Eating disorders (EDs) are complex mental health conditions influenced by biological, psychological, and environmental factors. Recent research highlights the significant role of trauma, particularly post-traumatic stress disorder (PTSD), in shaping treatment outcomes for EDs. The systematic review by Day et al. (2024) synthesises evidence on how trauma impacts recovery trajectories and suggests critical avenues for improving care for individuals with comorbid EDs and PTSD【1】.
Trauma and Eating Disorders: A Reciprocal Relationship
Trauma, including childhood abuse, neglect, or significant life stressors, has been identified as a key risk factor for developing EDs. PTSD symptoms, such as intrusive memories, hyperarousal, and emotional dysregulation, can exacerbate eating behaviours like bingeing, restricting, or purging. These behaviours often serve as maladaptive coping mechanisms to manage trauma-related distress【1,2】.
Conversely, the chronic stress and physiological impact of ED behaviours can worsen PTSD symptoms, creating a cyclical interaction that complicates treatment. For example, individuals with PTSD often experience higher rates of treatment dropout and slower recovery compared to those without a trauma history【1,3】.
Treatment Outcomes and Barriers
Day et al.’s review found that comorbid PTSD is associated with poorer treatment outcomes for EDs. Specifically, trauma-related symptoms contribute to lower rates of remission, greater risk of relapse, and diminished quality of life post-treatment. Key barriers to recovery include:
• Emotional dysregulation:Heightened difficulty in managing emotions interferes with ED therapy.
• Hypervigilance: PTSD-related hyperarousal can undermine the therapeutic alliance and limit engagement.
• Avoidance behaviours:Trauma survivors may avoid processing distressing memories, hindering recovery progress【1,2】.
Addressing the Gap in Care
Integrated trauma-informed care is essential to address these challenges. Trauma-focused therapies, such as Eye Movement Desensitisation and Reprocessing (EMDR) or trauma-focused Cognitive Behavioural Therapy (CBT), show promise in reducing PTSD symptoms alongside ED treatments【1,4】.
Additionally, emerging evidence supports the use of Dialectical Behaviour Therapy (DBT), which focuses on emotional regulation and distress tolerance. Combining trauma-focused interventions with evidence-based ED treatments, like Family-Based Therapy (FBT) or Enhanced CBT (CBT-E), can lead to better outcomes【1,3】.
The Role of Nutrition in Treatment
Proper nutrition plays a foundational role in the treatment of eating disorders, particularly when comorbid with PTSD. Balanced diets, tailored to individual needs, help address malnutrition and stabilise physical health, which is crucial for improving emotional regulation and cognitive function during trauma therapy. For instance, incorporating omega-3 fatty acids has been shown to reduce inflammation and support brain health, while micronutrients like zinc and vitamin B12 aid in mood stabilisation and neurotransmitter synthesis【5,6】. Dietitian-led interventions also ensure the re-establishment of regular eating patterns, which are vital for long-term recovery.
References
1. Day S, Hay P, Tannous WK, Fatt SJ, Mitchison D. A systematic review of the effect of PTSD and trauma on treatment outcomes for eating disorders. Trauma Violence Abuse. 2024 Apr;25(2):947–964. doi:10.1177/15248380231167399. Epub 2023 Apr 26. PMID: 37125723; PMCID: PMC10913314.
2. Brewerton TD. Eating disorders, trauma, and comorbidity: focus on PTSD. Eat Disord. 2007 Jul-Sep;15(4):285-304. doi: 10.1080/10640260701454311. PMID: 17710567.
3. Mitchell KS, Mazzeo SE. Mediators of the association between abuse and disordered eating in undergraduate men. Eat Behav. 2005 Dec;6(4):318-27. doi: 10.1016/j.eatbeh.2005.03.004. Epub 2005 Apr 25. PMID: 16257805.
4. Leppanen J, Brown D, McLinden H, Williams S, Tchanturia K. The Role of Emotion Regulation in Eating Disorders: A Network Meta-Analysis Approach. Front Psychiatry. 2022 Feb 23;13:793094. doi: 10.3389/fpsyt.2022.793094. PMID: 35280172; PMCID: PMC8904925..
5. Grajek M, Krupa-Kotara K, Białek-Dratwa A, Sobczyk K, Grot M, Kowalski O, Staśkiewicz W. Nutrition and mental health: A review of current knowledge about the impact of diet on mental health. Front Nutr. 2022 Aug 22;9:943998. doi: 10.3389/fnut.2022.943998. PMID: 36071944; PMCID: PMC9441951.
6. Bozzatello P., Laura De Rosa M.,
Rocca P. and Bellino S.
Effects of Omega 3 Fatty Acids on Main Dimensions of Psychopathology Int. J. Mol. Sci. 2020, 21(17), 6042; https://doi.org/10.3390/ijms21176042
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