Abstract: Objective Sexual abuse is associated with eating disorders (EDs) severity. However, the psychological mediators of this association have received scant attention in the literature. Method The present study aimed to evaluate the mediating role of psychological maladjustment, alexithymia, and self-esteem in the relationship between sexual abuse and EDs severity in a sample of 134 treatment-naïve patients with an EDs and 129 paired healthy controls. Results In the EDs group, EDs severity among participants who had been sexually abused was mediated by greater psychological maladjustment and alexithymia (indirect effects: ? = 12.55, 95% CI [6.11?19.87] p < 0.001; ? = 3.22, 95% CI [0.235?7.97] p < 0.05, respectively). By contrast, these variables had no significant mediating effect on EDs severity in the control group. Discussion These findings support the hypothesis of a disorder-related relationship between sexual abuse and alexithymia and psychological maladjustment, which, in turn, influences EDs severity. Alexithymia and psychological maladjustment appear to be promising therapeutic targets for patients with EDs who have a history of sexual abuse

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