This study examined the links among child maltreatment (i.e., child sexual abuse, child physical abuse, child emotional abuse, and child neglect), eating disorder symptoms, problematic use of drugs and alcohol, coping strategies, and emotion regulation in women. This study also examined coping strategies and emotion regulation as potential moderators of the links among child maltreatment, eating disorder symptoms, and problematic substance use. Maltreatment in childhood is linked with numerous adverse outcomes across the lifespan. For instance, the development of maladaptive coping styles, poor emotion regulation, substance use problems, and eating disorders all are linked to a history of child maltreatment, but how these factors interact has yet to be investigated. These constructs were examined through hierarchical multiple regressions in a sample of 383 women age 19 or older, recruited online. Results indicated that women who experienced greater overall child maltreatment engaged in more problematic drug use and more problematic alcohol use and women with child sexual abuse (CSA) engaged in greater levels of problematic drug use. Avoidance coping was associated with greater levels of problematic drug use, dieting, bulimia and food preoccupation, and overall eating disorder symptoms. Women with more severe eating disorder symptoms and who used greater expressive suppression, also engaged in more problematic alcohol use. When considered together, all forms of child maltreatment were associated with greater avoidance and problematic drug and alcohol use, CSA survivors used less avoidance and expressive suppression, and child neglect (CN) survivors used more avoidance and expressive suppression. These findings suggest that health care professionals working with women survivors of child maltreatment should be aware of increased risk of developing substance use problems as well as less effective coping and emotion regulation strategies that may be stemming from victimization experiences. In addition, it may be helpful for clinicians working with women with eating disorders or problematic substance use to focus on improving coping and emotion regulation skills. / Graduate

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Despite well-established diagnostic measures and measures of specific dimensions of eating disorder symptomatology, little work has been done to develop a brief, comprehensive, and valid measure for assessing change in eating disorder symptoms. Further, empirically-supported change indices to assess treatment progression and outcome have not yet been developed. The Change in Eating Disorder Symptoms Scale (CHEDS) is a new comprehensive measure designed to assess progress and change during treatment in persons with diagnoses on the eating disorder spectrum. Previous studies have demonstrated the subscale structure, reliability, and validity of the CHEDS. This study determined clinically significant change criteria for the CHEDS to complement the studies that have supported the CHEDS as a reliable and valid measure of eating disorder symptomatology. The CHEDS was also compared to a life functioning scale, the Clinical Impairment Assessment. A reliable change index (RCI) was developed, which generated an inferential statistic that estimates the magnitude of change in a score necessary for a change score to be considered statistically reliable. A cutscore was also developed, which differentiates between functional and dysfunctional populations, between eating disordered clinical subjects and non-clinical subjects. Trajectories were identified using hierarchical linear modeling methods for use in conjunction with clinical significance criteria to aid in the tracking of symptoms during treatment, treatment decision-making, and tailoring treatment according to expected and observed progress. The clinical significance change criteria were then applied to the clinical sample to determine change patterns descriptive of recovered, reliable improvement, deterioration, and no change. Finally, a scoring program with clinical significance change criteria and trajectory analyses for total and subscale scores was developed.