Early trauma, dissociation, and late onset in the eating disorders

Abstract

Although the majority of patients with anorexia nervosa and bulimia nervosa develop these disorders in their teens and 20s, some patients develop an eating disorder in their 30s, 40s, or 50s. We present a subgroup of patients with the following pattern of symptoms and historical detail: (1) severe sexual and physical abuse by family members; (2) relatively good premorbid professional and marital adjustment (considering later difficulties) though characterized by (3) hypomania, binge eating, and morbid obesity. A pronounced shift in eating behaviors follows (4) medical trauma (e.g., injury, cancer, surgery) that occurs after age 30, interrupts previous hypomanic adaptation, and leads to severe restriction, purging, and dramatic weight loss (e.g., 100 lb). Although only one patient met full criteria for anorexia nervosa, weight loss and starvation were serious enough to provoke further medical crises in all patients. Finally, (5) during both weight loss and weight restoration patients demonstrated significant dissociative disturbance, including dissociated mood and personality states (i.e., multiple personality disorder), self‐destructive behavioral episodes repeating early trauma, and avoidance of food as a way to manage PTSD symptoms. © 1995 by John Wiley & Sons, Inc.

Somatoform Dissociation Discriminates Among Diagnostic Categories Over and Above General Psychopathology

“…This result concurs with earlier findings that a subgroup of patients with eating disorders experienced substantial psychological dissociation [35,38]. About one-third surpassed the SDQ-5 cut-off in the screening for dissociative disorders.…”

Cognitive and emotional functioning in binge‐eating disorder: A systematic review

“…69 Furthermore, individuals with BED were also found to display more difficulties regarding externally oriented thinking, 67 while other studies did not support this finding. 80 Comparisons to individuals with BN yielded fewer difficulties regarding interoceptive awareness in individuals with BED, 73,76,81,82 while other studies reported no dif-ferences, 80,83,84 especially after controlling for age and depression. Interoceptive awareness was assessed in 16 studies using the Interoceptive Awareness subscale of the Eating Disorder Inventory or the Eating Disorder Inventory-2.…”

Early Life Loss and Trauma

“…Rates of onset are low over the age of 25 years (Hay, 2004;Hoek, 2006;Hudson et al, 2007, Patrick & Stahl, 2009 and rarely reported over the age of 40 years. The few studies available include 2 patients with onset after 40 years (Mynors-Wallis, Treasure, & Chee, 1992), a single case study with onset at 41 years (Gupta, 1990), 2 patients with onset in the 40s (Tobin, Molteni, & Elin, 1995), and 11 patients with onset over the age of 40 years (Beck, Casper, & Andersen, 1996). Cumella and Kally (2008) reported 50 cases with onset at 40 years or older.…”