Day Sinead, Mitchison Deborah, Tannous W Kathy, Hay Phillipa
Translational Health Research Institute, Western Sydney University, Penrith, Australia.
Graduate School of Health, University of Technology Sydney, Ultimo, Australia.
Int J Eat Disord. 2025 Sep;58(9):1732-1746. doi: 10.1002/eat.24465. Epub 2025 May 26.
Eating disorders (EDs) and symptoms of trauma commonly co-occur, yet research is limited on how trauma affects ED treatment outcomes. This is particularly true for complex post-traumatic stress disorder (CPTSD). Differentiating between the treatment impacts of PTSD and CPTSD (which includes both PTSD symptoms and disturbances in self-organization [DSO]) may help ED providers address this common comorbidity.
The current study included 95 women (M = 26 years) with EDs (largely anorexia nervosa) who received residential treatment (M = 81 days). Participants completed measures of ED symptoms, anxiety, depression, body mass index (BMI), ED-specific health-related quality-of-life (ED-HRQoL) impairment, functional disability, and trauma symptoms at admission, week 4 of treatment, discharge, and 6 months post-discharge.
All outcomes except BMI were more severe at admission and week 4 of treatment for individuals with comorbid trauma (based on probable CPTSD or exceeding the clinical threshold for PTSD and DSO symptom domains); however, these differences resolved by discharge and remained non-significant at follow-up. Some forms of comorbid trauma moderated outcome trajectories for anxiety, depression, and disability (but not ED symptoms), such that individuals with comorbid trauma showed slower improvement early in treatment, steeper improvement later in treatment, and greater resurgence after discharge.
These findings highlight that PTSD and CPTSD symptom domains may be associated with more severe ED outcomes early in residential treatment that resolve by discharge, and may predict differential treatment response for secondary outcomes. Implications are discussed for clinical assessment and treatment of comorbid trauma-related disorders in residential care.
The study was prospectively registered on the Australian and New Zealand Clinical Trials Registry in November 2021, registration number ACTRN12621001651875.
饮食失调（EDs）与创伤症状常同时出现，但关于创伤如何影响饮食失调治疗结果的研究有限。对于复杂创伤后应激障碍（CPTSD）而言尤其如此。区分创伤后应激障碍（PTSD）和CPTSD（包括PTSD症状和自我组织障碍[DSO]）的治疗影响，可能有助于饮食失调治疗提供者应对这种常见的共病情况。
本研究纳入了95名患有饮食失调（主要为神经性厌食症）的女性（平均年龄=26岁），她们接受了住院治疗（平均住院时间=81天）。参与者在入院时、治疗第4周、出院时以及出院后6个月完成了饮食失调症状、焦虑、抑郁、体重指数（BMI）、饮食失调特定的健康相关生活质量（ED-HRQoL）损害、功能残疾和创伤症状的测量。
对于合并创伤的个体（基于可能的CPTSD或超过PTSD和DSO症状领域的临床阈值），除BMI外，所有结果在入院时和治疗第4周都更为严重；然而，这些差异在出院时得到解决，并且在随访时仍无统计学意义。某些形式的合并创伤调节了焦虑、抑郁和残疾（但不包括饮食失调症状）的结果轨迹，使得合并创伤的个体在治疗早期改善较慢，在治疗后期改善较快，并且在出院后复发较多。
这些发现突出表明，PTSD和CPTSD症状领域可能与住院治疗早期更严重的饮食失调结果相关，这些结果在出院时得到解决，并且可能预测次要结果的不同治疗反应。讨论了对住院护理中合并创伤相关疾病的临床评估和治疗的影响。
该研究于2021年11月在澳大利亚和新西兰临床试验注册中心进行了前瞻性注册，注册号为ACTRN12621001651875。
