Adverse Childhood Experiences and Depression, Anxiety, and Eating Disorders: The Mediating Role of Intolerance of Uncertainty and Emotion Regulation Difficulty

Adverse childhood experiences (ACEs) have been associated with an array of psychological disorders, and research into the processes that underpin this relationship has the potential to inform intervention and prevention strategies. Three forms of psychopathology that are associated with ACEs are depression, anxiety, and eating disorders. These conditions are also highly comorbid with each other, and two transdiagnostic processes-intolerance of uncertainty (IoU) and emotion regulation (ER) difficulty-have been demonstrated to partly explain this comorbidity. The present study investigated whether IoU, ER difficulty, and the relationship between these processes, may also explain the associations between ACEs and symptoms of depression, anxiety, and eating disorders. A mediation model was proposed whereby ACEs were indirectly related to symptoms of depression, anxiety, and eating disorders via IoU, ER difficulty, and a serial pathway (IoU ? ER). A cross-sectional design was applied with a mixed community and clinical sample of 1,024. Self-report measures were completed online for ACEs, IoU, ER difficulty, and symptoms of depression, anxiety, and eating disorders. Significant mediating effects were identified for IoU, ER difficulty, and the serial pathway (IoU ? ER) in the relationships between ACEs and psychological symptoms. Findings suggest that the indirect and serial effects of IoU and ER difficulties are important in understanding the relationship between ACEs and depression, anxiety and eating disorder symptoms. Transdiagnostic cognitive interventions targeting IoU and ER may be beneficial in reducing the effects of ACEs on comorbid depression, anxiety, and eating disorder symptoms in adulthood.