The Role of Trauma and PTSD in Eating and Related Disorders

Timothy D. Brewerton, MD,

NWS Prevalence RatesBN (n=72)

BED (n=30)

Non-BN/BED (n=2911)

Completed Rape ** 26.6%

11.5% ** 13.3%

Contact Sexual Molestation

* 22.0% 12.9% * 12.0%

Attempted Sexual Assault 10.7% 17.3% 9.4%

Aggravated Assault *** 26.8%

* 9.3% *** 8.4%

Direct Crime Victimization *** 54.4%

43.3% *** 31.0%

*p < 0.05 ** p < 0.01 *** p < 0.001

Dansky BS, Brewerton TD, et al. IJED 21:213-228, 1997

**

**

***

0%

2%

4%

6%

8%

10%

12%

Rape + PTSD Rape - PTSD No Rape

Chi-square

P<0.001

Hudson J, et al., Biol Psychiatry 2007; 61:348

Hudson et al., 2007

EATING

SUBSTANCEUSE

IMPULSECONTROL

DISRUPTIVEBEHAVIOR

PERSONALITY(CLUSTER B)

SOMATO-FORM

DISSOCIA-TIVE

ANXIETYMOOD

T P

OR’s for comorbid disorders = 2.4 - 4.5

+

Genetic Predisposition

-

Social Support

+

Comorbidity between bulimic-spectrum EDs (bED) & SUDs may be due in large part to a history of Trauma and resultant PTSD/pPTSD.

The relationship between bEDs-SUDs-PTSD were particularly strong among men (rates for SUDs = 66-88%).

Results highlight the need for treatment studies of this subgroup (bED+SUD+PTSD/pPTSD).

This group may have higher rates of treatment resistance as well as poor treatment outcome.

Results add to the considerable body of literature indicating links between trauma/PTSD & EDs with SUDs.

Trauma may serve as an “organizing principle” when thinking about etiology from a biopsychosocial and developmental perspective.

The more psychiatric comorbidity there is, the more likely prior Trauma played a role in precipitating the overall course of mental illness.

Trauma-related D/O’s may share common underlying factors that account for such interrelationships:– dysregulation in neuropsychobiological

mechanisms, triggered by gene expression, underlies affective dysregulation;

– common cognitive schemas involving issues of self-esteem, control, guilt & shame.