Childhood traumatic experiences and addiction-like eating behaviors: the mediating roles of attachment, mentalization, and emotional eating

Introduction: Childhood traumatic experiences (CTEs) represent a significant vulnerability factor for addiction-like eating behaviors, yet the underlying developmental pathways remain poorly understood. According to infancy research and attachment theory, this study tested a comprehensive mediation model examining how CTEs contribute to addiction-like eating patterns (i.e., appetite drive and low diet control) through attachment insecurity, impaired reflective functioning, and emotional eating. Method: A cross-sectional study was conducted on a conventional non-clinical sample 1,014 Italian adults. Participants completed a set of validated and standardized scales. Structural equation modeling with latent variables and bootstrap resampling (10,000 iterations) was employed to test the hypothesized model. Results: The model demonstrated adequate fit and supported all hypotheses. CTEs significantly predicted both attachment anxiety, attachment avoidance, and impaired reflective functioning. Attachment anxiety, but not avoidance, mediated the relationship between CTEs and impaired reflective functioning. Also, impaired reflective functioning significantly predicted emotional eating, which in turn predicted both appetite drive and low dietary control. The complete mediation pathway was statistically significant, explaining 53.5% of variance in appetite drive and 20.6% in dietary control. Discussion: These findings provide the first empirical support for a trauma-based developmental model of addiction-like eating behaviors. The results highlight the central role of attachment anxiety and impaired reflective functioning in linking early relational trauma to emotional eating and food addiction-like patterns. Clinical implications suggest that mentalization-based interventions targeting attachment insecurity and emotion regulation may be particularly beneficial for individuals with trauma histories and problematic eating behaviors.