional abuse in a cohort of female college students [ 32 ]. Friedman et al. discovered that childhood physical and emotional abuse is a risky reason for the progress of binge eating problems in adulthood among women [ 33 ]. However, studies on the relationship between these factors are still limited, and controversy exists. This is also one of the starting points of this study. Based upon the framework of emotion regulation theory, we posit that childhood adversity impedes the establishment of adaptive affective modulation, thereby fostering adult emotion dysregulation. And this dysregulation would enhance vulnerability to anxiety and depression, with disordered eating functioning as a mediating pathway. Additionally, these affective disturbances may further degrade regulatory capacities of individuals, creating a self-perpetuating loop that solidifies maladaptive coping behaviors, including disordered eating. Given that the proportion of childhood abuse victims is much higher in girls than in boys [ 3 ], the present study focuses on female college students to investigate the interrelation between childhood abuse experience, depression, anxiety, and disordered eating behaviors. The incidence of these issues is also higher in women than in men. This study presents evidence and insights into the symptoms of anxiety and depression experienced by female college students. Materials and methods Participants Using the principle of convenience sampling, a multi-stage sampling method was employed with classes as the unit. From April 2018 to June 2020, 850 questionnaires were distributed to female college students from seven universities in Nanjing. The trained master test was administered to the subjects in groups. The test lasted for 30 min and had unified instructions. We collected 832 valid questionnaires on the spot, resulting in a valid recovery rate of 97.88%. Measures The Hospital Anxiety and Depression Scale (HADS). It is compiled by Zigmond et al. in 1983. This measurement tool comprises of two subscales, each composing of 7 items rated on a 4-point Likert scale. Scores are calculated by summing the ratings for all 14 items. In our present study, the original author's criteria were applied. The two subscales are grouped based on the scores: 0–7 indicates no symptoms, 8–10 indicates possible symptoms, and 11–21 indicates definite symptoms. The Cronbach’s α was 0.70 for the depression subscale and 0.734 for the anxiety subscale [ 34 ]. The Eating Disorder Inventory Scale (EDI). It is compiled by Garner et al. in 1983. It consists of 64 items rated on a 6-point Likert scale and the scores range from 1 to 6. The severity of the problem increases with a higher score [ 35 ]. The Chinese version of this scale was translated by Li Cheng of the Chinese University of Hong Kong using the double-blind translation method, and it also has high validity and reliability in Hong Kong and mainland China [ 36 ]. The full scale had a Cronbach’s α of 0.909. The Personal Report of Childhood Abuse Self-Assessment Scale (PRCA) . It is developed by Zhu et al. in 2006 based on the WHO definition and the theory of Mash EJ et al. It was mainly used to assess the degree of severity of parental maltreatment suffered by the subjects during childhood. The scale contains 20 entries, including four subscales of emotional abuse, physical abuse, sexual abuse, and neglect, each of which rates the frequency of abusive behaviors and the degree of harm, and is scored on a 5-point Likert scale, with higher subscale scores and scale totals indicating that the subject was more severely childhood abused [ 37 ]. The full scale had a Cronbach’s α of 0.871 in our present study. Statistical analyses The data from our study underwent statistical processing using SPSS version 22.0 and Amos version 24.0.Statistical significance level for each statistical analysis was set at p < 0.05. Spearman correlation analysis was utilized to investigate the correlation between childhood abuse, disordered eating behaviors, anxiety and depression. Kruskal–Wallis analysis was applied to compare the scores of childhood abuse among different depression and anxiety groups. Amos 24.0 was used to construct the mediating effect models of disordered eating behaviors between childhood abuse and depression or anxiety. Results Sociodemographic information Further information is reported in Table 1 . Table 1. Demographic characteristics of participants ( N = 832) M (SD) n (%) Age 21.35 (1.24) Major HADS-D 4.94 (3.13) Pharmacy 331 (39.8%) HADS-A 6.62 (3.11) Science 166 (20.0%) EDI 41.47(21.44) Art 85 (10.2%) EDI-DT 4.39(4.52) Economics 13 (1.6%) EDI-B 10.54(6.55) Engineering 28 (3.4%) EDI-BD 1.99(2.89) Education 119 (14.3) EDI-P 4.98(3.52) Literary 14 (1.7%) EDI-IE 3.39(3.19) Management 76 (9.1%) EDI-ID 7.78(4.29) Origin of student EDI-IA 4.13(4.39) Town 506 (60.8%) EDI-MF 4.27(4.29) Rural 325 (39.1%) PRCA 2.47 (4.67) PRCA-PA 0.49(1.24) PRCA-EA 1.29(2.65) PRCA-SA 0.02(0.17) PRCA-Neglect 0.62(1.33) Open in a new tab HADS-D : Hospital Anxiety and Depression Scale-Depression; HADS-D : Hospital Anxiety and Depression Scale-Anxiety; EDI : Eating Disorder Inventory; DT : drive for thinness; B : bulimia; BD : body dissatisfaction; P : perfectionism; IE : ineffectiveness; ID : interpersonal distrust; IA : interoceptive awareness; MF : maturity fears; PRCA : Personal Report of Childhood Abuse; PA : Physical abuse; EA : emotional abuse; SA : sexual abuse Correlation analysis of depression, anxiety, disordered eating and childhood maltreatment Correlation analyses were conducted to correlate the scale scores for the variables of childhood abuse, disordered eating behaviors, anxiety, and depression. Correlations among study variables are presented in Table 2 . Depression and anxiety were significantly associated with childhood abuse and all its subtypes: physical, emotional, and sexual abuse, and neglect ( r = 0.228, 0.154, 0.205, 0.101, 0.220, all p < 0.01). Disordered eating behavior was positively correlated with childhood abuse, physical abuse, emotional abuse, and neglect ( r = 0.203, 0.181, 0.176, 0.166; all p < 0.01), but not sexual abuse ( r = 0.042, p > 0.05). Furthermore, disordered eating behaviors showed significant correlations with depression ( r = 0.406, p < 0.01) and anxiety ( r = 0.449, p < 0.01). Table 2. Bivariate correlations for all measures 1 2 3 4 5 6 7 8 1.PRCA 1 2.PA 0.800 ** 1 3.EA 0.950 ** 0.693 ** 1 4.SA 0.227 ** 0.201 ** 0.144 ** 1 5.Neglect 0.753 ** 0.422 ** 0.591 ** 0.194 ** 1 6.EDI 0.203 ** 0.181 ** 0.176 ** 0.042 0.166 ** 1 7.HADS-D 0.228 ** 0.154 ** 0.205 ** 0.101 ** 0.220 ** 0.406 ** 1 8.HADS-A 0.242 ** 0.173 ** 0.229 ** 0.113 ** 0.195 ** 0.449 ** 0.608 ** 1 Open in a new tab PRCA: Personal Report of Childhood Abuse; PA: Physical abuse; EA: emotional abuse; SA: sexual abuse. EDI: Eating Disorder Inventory; HADS-D: Hospital Anxiety and Depression Scale-Depression; HADS-D: Hospital Anxiety and Depression Scale-Anxiety ** p < 0.01 The difference of CA in groups with different levels of depression and anxiety The subjects were categorized into three groups, the asymptomatic group, the group with suspected presence of symptoms, and the group with definite presence of symptoms, according to the division criteria in the previous section. Non-parametric tests showed that there were notable differences between subjects in the different depressive symptom groups on the total childhood abuse experience score, the emotional abuse and neglect subscale ( χ 2 = 26.274, 24.762, 24.066, p < 0.001), and the sexual abuse subscale ( χ 2 = 8.651, p < 0.05), while there were no significant differences on the physical abuse subscale. The results are shown in Table 3 .There were notable differences between subjects in different anxiety symptom groups on the total childhood abuse experience score, physical abuse, emotional abuse, and neglect subscales, and on the sexual abuse subscale ( χ 2 = 58.303, 24.749, 57.982, 46.696, p < 0.001), while no notable differences were found on the sexual abuse subscale. The results are shown in Table 4 . Table 3. The difference of childhood abuse among the three groups( n = 832) A( n = 667) B( n = 117) C( n = 48) χ 2 PRCA 2.01 ± 4.11 3.97 ± 6.02 5.51 ± 6.45 26.274 *** PA 0.43 ± 1.16 0.59 ± 1.20 1.08 ± 2.06 5.538 EA 1.04 ± 2.31 2.10 ± 3.56 2.74 ± 3.56 24.762 *** SA 0.01 ± 0.11 0.06 ± 0.31 0.06 ± 0.32 8.651 * Neglect 0.49 ± 1.13 1.15 ± 1.87 1.18 ± 1.79 24.066 *** Open in a new tab A, asymptomatic with depression; B, suspected depression; C, definitely symptomatic with depression PRCA: Personal Report of Childhood Abuse; PA: Physical abuse; EA: emotional abuse; SA: sexual abuse. *** p < 0.001, * p < 0.05 Table 4. The difference of childhood abuse among the three groups( n = 832) D( n = 534) E( n = 210) F( n = 88) χ 2 PRCA 1.75 ± 4.06 2.91 ± 4.35 5.74 ± 6.89 58.303 *** PA 0.38 ± 1.09 0.54 ± 1.19 1.09 ± 1.85 24.749 *** EA 0.88 ± 2.23 1.63 ± 2.53 2.97 ± 4.13 57.982 *** SA 0.01 ± 0.14 0.01 ± 0.97 0.07 ± 0.37 3.407 Neglect 0.46 ± 1.16 0.67 ± 1.22 1.51 ± 2.02 46.696 *** Open in a new tab A, asymptomatic with anxiety; B, suspected anxiety; C, definitely symptomatic with anxiety PRCA: Personal Report of Childhood Abuse; PA: Physical abuse; EA: emotional abuse; SA: sexual abuse *** p < 0.001 Post hoc comparisons of the no-depressive symptoms group, the group with suspected presence of depression, and the group with definite presence of depression showed significant differences between the non-depression group and the group with suspected presence of depression ( p < 0.01) and the group with definite presence of depression ( p < 0.001) on the PRCA, EA, and Neglect Subscale, whereas no remarkable differences were found between the group with suspected presence of depression and the group with definite presence of depression. No notable differences were found between the group with suspected presence of depression and the group with definite presence of depression. On the SA subscale, the difference in scores between any two groups was not significant. Post hoc comparisons of the anxiety-free, anxiety-suspect, and anxiety-affirmative groups revealed significant differences in scores between any two groups on the PRCA and EA subscales ( p < 0.001), on the PA subscale, there was a significant difference between the anxiety-affirmative group and the anxiety-free group ( p < 0.001) and anxiety-suspect group ( p < 0.01). On the neglect subscale, there was a significant difference between the anxiety-affirmative group and the anxiety-free group ( p < 0.01) and the anxiety-suspect group ( p < 0.05). The mediating role of disordered eating behaviors Childhood abuse was used as the independent variable (with physical abuse, emotional abuse, sexual abuse, and neglect as observed variables), depression as the dependent variable, and disordered eating as the mediating variable. The results showed that the model had excellent fit indices ( χ 2 /df = 2.783, GFI = 0.972, NFI = 0.935, IFI = 0.957, CFI = 0.957, RMSEA = 0.046). And it was also found that disordered eating behavior predicted depression ( β = 0.43, p < 0.001), while childhood abuse predicted disordered eating ( β = 0.20, p < 0.001) and depression ( β = 0.17, p < 0.001) in this study. The mediating role of disordered eating behavior between childhood abuse and depression is shown in Fig. 1 . Fig. 1. Open in a new tab The mediating role of disordered eating between childhood abuse and depression. CA, Childhood Abuse; PA, Physical abuse; EA, emotional abuse; SA, sexual abuse. DEB, Disordered Eating Behavior Childhood abuse was used as the independent variable (with physical abuse, emotional abuse, sexual abuse, and neglect as observed variables), anxiety as the dependent variable, and disordered eating as the mediator. The results showed that all the fit indices of the model were excellent ( χ 2 /df = 2.422, GFI = 0.972, NFI = 0.945, IFI = 0.967, CFI = 0.967, RMSEA = 0.046). Disordered eating behavior was significantly associated with anxiety ( β = 0.48, p < 0.001), while childhood abuse predicted disordered eating ( β = 0.20, p < 0.001) and anxiety ( β = 0.20, p < 0.001). Path coefficients are detailed in in Table 5 . The mediating role of disordered eating behavior between childhood abuse and anxiety is shown in Fig. 2 . Table 5. Path results of the research model Pathways Std SE P Model 1 CA → DEB 0.20 0.954 < 0.001 CA → Depression 0.17 0.011 < 0.001 DEB → Depression 0.43 0.001 < 0.001 Model 2 CA → DEB 0.20 0.955 < 0.001 CA → Anxiety 0.20 0.015 < 0.001 DEB → Anxiety 0.48 0.001 < 0.001 Open in a new tab CA: Childhood Abuse; DEB: Disordered Eating Behavior Fig. 2. Open in a new tab The mediating role of disordered eating between childhood abuse and anxiety. CA, Childhood Abuse; PA, Physical abuse; EA, emotional abuse; SA, sexual abuse. DEB, Disordered Eating Behavior In our study, Bootstrap method was used to test the significance of the mediating role of disordered eating behavior. 5,000 bootstraps from the original data were carried out, and determined that disordered eating behavior mediated the relationship between the impact of childhood maltreatment on depression [95% CI (0.109, 0.321)] and anxiety [95% CI (0.020,0.043)]. These findings confirm the association between childhood abuse and affective symptoms, while establishing disordered eating behaviors as a significant mediator for both anxiety and depression. Path coefficients are detailed in Table 6 . Table 6. Standardized indirect effects and 95% confidence intervals Estimate SE LLCI ULCI Model 1 Indirect effect 0.087 0.022 0.049 0.138 Direct effect 0.167 0.055 0.066 0.278 Total effect 0.254 0.058 0.139 0.368 Model 2 Indirect effect 0.036 0.009 0.021 0.060 Direct effect 0.076 0.020 0.043 0.123 Total effect 0.112 0.023 0.075 0.167 Open in a new tab Discussion The destination of this study was to investigate the correlation between childhood abuse, disordered eating behaviors, depression, and anxiety among female college students. Additionally, the study aimed to identify the mechanisms by which childhood abuse contributes to adulthood anxiety and depression. This study may offer novel intervention strategies for preventing and treating depression and anxiety symptoms in female undergrads who have been subjected to childhood abuse. Consistent with prior research, we also discovered a strong correlation between childhood abuse and adulthood depression as well as anxiety [ 38 – 41 ]. These adverse childhood events may have a long-lasting negative impact on individuals later in life. Individuals who suffered from childhood abuse are more likely to develop feelings of loss and insecurity, and may lack of the sense of self-identity, greatly increasing the risk of depression. These experiences can further deteriorate an individual's sense of self-esteem and cause symptoms of anxiety, particularly social anxiety [ 42 ]. At the same time, multiple experiences of abuse are often present in maltreated children [ 43 ], which further perpetuates the function of maltreatment on their healthy growth, makes it difficult to intervene clinically. Childhood abuse is associated with various psychological factors that can lead to depression and anxiety in adulthood. Identifying easy-to-intervene mediators can be helpful in improving emotional well-being in individuals who have subjected to childhood abuse. Despite statistical significance, the cross-sectional design precludes causal inferences, limiting our conclusions to associations. These exploratory findings warrant cautious generalization. Future research utilizing longitudinal designs and diverse samples is essential to elucidate the temporal dynamics of these relationships. Second, we discovered that there is a remarkable association between childhood abuse and eating disordered behavior in adulthood, which is essentially the same point that previous researchers have made. For example, Armour et al. surveyed 4,206 British women in 2016 and found that childhood maltreatment had significantly relevance to disordered eating behavior [ 44 ]. Strodl et al.'s 2020 survey of 819 adults showed that childhood maltreatment was remarkably associated with eating disorder symptoms in adulthood, with more childhood abuse experiences predicting more eating disorder symptom [ 45 ]. This could mean that disordered eating behavior may be a coping mechanism for childhood abuse, i.e., the tendency of children to disordered eating to cope with the severe physical and psychological effects of abuse persists into adulthood. Third, although the remarkable associations between depression, anxiety and childhood sexual abuse experiences have been found in previous studies [ 46 – 48 ], the present study did not find a significant correlation between disordered eating behaviors and childhood sexual abuse. Exclusive reliance on retrospective self-reports renders the data susceptible to recall, social desirability, and underreporting biases, particularly regarding sensitive topics like sexual abuse. Evidence suggests that females often resist labeling such experiences as ‘abuse’or deny victimization [ 49 ]; consequently, our statistical outcomes may reflect this reticence to disclose. Additionally, due to the limitations of the empirical instrument, the questionnaire questions may have missed some type of childhood sexual abuse experienced by participants, which may have been a form of trauma not considered. Findings warrant cautious interpretation, as they may not fully encapsulate participant realities. Future studies should incorporate multi-method assessments, such as clinical interviews, to mitigate the inherent biases of self-report measures. Finally, an interesting result is that the present study found a noteworthy mediating role for disordered eating behaviors in both the correlation between childhood abuse and depression as well as anxiety. Previous researches have mostly pointed to the mediating role of anxiety and depression between disordered eating phenomena and childhood abuse. Romans et al. probed into the correlation between disordered eating phenomena and childhood abuse in women and found that childhood abuse primarily mediated eating disorder symptoms in women through depression and anxiety [ 50 ]. In a research study of 588 female college students, Hund found that there was a tendency to believe that the association between childhood abuse and eating disorders could be mediated through narrative disorders, depression, and anxiety [ 51 ]. Although specific EDI subscales were not analyzed, distinct dimensions likely exert differential mediating effects on psychological outcomes. Prior evidence [ 52 , 53 ] suggests bulimia is particularly salient for depression, whereas drive for thinness correlates more strongly with anxiety. Future research utilizing longitudinal approaches or subscale-specific scrutiny is warranted to elucidate these mechanisms and optimize clinical interventions. Research has shown that children who have experienced childhood abuse often lack the ability to self-soothe negative emotions. As a result, they may perceive depression and anxiety as overwhelming or uncontrollable [ 45 ]. It is possible that, without adaptive coping strategies or social support, individuals may regulate negative emotions through the symptoms of eating disorders, which is a more primitive method. The study conducted by O'Loghlen et al. found a conspicuous association between childhood abuse and disordered eating behaviors [ 54 ]. In contrast, Lian et al. noted a significant interaction between depression and anorexia nervosa. Depression may cause anorexia nervosa, which in turn exacerbates depressive symptoms [ 55 ]. Childhood abuse has an impact on eating behavior, and frequent binge eating can worsen anxiety symptoms. Based on the present study, it appears that there may be a cyclical relationship between childhood abuse, disordered eating, and depression or anxiety. Eating disorder symptoms may be a coping mechanism for individuals who have experienced childhood abuse. Therefore, childhood abuse experiences may be closely related to eating disorder symptoms. Additionally, frequent eating disorders can exacerbate passive emotions such as anxiety or depression, which can further perpetuate an individual's reliance on eating disorder symptoms as a coping mechanism. In summary, it is possible that anxiety, depression and disordered eating behaviors may influence each other, creating a cycle for coping with real-life conflicts in a group of people who have been suffered from childhood abuse. This study confirms the strong correlation between childhood abuse, depression, anxiety, and disordered eating behavior. The experience of childhood abuse is suggested to be a crucial factor in an individual's healthy growth, significantly affecting future disordered eating behavior, as well as passive emotions. Childhood abuse experiences can cause serious physical and psychological damage, and this is something that needs to be looked at [ 56 ]. However, it is crucial to maintain objectivity and avoid subjective evaluations. Disordered eating behaviors and negative emotions can mediate these negative effects. Research indicates that addressing anxiety and depression, may help reduce the impact of childhood abuse on disordered eating behavior. The present study suggests that targeting disordered eating behavior directly may have a similar effect. Due to the high incidence of disordered eating behaviors among female college students [ 57 ], this study offers new ideas for mental and physical health interventions for those with experiences of childhood abuse, especially those with disordered eating behaviors and negative emotions such as depression or anxiety. This study is constrained by a convenience sampling approach limited to university students in Nanjing, China, and the absence of a comparison cohort. These factors restrict the generalizability of our findings, as cultural, regional, and educational specificities may hinder applicability to broader demographics, including non-students and other genders. Future investigations are advised to adopt diversified, multi-cultural sampling to bolster external validity and examine cross-contextual variations, thereby providing a holistic perspective on the subject. We acknowledge that several unassessed covariates—including body mass index, socioeconomic status [ 58 ], psychiatric history [ 59 ], and ongoing psychological treatment—could confound the observed associations. Consequently, future investigations should prioritize broader geographic sampling and the rigorous adjustment for such confounders to optimize both internal and external validity. Clinical implications This investigation elucidates a robust correlation between childhood maltreatment and adult anxiety and depression, mediated by disordered eating behaviors. Specifically, early adversity appears to precipitate maladaptive eating patterns, which subsequently intensify affective symptomatology. Given the pivotal developmental stage of female university students, these findings offer critical empirical support for the design of precision-targeted interventions. Given the heightened vulnerability of female students with histories of childhood maltreatment to disordered eating, prioritizing early identification and intervention is paramount. Timely management of these behaviors is critical for mitigating the risks of anxiety and depression, thereby fostering enduring psychological well-being. University mental health initiatives must urgently prioritize disordered eating among female students. Delivering tailored resources is critical for mitigating risks in survivors of childhood abuse, a demographic facing significant clinical vulnerability. What is already known on this subject? Research suggests that exposure to childhood abuse is associated with disordered eating, depression and anxiety in adulthood. Indeed, there are differing opinions on the intermediary mechanisms at play. What this study adds Childhood abuse can is positively associated with  depression and anxiety, both directly and indirectly through the mediating effect of disordered eating behavior. This provides a new perspective for interventions aimed at alleviating the symptoms of depression and anxiety in individuals with a history of childhood abuse. Author contributions All authors contributed to the study conception and design. Material preparation, data collection were performed by Wenyue Han and Zheng zheng. Huizi Li analyzed data, and drafted the manuscript. Zheng Zheng and Yueyi Sun was responsible for manuscript revision. Shaoshan Zhuang and Jialong Xu provided suggestions for revision. All authors agreed on the fnal version of the manuscript and approved the submission on Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity. Funding This study was supported by "14th Five-Year Plan" for Education Science of Jiangsu Province in 2021 (B/2021/01/34), Project of Philosophy and Social Science Research in Colleges and Universities of Jiangsu Province (2019SJA0315; 2023SJYB0329). Data availability The datas analyzed during the current study are available from the corresponding author upon reasonable request． Declarations Ethics approval and consent to participate This study involving human participants were reviewed and approved by the Ethics Committee of The Affiliated Hospital of Nanjing University of Chinese Medicine (registration number: 2022NL-134–02). Informed consent Written informed consent was obtained before participants who joined the study, and all participants signed consent on data publishing. The welfare of animals Not applicable. Competing interests The authors declare no competing interests. Footnotes Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Huizi Li and Wenyue Han equally to this work and should be considered co-first authors. Contributor Information YueYi Sun, Email: [email protected]. Zheng Zheng, Email: [email protected], Email: [email protected]. References 1. Li X, Tu L, Jiang X (2022) Childhood maltreatment affects depression and anxiety: the mediating role of benign envy and malicious envy. Front Psychiatry 13:924795. 10.3389/fpsyt.2022.924795 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 2. Finkelhor D, Turner HA, Shattuck A, Hamby SL (2015) Prevalence of childhood exposure to violence, crime, and abuse: results from the National Survey of Children’s Exposure to Violence. JAMA Pediatr 169(8):746–754. 10.1001/jamapediatrics.2015.0676 [ DOI ] [ PubMed ] [ Google Scholar ] 3. 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