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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.