Objective: Traumatic events, posttraumatic stress disorder (PTSD) and related symptoms are commonly associated with eating disorders (ED). Several clinical features indicative of a more severe and complex course have been associated with traumatized ED patients, especially those with PTSD, who may be more likely admitted to residential treatment (RT). Research in this population is sparse but of increasing interest. Method: Adult participants (96.7% female) with EDs entering RT (n = 642) at seven sites in the U.S. completed validated self-report assessments of ED, PTSD, major depression, state-trait anxiety, and quality of life. Presumptive diagnoses of DSM-5 PTSD (PTSD+) were made via the Life Events Checklist-5 and the PTSD Symptom Checklist for DSM-5. Results: PTSD+ occurred in 49.3% of patients. PTSD+ patients had significantly higher scores on all assessment measures (p ≤ .001), including measures of ED psychopathology, depression, state-trait anxiety, and quality of life. Those with PTSD+ had significantly higher numbers of lifetime traumatic event types, higher rates of almost all lifetime traumatic events, and a greater propensity toward binge-type EDs. Discussion: Results confirm that ED-PTSD+ patients in RT are more symptomatic and have worse quality of life than ED patients without PTSD+. Integrated treatment approaches that effectively address ED-PTSD+ are greatly needed.

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Objective Past traumatic events, subsequent posttraumatic stress disorder (PTSD) and related psychiatric comorbidities are commonly associated with eating disorders (EDs) in adults but remain understudied in adolescents. Methods Adolescent participants (mean [SD] age = 15.1 ± 1.5 years, 96.5% female) with EDs entering residential treatment (n = 647) at six sites in the United States completed validated self‐report assessments of ED, PTSD, major depression, anxiety disorders and quality of life. Provisional DSM‐5 PTSD diagnoses (PTSD+) were made via the Childhood Trauma Questionnaire, admission interviews and the PTSD Symptom Checklist for DSM‐5. Results PTSD+ occurred in 35.4% of participants, and those with ED‐PTSD+ had significantly higher scores on all assessments (p ≤ 0.001), including measures of ED psychopathology, major depression, anxiety disorders and quality of life, as well as significantly higher rates of all forms of childhood trauma. Those with PTSD+ also exhibited a significantly higher percent median body mass index for age and sex and a lower propensity toward anorexia nervosa, restricting type. Conclusions Results confirm that adolescent patients in residential treatment with ED‐PTSD+ are more symptomatic and have worse quality of life than their ED counterparts without PTSD. Integrated treatment approaches that effectively address ED‐PTSD+ are greatly needed in ED programs that treat adolescents.

Objective: Age of eating disorder (ED) onset has been of significant interest to both researchers and clinicians. The identification of factors associated with early or child onset has important prevention and treatment implications. The presence of prior trauma, resultant posttraumatic stress disorder (PTSD), ED severity, and comorbid psychopathology are of particular relevance to age of ED onset, but data are limited. Methods: Adults (≥18 years, 93% female, total n = 1283) admitted to residential ED treatment self-reported age of ED onset. Patients were divided into child onset (ages 5-10 years), adolescent onset (11-17 years), and adult onset (≥18 years) groups and compared on a number of clinical features and assessment measures. Results:The child onset group had significantly higher rates and doses of traumatic life events; higher current PTSD prevalence; higher BMIs, higher severity of ED, depression and state-trait anxiety symptoms; worse quality of life; and more prior inpatient and residential admissions for ED treatment, in comparison to both the adolescent and adult onset groups. Similarly, the adolescent onset group had significantly higher rates than the adult onset group. Conclusions: These results have important implications for prevention, treatment and long-term follow-up and highlight the need for early traumafocussed treatment of ED patients.

Introduction We studied whether provisional posttraumatic stress disorder (PTSD) moderated discharge (DC) and 6-month follow-up (FU) outcomes of multi-modal, integrated eating disorder (ED) residential treatment (RT) based upon principles of cognitive processing therapy (CPT). Methods ED patients [N = 609; 96% female; mean age (± SD) = 26.0 ± 8.8 years; 22% LGBTQ +] with and without PTSD completed validated assessments at admission (ADM), DC and 6-month FU to measure severity of ED, PTSD, major depressive disorder (MDD), state-trait anxiety (STA) symptoms, and eating disorder quality of life (EDQOL). We tested whether PTSD moderated the course of symptom change using mixed models analyses and if ED diagnosis, ADM BMI, age of ED onset and LGBTQ + orientation were significant covariates of change. Number of days between ADM and FU was used as a weighting measure. Results Despite sustained improvements with RT in the total group, the PTSD group had significantly higher scores on all measures at all time points (p ≤ .001). Patients with (n = 261) and without PTSD (n = 348) showed similar symptom improvements from ADM to DC and outcomes remained statistically improved at 6-month FU compared to ADM. The only significant worsening observed between DC and FU was with MDD symptoms, yet all measures remained significantly lower than ADM at FU (p ≤ .001). There were no significant PTSD by time interactions for any of the measures. Age of ED onset was a significant covariate in the EDI-2, PHQ-9, STAI-T, and EDQOL models such that an earlier age of ED onset was associated with a worse outcome. ADM BMI was also a significant covariate in the EDE-Q, EDI-2, and EDQOL models, such that higher ADM BMI was associated with a worse ED and quality of life outcome. Conclusions Integrated treatment approaches that address PTSD comorbidity can be successfully delivered in RT and are associated with sustained improvements at FU. Improving strategies to prevent post-DC recurrence of MDD symptoms is an important and challenging area of future work.