The impact of comorbid posttraumatic stress disorder on eating disorder treatment outcomes: Investigating the unified treatment model

Mitchell, Karen S.; Singh, Simar; Hardin, Sabrina; Thompson‐Brenner, Heather

doi:10.1002/eat.23515

Cited by 19 publications

(25 citation statements)

References 35 publications

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“…Symptoms of ASD are frequently exhibited by patients with AN [ 53 , 54 ]. An assessment of common phenomena between ARFID and ASD in children found a shared symptom profile of eating difficulties, behavioural problems and sensory hypersensitivity beyond what is observed in children without ASD [ 55 ] Post traumatic stress disorder (PTSD) (3 studies) A broad range of prevalence rates between PTSD and EDs have been reported; between 16.1–22.7% for AN, 32.4–66.2% for BN and 24.02–31.6% for BED [ 56 ]. EDs might have a functional role to manage PTSD symptoms and reduce negative affect [ 57 ] Suicidality (22 studies) Suicide is one of the leading causes of death for individuals with EDs [ 58 ].…”

Section: Resultsmentioning

confidence: 99%

“…Many individuals with EDs report historical traumatic experiences, and for a proportion of the population, symptoms of post traumatic stress disorder (PTSD). A broad range of prevalence rates between PTSD and EDs have been reported; between 16.1–22.7% for AN, 32.4–66.2% for BN and 24.02–31.6% for BED [ 56 ]. A review noted self-criticism, low self-worth, guilt, shame, depression, anxiety, emotion dysregulation, anger and impulsivity were linked to the association between EDs and trauma [ 57 ].…”

Section: Psychiatric Comorbiditiesmentioning

confidence: 99%

“…Few studies have explored the impact of comorbid PTSD on ED treatment outcomes. A study of inpatients admitted to a residential ED treatment service investigated whether PTSD diagnosis at admission was associated with symptom changes [ 56 ]. Cognitive and behavioural symptoms related to the ED had decreased at discharge, however, they increased again at six-month follow up.…”

Section: Psychiatric Comorbiditiesmentioning

confidence: 99%

See 2 more Smart Citations

Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature

Aouad¹,

Barakat

Boakes³

et al. 2022

J Eat Disord

102

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Background Eating disorders (EDs) are potentially severe, complex, and life-threatening illnesses. The mortality rate of EDs is significantly elevated compared to other psychiatric conditions, primarily due to medical complications and suicide. The current rapid review aimed to summarise the literature and identify gaps in knowledge relating to any psychiatric and medical comorbidities of eating disorders. Methods This paper forms part of a rapid review) series scoping the evidence base for the field of EDs, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021–2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for English-language studies focused on the psychiatric and medical comorbidities of EDs, published between 2009 and 2021. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised. Results A total of 202 studies were included in this review, with 58% pertaining to psychiatric comorbidities and 42% to medical comorbidities. For EDs in general, the most prevalent psychiatric comorbidities were anxiety (up to 62%), mood (up to 54%) and substance use and post-traumatic stress disorders (similar comorbidity rates up to 27%). The review also noted associations between specific EDs and non-suicidal self-injury, personality disorders, and neurodevelopmental disorders. EDs were complicated by medical comorbidities across the neuroendocrine, skeletal, nutritional, gastrointestinal, dental, and reproductive systems. Medical comorbidities can precede, occur alongside or emerge as a complication of the ED. Conclusions This review provides a thorough overview of the comorbid psychiatric and medical conditions co-occurring with EDs. High psychiatric and medical comorbidity rates were observed in people with EDs, with comorbidities contributing to increased ED symptom severity, maintenance of some ED behaviours, and poorer functioning as well as treatment outcomes. Early identification and management of psychiatric and medical comorbidities in people with an ED may improve response to treatment and overall outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Psychiatric Comorbiditiesmentioning

confidence: 99%

Section: Psychiatric Comorbiditiesmentioning

confidence: 99%

See 1 more Smart Citation

Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature

Aouad¹,

Barakat

Boakes³

et al. 2022

J Eat Disord

102

View full text Add to dashboard Cite

show abstract

“…There are several limitations to our study. Most notably, this is not a representative sample of EDs in the general population, although it may represent individuals with EDs seeking care in residential treatment centres, who have been reported to have high rates of traumatic histories, PTSD and comorbid symptoms and disorders in multiple locations and programs (Brewerton et al., 2020; Mitchell et al., 2021; Rienecke et al., 2020; Scharff et al., 2019). Residential care in the United States is also often limited to those with private health insurance, and our sample largely consists of white, non‐Hispanic women.…”

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

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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.

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“…It is also hypothesized that a history of trauma and current posttraumatic stress disorder (PTSD) symptoms will moderate treatment effects, in that improvements in eating disorder symptoms will be less marked among those with a history of trauma or current PTSD symptoms. Although some studies have found that PTSD does not result in poorer treatment outcomes for binge eating [ 19 , 20 ], other studies have found that PTSD predicts more binge eating at end of treatment [ 21 ] and premature treatment dropout for patients with BN [ 22 ]. Given these mixed findings and the assumed increased level of severity in the current population seeking higher level of care treatment, PTSD will be examined as a moderator.…”

Section: Introductionmentioning

confidence: 99%

Treatment Outcome for Adults in a Residential Program for Binge Eating Spectrum Disorders: Protocol for a Prospective Pragmatic Single-Arm Trial

Rienecke¹,

Blalock²,

Mills³

et al. 2022

JMIR Res Protoc

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Background Most studies reporting treatment outcomes for eating disorders at higher levels of care focus on anorexia nervosa and bulimia nervosa. No studies have been published with a singular focus on examining treatment outcomes for adults receiving residential programming specifically designed for the treatment of binge eating spectrum disorders (BESD), including binge eating disorder and bulimia nervosa. Objective The purpose of this paper is to outline the protocol of a prospective study examining treatment outcomes at discharge and 3-month, 6-month, and 12-month postdischarge follow-up, for a sample of consecutive admissions to a residential program specifically for patients with BESD. Methods One hundred consecutive admissions to a binge eating treatment program were enrolled in the prospective single-arm trial between January 2019 and February 2020. Data were collected at admission, discharge, and 3, 6, and 12 months postdischarge, with admission, discharge, and 12-month follow-up as the major timepoints of interest. Results across the major timepoints will be analyzed with mixed effects general linear models. Results The primary aim is to assess the impact of the program on eating disordered behaviors at discharge and 12-month follow-up, which are hypothesized to improve as a result of treatment. Secondary hypotheses include improvements on comorbid symptoms, including trauma, depression, and obsessive-compulsive symptoms, as well as improvements on medical indicators of health, including cholesterol and triglycerides, at discharge and 12-month follow-up. Conclusions This study may aid in the development of treatment guidelines for patients with BESD at higher levels of care and lend support to having specialty treatment programs for patients with BESD. International Registered Report Identifier (IRRID) DERR1-10.2196/32270

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The impact of comorbid posttraumatic stress disorder on eating disorder treatment outcomes: Investigating the unified treatment model

Cited by 19 publications

References 35 publications

Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature

Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature

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

Treatment Outcome for Adults in a Residential Program for Binge Eating Spectrum Disorders: Protocol for a Prospective Pragmatic Single-Arm Trial

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