Treatment outcomes of psychotherapy for binge-eating disorder in a randomized controlled trial: examining the roles of childhood abuse and post-traumatic stress disorder
Open accessAbstract
Objective: To examine childhood abuse and post‐traumatic stress disorder (PTSD) as predictors and moderators of binge‐eating disorder (BED) treatment outcomes in a randomized controlled trial comparing Integrative Cognitive‐Affective Therapy with cognitive‐behavioural therapy administered using guided self‐help. Method: In 112 adults with BED, childhood abuse was defined as any moderate/severe abuse as assessed by the Childhood Trauma Questionnaire, lifetime PTSD was assessed via the Structured Clinical Interview for DSM‐IV, and outcomes were assessed via the Eating Disorder Examination (EDE). Covariate‐adjusted regression models predicting binge‐eating frequency and EDE global scores at end of treatment and 6‐month follow‐up were conducted. Results: Lifetime PTSD predicted greater binge‐eating frequency at end of treatment (B = 1.32, p = 0.009) and childhood abuse predicted greater binge‐eating frequency at follow‐up (B = 1.00, p = 0.001). Lifetime PTSD moderated the association between childhood abuse and binge‐eating frequency at follow‐up (B = 2.98, p = 0.009), such that childhood abuse predicted greater binge‐eating frequency among participants with a history of PTSD (B = 3.30, p = 0.001) but not among those without a PTSD history (B = 0.31, p = 0.42). No associations with EDE global scores or interactions with treatment group were observed. Conclusions: Results suggest that a traumatic event history may hinder treatment success and that PTSD may be more influential than the trauma exposure itself.
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Trauma histories and PTSD symptoms predict more complicated courses of illness, higher dropout rates, and worse outcomes following treatment.
“trauma histories and PTSD symptoms have been reported to predict more complicated courses of illness, higher dropout rates, and worse outcomes following treatment (11, 17–26).”
From The integrated treatment of eating disorders, posttraumatic stress disorder, and psychiatric comorbidity: a commentary on the evolution of principles and guidelines (2023) · cites this paper as [21]
The Introduction reports that patients with trauma histories have greater psychiatric comorbidity, are more likely to drop out of treatment, and may respond less well. The Results also link lifetime PTSD and childhood abuse to poorer binge-eating outcomes. But the study did not measure PTSD symptom severity or establish a more complicated course of illness; its Discussion identifies the lack of a continuous PTSD-symptom measure as a limitation. (LLM, conf=0.84)
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- Authors
- Hazzard, V. M., Crosby, R. D., Crow, S. J., Engel, S. G., Schaefer, L. M., Brewerton, T. D., Castellini, G., Trottier, K., Peterson, C. B., & Wonderlich, S. A.
- Affiliations
- Sanford Center for Biobehavioral Research Fargo North Dakota USA
- University of North Dakota (US)
- University of Minnesota (US)
- Medical University of South Carolina (US)
- University of Florence (IT)
- University of Toronto (CA)
- Corresponding author
- Hazzard, Vivienne M.
- ORCID
- Venue
- European Eating Disorders Review
- Publisher
- Wiley
- Published
- 2021-03-04
- Volume
- 29
- Issue
- 4
- Pages
- 611-621
- ISSN
- 1072-4133 (ISSN-L)
- 1099-0968
- PMC
- PMC8187312
- OpenAlex
- W3135843262
- Cited by
- 44
- References
- 54
- Citations by year
- 2026: 4 · 2025: 12 · 2024: 6 · 2023: 11 · 2022: 9 · 2021: 2
- FWCI
- 4.77
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- European Eating Disorders Review (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Florence Research (University of Florence) (submittedVersion, other-oa)
- Funders
- National Institute of Mental Health (R34MH098995, R34MH099040, T32MH082761)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK60456)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- binge eating disorder, childhood abuse, post-traumatic stress disorder, cognitive behavioral therapy, guided self-help, binge eating frequency, trauma exposure, predictors of treatment response
- MeSH terms
- Adult, Child, Child Abuse, Humans, Psychotherapy, Stress Disorders, Post-Traumatic, Treatment Outcome, Binge-Eating Disorder
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