Trauma-informed care and practice for eating disorders: personal and professional perspectives of lived experiences

Brewerton, Timothy D.; Alexander, June; Schaefer, Jenni

doi:10.1007/s40519-018-0628-5

Cited by 22 publications

(20 citation statements)

References 62 publications

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“…Collectively, our results confirm that ED‐PTSD+ patients entering RT have more complex presentations and are more likely to have binge‐purge features (Brewerton, 2007; Brewerton, 2018). Specifically, our findings pose major challenges for ED programs and practitioners to embrace trauma‐informed care and to develop integrated treatment protocols for the treatment of ED‐PTSD+ patients (Brewerton, 2018; Brewerton, Alexander, & Schaefer, 2019; Brewerton, Trottier, Trim, Myers, & Wonderlich, 2020; Trottier, Monson, Wonderlich, & Olmsted, 2017).…”

Section: Discussionmentioning

confidence: 99%

The association of traumatic events and posttraumatic stress disorder with greater eating disorder and comorbid symptom severity in residential eating disorder treatment centers

Brewerton

Perlman

Gavidia³

et al. 2020

Intl J Eating Disorders

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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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Section: Discussionmentioning

confidence: 99%

The association of traumatic events and posttraumatic stress disorder with greater eating disorder and comorbid symptom severity in residential eating disorder treatment centers

Brewerton

Perlman

Gavidia³

et al. 2020

Intl J Eating Disorders

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“…When food alters DA circuitry, efforts to moderate become more difficult and “intuitive eating” can feel impossible. Trauma-informed care should be applied to recovery systems and providers servicing EDs [ 238 , 239 ].…”

Section: Discussionmentioning

confidence: 99%

Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint

Wiss

Brewerton

2020

Nutrients

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Converging evidence from both animal and human studies have implicated hedonic eating as a driver of both binge eating and obesity. The construct of food addiction has been used to capture pathological eating across clinical and non-clinical populations. There is an ongoing debate regarding the value of a food addiction “diagnosis” among those with eating disorders such as anorexia nervosa binge/purge-type, bulimia nervosa, and binge eating disorder. Much of the food addiction research in eating disorder populations has failed to account for dietary restraint, which can increase addiction-like eating behaviors and may even lead to false positives. Some have argued that the concept of food addiction does more harm than good by encouraging restrictive approaches to eating. Others have shown that a better understanding of the food addiction model can reduce stigma associated with obesity. What is lacking in the literature is a description of a more comprehensive approach to the assessment of food addiction. This should include consideration of dietary restraint, and the presence of symptoms of other psychiatric disorders (substance use, posttraumatic stress, depressive, anxiety, attention deficit hyperactivity) to guide treatments including nutrition interventions. The purpose of this review is to help clinicians identify the symptoms of food addiction (true positives, or “the signal”) from the more classic eating pathology (true negatives, or “restraint”) that can potentially elevate food addiction scores (false positives, or “the noise”). Three clinical vignettes are presented, designed to aid with the assessment process, case conceptualization, and treatment strategies. The review summarizes logical steps that clinicians can take to contextualize elevated food addiction scores, even when the use of validated research instruments is not practical.

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“…Future research should aim to test the specific components of a treatment intervention to better understand what elements make a program effective, particularly for the SGM population—in this case so much that there were no significant differences between the ED symptom severity of SGMs and CHs upon discharge. The participants in this study received a trauma‐informed (Brewerton, Alexander, & Schaefer, ) and compassion‐focused approach rooted in principles of Health‐At‐Every‐Size® (Tylka et al, )—attributes that are all, arguably, important components of gender‐inclusive ED treatment. Additionally, SGMs received gender‐identity affirming care in that pronouns were recognized and honored, and placement in single‐sex residential treatment centers was based on gender‐identity and not sex assigned at birth or status of transition.…”

Section: Discussionmentioning

confidence: 99%

Sexual and gender minority individuals report higher rates of abuse and more severe eating disorder symptoms than cisgender heterosexual individuals at admission to eating disorder treatment

Mensinger

Granche

Cox

et al. 2020

Intl J Eating Disorders

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Eating disorders (EDs) occur at higher rates among sexual/gender minorities (SGMs). We currently know little about the risk factor profile of SGMs entering ED specialty care.Objective: To (a) compare history of abuse-related risk in SGMs to cisgender heterosexuals (CHs) when entering treatment, (b) determine if SGMs enter and exit treatment with more severe ED symptoms than CHs, and (c) determine if SGMs have different rates of improvement in ED symptoms during treatment compared to CHs.Method: We analyzed data from 2,818 individuals treated at a large, US-based, ED center, 471 (17%) of whom identified as SGM. Objective 1 was tested using logistic regression and Objectives 2 and 3 used mixed-effects models.Results: SGMs had higher prevalence of sexual abuse (OR = 2.10, 95% CI = 1.71, 2.58), other trauma (e.g., verbal/physical/emotional abuse; OR = 2.07, 95% CI = 1.68, 2.54), and bullying (OR = 2.13, 95% CI = 1.73, 2.62) histories. SGMs had higher global EDE-Q scores than CHs at admission (γ = 0.42, SE = 0.08, p < .001) but improved faster early in treatment (γ = 0.316, SE = 0.12, p = .008). By discharge, EDE-Q scores did not differ between SGMs and CHs.Discussion: Our main hypothesis of greater abuse histories among SGMs was supported and could be one explanation of their more severe ED symptoms at treatment admission compared to CHs. In addition, elevated symptom severity in SGMs at admission coincides with greater delay between ED onset and treatment initiation among SGMs-possibly a consequence of difficulties with ED recognition in SGMs by healthcare providers. We recommend increased training for providers on identifying EDs in SGMs to reduce barriers to early intervention. Janell L. Mensinger author began the work while a faculty member in the

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Trauma-informed care and practice for eating disorders: personal and professional perspectives of lived experiences

Cited by 22 publications

References 62 publications

The association of traumatic events and posttraumatic stress disorder with greater eating disorder and comorbid symptom severity in residential eating disorder treatment centers

The association of traumatic events and posttraumatic stress disorder with greater eating disorder and comorbid symptom severity in residential eating disorder treatment centers

Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint

Sexual and gender minority individuals report higher rates of abuse and more severe eating disorder symptoms than cisgender heterosexual individuals at admission to eating disorder treatment

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