Posttraumatic stress disorder and eating disorders: maintaining mechanisms and treatment targets

Many individuals with lifetime histories of eating disorders (EDs) report exposure to interpersonal trauma and posttraumatic stress disorder (PTSD). However, this relationship is not well-understood, and there are no established, evidence-based therapies for the concurrent treatment of EDs and PTSD....

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Bibliographic Details
Published in:Eating disorders 2021-05, Vol.29 (3), p.292-306
Main Authors: Mitchell, Karen S., Scioli, Erica R., Galovski, Tara, Belfer, Perry L., Cooper, Zafra
Format: Article
Language:English
Subjects:
Avoidance behavior
Behavior
Bidirectionality
Binge eating
Cognitive behavioral therapy
Cognitive-behavioral factors
Comorbidity
Coping strategies
Eating disorders
Emotional regulation
Evidence-based medicine
Guilt
Hyperarousal
Impulsivity
Negative emotions
Post traumatic stress disorder
Psychological trauma
Purging
Selfcriticism
Selfworth
Shame
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Summary:Many individuals with lifetime histories of eating disorders (EDs) report exposure to interpersonal trauma and posttraumatic stress disorder (PTSD). However, this relationship is not well-understood, and there are no established, evidence-based therapies for the concurrent treatment of EDs and PTSD. This review focuses on studies of the mechanisms associating trauma exposure and/or PTSD with EDs. Possible mechanisms of the trauma-ED association identified from the literature include self-criticism, low self-worth, guilt, shame, depression, anxiety, emotion dysregulation, anger, and impulsivity/compulsivity. ED behaviors may be used as coping strategies to manage PTSD symptoms and negative affect. Avoidance of hyperarousal symptoms by engaging in binge eating, purging, and/or restriction may serve to maintain both the ED as well as the PTSD. Given the evidence of the bidirectional relationship between EDs and PTSD, we describe an integrated cognitive behavioral theory that may account for the persistence of comorbid PTSD and EDs. The integrated model is based on the theoretical models that underpin existing evidence-based treatments for PTSD and ED and incorporates many of the potential mechanisms highlighted to date. The primary aim of the model is to identify potential treatment targets as well as elucidate future directions for research.
ISSN:1064-0266
1532-530X
DOI:10.1080/10640266.2020.1869369