The relationship between childhood maltreatment and later disordered eating behaviors among the Tunisian population: mediating role of emotion dysregulation.

Background and aims : Eating disorders (EDs) are a major public health problem, due to their serious psychological, somatic, and social consequences. Previous studies have extensively documented the role of childhood maltreatment (CM) in the development of EDs. Some authors suggest that emotion dysregulation plays a mediating role in this relationship. This study aimed to examine the association between CM and EDs in the Tunisian population, by considering emotion dysregulation as a mediator. Methods: We conducted a cross-sectional, descriptive, analytical, and mediational study among members of Facebook groups using an online questionnaire from February 17, 2023, to May 26, 2023. The Eating Attitude Test (EAT-26) was used to assess the risk of developing EDs. Emotion dysregulation and CM were assessed via the "Difficulties in Emotion Regulation Scale" (DERS) and the “Childhood Trauma Questionnaire” (CTQ), respectively. Results: According to our bivariate analysis, EDs were associated with younger age (p<0,001), female gender (p<0,001), unmarried status (p=0,001), low socioeconomic status (p=0,002), high education level (p<0.001), psychiatric history (p<0,001), physical activity (p=0,038), greater difficulty in emotion regulation (p<0,001) and higher levels of CM (p<0,001). According to the multivariate analysis, female gender (p= 0,006), psychiatric history (p<0,001), and greater emotion dysregulation (p= 0.001) were significantly associated with a greater risk of EDs. Mediation analysis revealed that emotion dysregulation fully mediated the relationship between CM and EDs among the general Tunisian population. Conclusion: Our findings align with previous research findings suggesting a relationship between CM and EDs and confirming the role of emotion dysregulation as a mediator. This underlines the importance of preventing and early detecting CM, particularly in schools. Moreover, in the context of treating EDs, emotion regulation appears to be an important psychotherapeutic target.