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Cited by 106Eating Disorders and BehaviorsPosttraumatic Stress Disorder ResearchPersonality Disorders and Psychopathology

Posttraumatic stress disorder in anorexia nervosa

Open access
Reyes-Rodríguez, Mae Lynn, Von Holle, Ann, Ulman, Teresa Frances, Thornton, Laura M, Klump, Kelly L., Brandt, Harry, Crawford, Steve, Fichter, Manfred M. +12 more·2011·Psychosomatic Medicine
DOI 10.1097/psy.0b013e31822232bbPMC PMC3132652
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Abstract

Objectives: Comorbidity among eating disorders, traumatic events, and posttraumatic stress disorder (PTSD) has been reported in several studies. The main objectives of this study were to describe the nature of traumatic events experienced and to explore the relationship between PTSD and anorexia nervosa (AN) in a sample of women. Methods: Eight hundred twenty-four participants from the National Institutes of Health-funded Genetics of Anorexia Nervosa Collaborative Study were assessed for eating disorders, PTSD, and personality characteristics. Results: From a final sample of 753 women with AN, 13.7% (n = 103) met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for PTSD. The sample mean age was 29.5 (standard deviation = 11.1) years. In pairwise comparisons across AN subtypes, the odds of having a PTSD diagnosis were significantly lower in individuals with restricting AN than individuals with purging AN without binge eating (odds ratio = 0.49, 95% confidence interval = 0.30-0.80). Most participants with PTSD reported the first traumatic event before the onset of AN (64.1%, n = 66). The most common traumatic events reported by those with a PTSD diagnosis were sexually related traumas during childhood (40.8%) and during adulthood (35.0%). Conclusions: AN and PTSD do co-occur, and traumatic events tend to occur before the onset of AN. Clinically, these results underscore the importance of assessing trauma history and PTSD in individuals with AN and raise the question of whether specific modifications or augmentations to standard treatment for AN should be considered in a subgroup to address PTSD-related psychopathology. AN = anorexia nervosa; ANBN = lifetime diagnosis of both anorexia and bulimia nervosa; BAN = anorexia nervosa with binge, with or without purging; BN = bulimia nervosa; BMI = body mass index; DSM-IV = Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition; HPA = hypothalamic-pituitary-adrenal; PAN = purging anorexia nervosa without binge eating; PTSD = posttraumatic stress disorder; RAN = restricting anorexia nervosa; Y-BOCS = Yale-Brown Obsessive Compulsive Scale; YBC-EDS = Yale-Brown-Cornell Eating Disorder Scale.

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  • Scientific evidence has established an association between trauma, PTSD and other trauma-related disorders in the predisposition, precipitation and perpetuation of eating disorders across various samples.

    “Scientific evidence for the association between trauma, PTSD and other trauma-related disorders in the predisposition, precipitation and perpetuation of eating disorders (EDs), has been established in a variety of samples, including treatment and non-treatment seeking individuals of various ages, genders and sexual orientations (1–6).”

    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 [5]

    The Introduction reports associations among eating disorders, traumatic events and PTSD across several studies, and the Results report that traumatic events preceded anorexia nervosa in most participants with PTSD. But the Discussion says the nature of the relationship is not fully understood; the paper does not establish trauma or PTSD as causes of eating-disorder predisposition, precipitation or perpetuation. Its study included only women, so it does not itself support the claim across genders or sexual orientations. (LLM, conf=0.88)

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Research works printed but not linked: 2

  1. Mantero, 2002, Eating disorders and chronic post traumatic stress disorder: issues of psychopathology and comorbidity., Eur Eat Disord Rev, 10, 1
  2. Brewerton, 2005, Psychological trauma and eating disorders., Rev Eat Disord, 1, 137

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Authors
Reyes-Rodríguez, M. L., Von Holle, A., Ulman, T. F., Thornton, L. M., Klump, K. L., Brandt, H., Crawford, S., Fichter, M. M., Halmi, K. A., Huber, T., Johnson, C., Jones, I., Kaplan, A. S., Mitchell, J. E., Strober, M., Treasure, J., Woodside, D. B., Berrettini, W. H., Kaye, W. H., & Bulik, C. M.
Affiliations
  • University of North Carolina at Chapel Hill (US)
  • Michigan State University (US)
  • University of Maryland, Baltimore (US)
  • Ludwig-Maximilians-Universität München (DE)
  • Cornell University (US)
  • Klinik Bad Oexen (DE)
  • University of Birmingham (GB)
  • University Health Network (CA)
  • University of North Dakota (US)
  • University of California, Los Angeles (US)
  • King's College London (GB)
  • University of Pennsylvania (US)
  • University of California San Diego (US)
Corresponding author
Bulik, Cynthia M.
ORCID
Venue
Psychosomatic Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2011-07
Volume
73
Issue
6
Pages
491-497
ISSN
0033-3174 (ISSN-L)
DOI
10.1097/psy.0b013e31822232bb
PMC
PMC3132652
OpenAlex
W1971529993
Cited by
106
References
67
Citations by year
2026: 2 · 2025: 13 · 2024: 8 · 2023: 11 · 2022: 4 · 2021: 16 · 2020: 8 · 2019: 9 · 2018: 4 · 2017: 2 · 2016: 3 · 2015: 8 · 2014: 4 · 2013: 7 · 2012: 6
FWCI
6.02
Type
journal article
Language
en
Open access
Locations
  • Psychosomatic Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
  • ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
  • Research Portal (King's College London) (submittedVersion)
  • UNC Libraries
Funders
  • National Institutes of Health
  • University of North Carolina at Chapel Hill
  • National Institute of Mental Health (R01MH092793, R01MH066117, R01MH082732, K23MH087954, R01MH066122, T32MH076694, R01MH042984)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
post-traumatic stress disorder, anorexia nervosa, traumatic events, child sexual abuse, bulimia nervosa, anorexia nervosa subtypes, restrictive anorexia nervosa, trauma history, women, comorbidities
MeSH terms
Adolescent, Adult, Age Factors, Anorexia Nervosa, Child, Child Abuse, Sexual, Female, Humans, Life Change Events, Male, Menarche, Middle Aged, Personality Assessment, Stress Disorders, Post-Traumatic, Comorbidity, Body Mass Index, Prevalence, Genetic Predisposition to Disease, Diagnostic and Statistical Manual of Mental Disorders, Epigenomics

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