National Eating Disorders Association
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Eating Disorders and Complex Post Traumatic Stress Disorder

Heather Hower, MSW, LICSW, QCSW, ACSW

Exposure to multiple traumas, particularly in childhood, has been proposed to result in a complex of symptoms that includes posttraumatic stress disorder (PTSD) as well as a constrained, but variable, group of symptoms that highlight self-regulatory disturbances (e.g. depression, anxiety, dissociation). Van der Kolk and colleagues have researched these symptoms extensively, and correspondingly suggested the diagnosis of Complex PTSD for inclusion in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5); unfortunately, it was left out of the manual due to politics. In a related study, Cloitre found that childhood cumulative trauma predicted increasing symptom complexity in both children and adults.

Complex PTSD is the result not of a small number of dramatic events, but rather a prolonged series of abusive events, which take place as part of an asymmetric relationship, often during childhood, due to a parental figure. Perhaps the most characteristic signs of Complex PTSD are having a negative self-image and an inability to cope with strong feelings of anger or sadness. PTSD is noted to have a specific onset, with the memory of the trauma intact. By contrast, Complex PTSD is frequently characterized by absences of memory. Indeed, one way of understanding Complex PTSD is an elaborate and self-destructive strategy by the brain to force out memories that are too painful to bear.

The comorbidity between PTSD and eating disorders is well established; the relationship appears to be largely related to a form of ‘self-medicating’ behavior. People who have been through traumatic experiences often feel a sense of powerlessness, brought on to them by their inability to prevent the traumatic incident from happening or prevent themselves from being traumatized by it. The act of consciously starving oneself in order to change one’s body shape is a method the victim uses to reassert control over their own body.

In addition, the sexual abusive nature of many Complex PTSD cases is also a further risk factor for eating disorders. It is well documented that victims of rape and other forms of sexual abuse are more likely to develop eating disorders, though the exact reasons for this are unclear. Further research is needed in order to investigate this correlation, providing better treatment.

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References

Cloitre, M., Stolbach, B.C., Herman, J.L., van der Kolk, B., Pynoos, R. Wang, J., Petkova, E.  (2009). A developmental approach to complex PTSD: childhood and adult cumulative trauma as predictors of symptom complexity.  Journal of Traumatic Stress, 1-10. https://doi.org/10.1002/jts.20444

Tagay, S., Schlottbohm, E., Reyes-Rodriguez, M. L., Repic, N., & Senf, W. (2014). Eating Disorders, Trauma, PTSD and Psychosocial Resources. Eating Disorders, 22(1), 33–49. http://doi.org/10.1080/10640266.2014.857517

Backholm, K., Isomaa, R., & Birgegård, A. (2013). The prevalence and impact of trauma history in eating disorder patients. European Journal of Psychotraumatology, 4, 10.3402/ejpt.v4i0.22482. http://doi.org/10.3402/ejpt.v4i0.22482

Mason, S. M., Flint, A. J., Roberts, A. L., Agnew-Blais, J., Koenen, K. C., & Rich-Edwards, J. W. (2014). Posttraumatic stress disorder symptoms and food addiction in women, by timing and type of trauma exposure. JAMA Psychiatry, 71(11), 1271–1278. http://doi.org/10.1001/jamapsychiatry.2014.1208

McCauley, J. L., Killeen, T., Gros, D. F., Brady, K. T., & Back, S. E. (2012). Posttraumatic Stress Disorder and Co-Occurring Substance Use Disorders: Advances in Assessment and Treatment. Clinical Psychology : A Publication of the Division of Clinical Psychology of the American Psychological Association, 19(3), 10.1111/cpsp.12006. http://doi.org/10.1111/cpsp.12006

Ford, J. D., & Courtois, C. A. (2014). Complex PTSD, affect dysregulation, and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation, 1, 9.

Sar, V. (2011). Developmental trauma, complex PTSD, and the current proposal of DSM-5 . European Journal of Psychotraumatology, 2, 10.3402/ejpt.v2i0.5622. http://doi.org/10.3402/ejpt.v2i0.5622