Limitations of the protective measure theory in explaining the role of childhood sexual abuse in eating disorders, addictions, and obesity: an updated model with emphasis on biological embedding

Wiss, David A.; Brewerton, Timothy D.; Tomiyama, A. Janet

doi:10.1007/s40519-021-01293-3

Cited by 14 publications

(14 citation statements)

References 211 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In summary, such biological embedding involves chronic disruption in a variety of interrelated neurodevelopmental pathways, including activation of the HPA axis, increased allostatic load, enhanced inflammation, altered reward sensitivity, consequential epigenetic changes, as well as profound structural and functional changes in the brain [ 303 – 306 ]. These pathways are in turn theorized to lead to EDs, food addiction, and SUDs, each of which have been linked to obesity and other related comorbidities [ 298 , 299 , 307 – 312 ]. Social, emotional and cognitive impairment Traumatic sequelae as a result of maltreatment, including PTSD, involve impairments in the ability to process social, emotional and cognitive information [ 313 – 320 ].…”

Section: Methodsmentioning

confidence: 99%

“…Likewise, the presence of PTSD in patients with EDs is also associated with greater severity of illness, greater psychiatric comorbidity, greater prevalence of somatic symptoms, worse quality of life, and worse outcomes [20,32,40,214,[295][296][297]. Essentially, trauma has been described as being "biological embedded, " a term which very much applies to individuals with both EDs and PTSD [298][299][300][301][302]. In summary, such biological embedding involves chronic disruption in a variety of interrelated neurodevelopmental pathways, including activation of the HPA axis, increased allostatic load, enhanced inflammation, altered reward sensitivity, consequential epigenetic changes, as well as profound structural and functional changes in the brain [303][304][305][306].…”

Section: Social Conditions / Local Contextmentioning

confidence: 99%

“…In summary, such biological embedding involves chronic disruption in a variety of interrelated neurodevelopmental pathways, including activation of the HPA axis, increased allostatic load, enhanced inflammation, altered reward sensitivity, consequential epigenetic changes, as well as profound structural and functional changes in the brain [303][304][305][306]. These pathways are in turn theorized to lead to EDs, food addiction, and SUDs, each of which have been linked to obesity and other related comorbidities [298,299,[307][308][309][310][311][312]. V. Social, emotional and cognitive impairment Traumatic sequelae as a result of maltreatment, including PTSD, involve impairments in the ability to process social, emotional and cognitive information [313][314][315][316][317][318][319][320].…”

Section: Social Conditions / Local Contextmentioning

confidence: 99%

See 2 more Smart Citations

Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span

Brewerton

2022

J Eat Disord

Self Cite

View full text Add to dashboard Cite

Background Multiple published sources from around the world have confirmed an association between an array of adverse childhood experiences (ACEs) and other traumatic events with eating disorders (EDs) and related adverse outcomes, including higher morbidity and mortality. Methods In keeping with this Special Issue’s goals, this narrative review focuses on the ACEs pyramid and its purported mechanisms through which child maltreatment and other forms of violence toward human beings influence the health and well-being of individuals who develop EDs throughout the life span. Relevant literature on posttraumatic stress disorder (PTSD) is highlighted when applicable. Results At every level of the pyramid, it is shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide. Conclusions The implications of these cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. This overview offers multiple opportunities at every level for the palliation and prevention of EDs and other associated trauma-related conditions, including PTSD.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Social Conditions / Local Contextmentioning

confidence: 99%

“…In summary, such biological embedding involves chronic disruption in a variety of interrelated neurodevelopmental pathways, including activation of the HPA axis, increased allostatic load, enhanced inflammation, altered reward sensitivity, consequential epigenetic changes, as well as profound structural and functional changes in the brain [303][304][305][306]. These pathways are in turn theorized to lead to EDs, food addiction, and SUDs, each of which have been linked to obesity and other related comorbidities [298,299,[307][308][309][310][311][312]. V. Social, emotional and cognitive impairment Traumatic sequelae as a result of maltreatment, including PTSD, involve impairments in the ability to process social, emotional and cognitive information [313][314][315][316][317][318][319][320].…”

Section: Social Conditions / Local Contextmentioning

confidence: 99%

See 1 more Smart Citation

Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span

Brewerton

2022

J Eat Disord

Self Cite

View full text Add to dashboard Cite

show abstract

“…Notably, 75.5% of the child onset group met criteria for PTSD+ compared to 45.5% of patients with adolescent onset and 31.3% of those with adult onset. In parallel to this was the finding that the child onset group reported the highest number of traumatic life experiences, which adds to the literature about the importance of trauma dose, or allostatic load, in the development of psychopathology, including EDs (Brewerton et al., 2020, 2021a; Lie et al., 2021; Molendijk et al., 2017; Wiss et al., 2021). Specifically, reports of sexual and physical traumas were extremely common and significantly higher in the child onset group (88% and 74%, respectively) compared to both the adolescent and the adult onset groups.…”

Section: Discussionmentioning

confidence: 63%

“…It may be that early child maltreatment and subsequent PTSD has caused biological changes that negatively impact eating behaviour and metabolism. Such biological embedding implicates pathways such as activation of the hypothalamic‐pituitary‐adrenal axis, inflammation, allostatic load, epigenetics, reward sensitivity, and functional and structural changes in the brain (Wiss & Brewerton, 2020; Wiss et al., 2021).…”

Section: Discussionmentioning

confidence: 99%

Eating disorder onset during childhood is associated with higher trauma dose, provisional PTSD, and severity of illness in residential treatment

Brewerton

Gavidia²,

Suro³

et al. 2022

Euro Eating Disorders Rev

Self Cite

View full text Add to dashboard Cite

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.

show abstract

The treatment of dissociative identity disorder in an eating disorder residential treatment setting

Brewerton,

Perlman,

Gavidia

et al. 2023

Intl J Eating Disorders

Self Cite

View full text Add to dashboard Cite

ObjectiveChild maltreatment, dissociation and dissociative disorders have been noted in relationship to eating disorders (EDs) for decades, and their co‐occurrence generally is associated with greater morbidity, self‐harm and mortality. The concomitant presentation of dissociative identity disorder (DID) with an ED (ED + DID) is especially challenging, and there is limited information on approaches to and the effects of integrated treatment for this serious comorbidity, especially in higher levels of care. There are also limited treatment resources for such patients, since they are often turned away from specialty units due to lack of expertise with or bias toward one or the other disorder.MethodWe report our experience with a case series of 18 patients with DSM‐5 defined ED + DID (mean age (SD) = 32.6 (11.8) years) admitted to residential treatment (RT) and assessed using validated measures for symptoms of ED, major depression (MD), PTSD, state–trait anxiety, quality of life (QOL), age of ED onset, and family involvement during treatment. All patients received integrated, multimodal, trauma‐focused approaches including those based on DID practice guidelines, principles of cognitive processing therapy (CPT), and other evidence‐based approaches. Fifteen of 18 patients also completed discharge reassessments, which were compared to admission values using paired t‐tests.ResultsFollowing integrated, trauma‐focused RT, patients with ED + DID demonstrated statistically significant improvements in all measures, with medium (anxiety) to high (ED, PTSD, MD, QOL) effect sizes.DiscussionThese results provide positive proof of concept that patients with ED + DID can be effectively treated in a specialty, trauma‐focused ED program at higher levels of care.Public SignificanceEDs and dissociative identity disorder (DID) are related conditions, but little is known about treating patients with both conditions. We describe the clinical features and integrated treatment of 18 such patients, 15 of whom completed discharge assessments. Significant clinical improvements were found in multiple domains (ED, PTSD, mood, anxiety, quality of life), which demonstrate positive proof of concept that ED + DID can be effectively treated in a specialty, trauma‐focused ED program.

show abstract

Limitations of the protective measure theory in explaining the role of childhood sexual abuse in eating disorders, addictions, and obesity: an updated model with emphasis on biological embedding

Cited by 14 publications

References 211 publications

Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span

Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span

Eating disorder onset during childhood is associated with higher trauma dose, provisional PTSD, and severity of illness in residential treatment

The treatment of dissociative identity disorder in an eating disorder residential treatment setting

Contact Info

Product

Resources

About