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DeMartino J, Katsuki MY, Ansbro MR. Diversity, Equity, and Inclusion: Obstetrics and Gynecologist Hospitalists' Impact on Maternal Mortality. Obstet Gynecol Clin North Am 2024; 51:539-558. [PMID: 39098780 DOI: 10.1016/j.ogc.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
Obstetrics and gynecology hospitalists play a vital role in reducing maternal morbidity and mortality by providing immediate access to obstetric care, especially in emergencies. Their presence in hospitals ensures timely interventions and expert management, contributing to better outcomes for mothers and babies. This proactive approach can extend beyond hospital walls through education, advocacy, and community outreach initiatives aimed at improving maternal health across diverse settings.
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Affiliation(s)
- Julianne DeMartino
- University Hospitals MacDonald Women's Hospital, 2101 Adelbert Road, Cleveland, OH 44106, USA.
| | - Monique Yoder Katsuki
- Cleveland Clinic Foundation, Obstetric and Gynecologic Institute, 9500 Euclid Avenue/A81, Cleveland, OH 44195, USA
| | - Megan R Ansbro
- Cleveland Clinic Foundation, Obstetric and Gynecologic Institute, 9500 Euclid Avenue/A81, Cleveland, OH 44195, USA
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French LM, Brickell TA, Lippa SM, Rogers AA, Cristaudo KE, Walker TT, Higgins M, Bailie JM, Kennedy J, Hungerford L, Lange RT. Clinical relevance of subthreshold PTSD versus full criteria PTSD following traumatic brain injury in U.S. service members and veterans. J Affect Disord 2024; 358:408-415. [PMID: 38705525 DOI: 10.1016/j.jad.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/22/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND The purpose of this cross-sectional study was to examine the influence of subthreshold posttraumatic stress disorder (PTSD) and full PTSD on quality of life following mild traumatic brain injury (mTBI). METHODS Participants were 734 service members and veterans (SMV) classified into two injury groups: uncomplicated mild TBI (MTBI; n = 596) and injured controls (IC, n = 139). Participants completed a battery of neurobehavioral measures, 12-or-more months post-injury, that included the PTSD Checklist Civilian version, Neurobehavioral Symptom Inventory, and select scales from the TBI-QOL and MPAI. The MTBI group was divided into three PTSD subgroups: No-PTSD (n = 266), Subthreshold PTSD (n = 139), and Full-PTSD (n = 190). RESULTS There was a linear relationship between PTSD severity and neurobehavioral functioning/quality of life in the MTBI sample. As PTSD severity increased, significantly worse scores were found on 11 of the 12 measures (i.e. , MTBI Full-PTSD > Sub-PTSD > No-PTSD). When considering the number of clinically elevated scores, a linear relationship between PTSD severity and neurobehavioral functioning/quality of life was again observed in the MTBI sample (e.g., 3-or-more elevated scores: Full-PTSD = 92.1 %, Sub-PTSD = 61.9 %, No-PTSD = 19.9 %). LIMITATIONS Limitations included the use of a self-report measure to determine diagnostic status that may under/overcount or mischaracterize individuals. CONCLUSION PTSD symptoms, whether at the level of diagnosable PTSD, or falling short of that because of the intensity or characterization of symptoms, have a significant negative impact on one's quality of life following MTBI. Clinicians' treatment targets should focus on the symptoms that are most troubling for an individual and the individual's perception of quality of life, regardless of the diagnosis itself.
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Affiliation(s)
- Louis M French
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Tracey A Brickell
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; Contractor, General Dynamics Information Technology, Silver Spring, MD, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Sara M Lippa
- Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Alicia A Rogers
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; CICONIX, Annapolis, MD, USA
| | - Kendal E Cristaudo
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; CICONIX, Annapolis, MD, USA
| | - Thomas T Walker
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; CICONIX, Annapolis, MD, USA
| | - Molly Higgins
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; University of Colorado, Colorado Springs, CO, USA
| | - Jason M Bailie
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Contractor, General Dynamics Information Technology, Silver Spring, MD, USA; 33 Area Branch Clinic Camp Pendleton, CA, USA
| | - Jan Kennedy
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Contractor, General Dynamics Information Technology, Silver Spring, MD, USA; Brooke Army Medical Center, Joint Base San Antonio, TX, USA
| | - Lars Hungerford
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Contractor, General Dynamics Information Technology, Silver Spring, MD, USA; Naval Medical Center San Diego, CA, USA
| | - Rael T Lange
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; Contractor, General Dynamics Information Technology, Silver Spring, MD, USA; University of British Columbia, Vancouver, BC, Canada; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Martalek A, Dubertret C, Fovet T, Le Strat Y, Tebeka S. Distressing memories: A continuum from wellness to PTSD. J Affect Disord 2024; 363:198-205. [PMID: 39029679 DOI: 10.1016/j.jad.2024.07.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 07/09/2024] [Accepted: 07/14/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Exposure to traumatic events is a frequent source of distress, provoking isolated symptoms such as distressing memories (DM) to full-blown post-traumatic stress disorder (PTSD). We aimed to assess the continuum theory using DM as an isolated symptom, and to examine trauma consequences in a exposed to traumatic events. METHODS Using data from the National Epidemiologic Study of Alcohol and Related Conditions III, we assessed the prevalence of DM in a trauma exposed sample, and examined their sociodemographic and lifetime psychiatric correlates, comparing three groups: (i) controls (no DM, no PTSD); (ii) participants with isolated DM without PTSD; (iii) participants with PTSD. We estimated the sensitivity and specificity of DM for PTSD diagnosis. RESULTS In our sample of 17,505 participants exposed to trauma, 13 % had PTSD and 42 % had DM without PTSD. The sensitivity of DM for the diagnosis of PTSD was 95.14 %, specificity was 51.91 %. Participants with DM and those with PTSD shared the same socio-demographic correlates. Participants with DM reported more lifetime psychiatric disorders (mood disorders - mainly depressive disorders and bipolar type 1 disorder; anxiety disorders - mainly social anxiety disorder, substance use disorders - mainly opioid use disorder and cannabis disorder; eating disorders - mainly binge eating disorder; personality disorders - mainly borderline personality disorder- and suicidality) than controls, but less than participants with PTSD. CONCLUSION DM represent an intermediate state between well-being and post-traumatic stress disorder; DM is also associated with other psychiatric disorders. It should be considered as a transdiagnostic psychiatric symptom useful for clinicians in identifying psychiatric vulnerability.
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Affiliation(s)
- Alexandra Martalek
- Department of Psychiatry, Louis-Mourier Hospital, AP-HP, 92700 Colombes, France; Université Paris cité, Faculty of Medicine, Paris, France
| | - Caroline Dubertret
- Department of Psychiatry, Louis-Mourier Hospital, AP-HP, 92700 Colombes, France; Université Paris cité, Faculty of Medicine, Paris, France; INSERM U1266, Centre for Psychiatry and Neurosciences, 102 rue de la Santé, 75014 Paris, France
| | - Thomas Fovet
- Univ. Lille, Inserm, CHU Lille, U1172 - Lille Neuroscience & Cognition, F-59000 Lille, France
| | - Yann Le Strat
- Department of Psychiatry, Louis-Mourier Hospital, AP-HP, 92700 Colombes, France; Université Paris cité, Faculty of Medicine, Paris, France; INSERM U1266, Centre for Psychiatry and Neurosciences, 102 rue de la Santé, 75014 Paris, France
| | - Sarah Tebeka
- Department of Psychiatry, Louis-Mourier Hospital, AP-HP, 92700 Colombes, France; Université Paris cité, Faculty of Medicine, Paris, France.
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Lu W, Caldwell B, Gao N, Oursler J, Wang K, Beninato J, Srijeyanthan J, Kumi C, Sawyer J, Giacobbe G, Chen Y, Lin KWR, Mueser KT. Healing Trauma While Staying at Home: Using Telehealth to Conduct a Brief Treatment Program for Posttraumatic Stress Disorder. J Psychosoc Nurs Ment Health Serv 2024; 62:36-46. [PMID: 38095851 DOI: 10.3928/02793695-20231205-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Studies suggest that a three-session brief treatment program (Brief Relaxation, Education, and Trauma Healing [BREATHE]) can help treat posttraumatic stress disorder (PTSD) and symptoms of trauma; however, the program has not been examined via telehealth. Thus, the current study evaluated the feasibility of BREATHE delivered via telehealth. The intervention included breathing retraining and psychoeducation about PTSD and trauma. Thirty participants from the community with confirmed PTSD diagnoses participated in this telehealth program. Treatment retention was high, and participants showed decreased PTSD symptoms, posttraumatic cognitions, depression, anxiety, overall psychiatric symptoms, and internalized stigma and increased resiliency at posttreatment and 3-month follow up. Results suggest that a telehealth brief treatment program for PTSD is feasible and effective for individuals with PTSD. [Journal of Psychosocial Nursing and Mental Health Services, 62(7), 36-46.].
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Lagan S, Shott ME, Frank GKW. Adverse childhood experiences, low self-esteem, and salient stimulus response in eating disorders. EUROPEAN EATING DISORDERS REVIEW 2024; 32:618-632. [PMID: 38349113 DOI: 10.1002/erv.3064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/11/2023] [Accepted: 01/09/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are elevated in individuals with eating disorders (EDs), but how the neurobiology of EDs and ACEs interact is unclear. METHODS Women 18-45 years old with anorexia nervosa (AN, n = 38), bulimia nervosa (BN, n = 32), or healthy controls (n = 60) were assessed for ACEs and ED behaviours and performed a taste-conditioning task during brain imaging. Mediation analyses tested relationships between ACE score, self-esteem, and ED behaviours. RESULTS ACE scores were elevated in EDs and correlated positively with body mass index (p = 0.001), drive for thinness (p = 0.001), and body dissatisfaction (p = 0.032); low self-esteem mediated the relationship between ACEs and body dissatisfaction, drive for thinness, and bulimia severity. ACE scores correlated negatively (FDR-corrected) with unexpected, salient stimulus receipt in AN (substantia nigra) and BN (anterior cingulate, frontal and insular cortex, ventral striatum, and substantia nigra). When ACE scores were included in the model, unexpected stimulus receipt brain response was elevated in EDs in the anterior cingulate and ventral striatum. CONCLUSIONS ACEs attenuate unexpected salient stimulus receipt response, which may be a biological marker for altered valence or hedonic tone perception in EDs. Low self-esteem mediates the relationships between ACEs and ED behaviours. Adverse childhood experiences should be assessed in biological studies, and their effects targeted in treatment.
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Affiliation(s)
- Sarah Lagan
- University of California San Diego, School of Medicine, San Diego, California, USA
| | - Megan E Shott
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Guido K W Frank
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Rady Children's Hospital, San Diego, California, USA
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Levin-Aspenson HF, Greene AL. Rethinking trauma-related psychopathology in the Hierarchical Taxonomy of Psychopathology (HiTOP). J Trauma Stress 2024; 37:361-371. [PMID: 38270594 DOI: 10.1002/jts.23014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/17/2023] [Accepted: 12/12/2023] [Indexed: 01/26/2024]
Abstract
Research on trauma exposure and its consequences has made tremendous progress in elucidating the role of traumatic life events in the development and maintenance of psychopathology as well as in evaluating interventions aimed at addressing the personal and public burden of trauma-related psychopathology. However, there is growing concern that problems with predominant definitions of posttraumatic syndrome (e.g., content coverage and scope, within-category heterogeneity, excessive diagnostic comorbidity) limit further efforts to fully conceptualize trauma-related psychopathology and deliver appropriate, personalized interventions. As demonstrated by an impressive body of research over the past several years, the Hierarchical Taxonomy of Psychopathology (HiTOP) presents a compelling alternative to traditional nosologies in terms of empirically based characterizations of psychopathology phenotypes, with evidence of strong utility for research and clinical applications. However, HiTOP's primary focus on descriptive psychopathology has resulted in an unacceptable gap regarding the conceptualization of trauma-related psychopathology from a dimensional, transdiagnostic perspective. We see an important opportunity to clarify what HiTOP can offer the field of traumatic stress research and articulate a future for trauma-related psychopathology within HiTOP. We argue for disaggregating psychopathology symptoms from their purported causes and, instead, developing a detailed taxonomy of traumatic events alongside an ever-evolving HiTOP model. Doing so will help identify empirically based phenotypes of trauma-related psychopathology that (a) go beyond the traditional PTSD criterion sets and (b) allow for the possibility that different features of traumatic experiences (e.g., type, duration, subjective meaning) may be associated with different symptom sequelae across different psychopathology spectra.
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Affiliation(s)
| | - Ashley L Greene
- VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
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Holmes SC, Norton MK, Fogwell NT, Temes EE, Carr MM, Johnson DM. The impact of intuitive eating on the association between posttraumatic stress disorder (PTSD) symptoms and disordered eating among women who have experienced intimate partner violence (IPV). Eat Disord 2024:1-17. [PMID: 38796861 DOI: 10.1080/10640266.2024.2353475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
OBJECTIVE Trauma exposure is associated with disordered eating, with recent evidence suggesting PTSD symptoms may be a more proximal predictor. Intuitive eating is a well-established protective factor against disordered eating; however, no previous studies have assessed whether intuitive eating buffers the association between PTSD symptoms and disordered eating. METHODS Two hundred sixteen women who had experienced intimate partner violence (IPV) and were residing at a domestic violence shelter completed a survey. The current study assessed the moderating role of intuitive eating in the associations between PTSD symptoms and two types of disordered eating behaviors: binge eating and compensatory behaviors. RESULTS Intuitive eating did not moderate the association between PTSD symptoms and a dichotomous measure of binge eating (no binge eating vs. any binge eating). However, intuitive eating did moderate the association between PTSD symptoms and binge frequency, among participants endorsing any degree of binge eating, such that PTSD symptoms were significantly associated with binge frequency at low, but not moderate or high, levels of intuitive eating. Intuitive eating did not moderate the association between PTSD symptoms and compensatory behaviors. DISCUSSION Results suggest intuitive eating may be protective against binge eating frequency among women who have experienced IPV.
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Affiliation(s)
- Samantha C Holmes
- Department of Psychology, College of Staten Island, City University of New York, NY, Staten Island
| | - Marisa K Norton
- Department of Psychology, University of Akron Buchtel College of Arts and Sciences, Akron, OH, USA
| | - Nicole T Fogwell
- Department of Psychology, University of Akron Buchtel College of Arts and Sciences, Akron, OH, USA
| | - Erica E Temes
- Department of Psychology, University of Akron Buchtel College of Arts and Sciences, Akron, OH, USA
| | - Meagan M Carr
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Dawn M Johnson
- Department of Psychology, University of Akron Buchtel College of Arts and Sciences, Akron, OH, USA
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Tilstra-Ferrell EL, Braden A, Russin S. Military sexual trauma, combat trauma, and disordered eating among United States veterans: An exploration of underlying mechanisms. MILITARY PSYCHOLOGY 2024:1-12. [PMID: 38781487 DOI: 10.1080/08995605.2024.2336639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 03/22/2024] [Indexed: 05/25/2024]
Abstract
Military sexual trauma (MST) and combat trauma (CT) survivors experience disproportionate risk for disordered eating. A survey of MST, CT, disordered eating, trauma-related self-blame, emotion regulation challenges, body dissatisfaction, and dissociation among military personnel with a history of military-related trauma was conducted. These survey-based cross-sectional data were analyzed via parallel mediation analyses and Analyses of Covariance (ANCOVA). Six parallel mediation analyses were conducted examining trauma-related self-blame, emotion regulation challenges, body dissatisfaction, and dissociation as mediators linking MST and CT, separately, with purging, restricting, and bingeing. ANCOVAs were also performed to examine differences in levels of bingeing, restriction, and purging among people exposed to MST, CT, both MST and CT, and neither. MST and CT exposure was indirectly related to bingeing via emotion regulation challenges. MST and CT was also indirectly related to both restriction and purging via emotion regulation challenges and trauma-related self-blame. Dissociation and body dissatisfaction were not significant mediators in any model. Participants endorsed high levels of disordered eating. Individuals exposed to both MST and CT reported greater bingeing, restricting, and purging than individuals exposed to either CT, MST, or neither. Findings highlight the nuanced symptoms that may increase risk for disordered eating among MST and/or CT survivors. Future treatment research should explore how addressing emotion regulation and trauma-related self-blame among individuals with MST and/or CT may help address disordered eating. Implications and future directions for this area of research are discussed.
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Affiliation(s)
| | - Abby Braden
- Department of Psychology, Bowling Green State University (BGSU), Ohio
| | - Sarah Russin
- Department of Psychology, Bowling Green State University (BGSU), Ohio
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Bartone PT, Tripp KH. Stress, hardiness and eating disorder symptoms in military academy cadets. Eat Disord 2024:1-24. [PMID: 38709164 DOI: 10.1080/10640266.2024.2346681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Eating disorders are a persistent and debilitating problem, especially among college age men and women. This problem is exacerbated in occupations such as the military, where maintenance of strict standards regarding weight, fitness and appearance is important for job retention and promotion. Also, previous research confirms that stress is a contributing element to eating disorders. It is thus important to identify factors that may assist individuals to remain resilient and avoid stress-related health and eating difficulties. The present study utilizes historical data to examine the impact of stress on health and eating disorder symptoms in a representative sample of West Point military academy cadets, while testing the role of gender and hardiness as stress moderators in this relation. A survey containing measures of stress, hardiness and eating disorders symptoms was completed by 387 cadets in the fall and spring of 2000-2001. Moderation effects were tested with advanced conditional process analysis procedures developed recently by Hayes (2022). Results show that hardiness was a significant moderator, with cadets low in hardiness showing increased eating disorder symptoms and more general health symptoms. While gender was not a significant moderator with respect to eating disorder symptoms, it was significant for general health symptoms; female cadets showed more stress-related health symptoms than their male counterparts. These results suggest that eating disorder symptoms in military academy cadets and college students more generally may be reduced through programs aimed at developing hardiness attitudes and stress coping approaches.
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Affiliation(s)
- Paul T Bartone
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Kimberly H Tripp
- Emergency Medicine Department, St. Joseph Health Regional Hospital, Bryan, Texas, USA
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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; 25:947-964. [PMID: 37125723 PMCID: PMC10913314 DOI: 10.1177/15248380231167399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
There is growing evidence of prior experiences of trauma and trauma-related symptoms among people with eating disorders; however, there is little understanding as to how post-traumatic stress disorder (PTSD) and exposure to traumatic events affect treatment outcomes. Without this knowledge, eating disorder clinicians are unable to tailor treatment to ensure good outcomes for the large percentage of this population that is affected by PTSD and trauma. This systematic review aimed to identify how PTSD and trauma exposure influence outcomes in eating disorder treatment. Systematic searches of PsycINFO, MEDLINE, PubMed, and Scopus databases identified 16 articles that met the inclusion criteria. The results indicated a negative effect on rates of eating disorder treatment completion and eating disorder psychopathology posttreatment. These findings were evident across studies that investigated the impact of a history of traumatic events as well as studies that investigated the impact of the presence of trauma-related symptoms seen in PTSD. Several methodological limitations were identified in the literature. These include: heterogeneous and unstandardized measures of PTSD and trauma, high attrition rates with follow-up, and insufficient data to enable comparisons by treatment setting, diagnostic presentation, and type of trauma exposure. The findings of this review have implications for future research and clinical care, including the importance of considering PTSD and trauma in assessment, treatment planning, and provision of both trauma-informed care and trauma-focused treatments for individuals with eating disorders.
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Affiliation(s)
- Sinead Day
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, NSW, Australia
- Mental Health Services Camden and Campbelltown Hospitals, South West Sydney Local Health District, NSW, Australia
| | - Wadad. Kathy Tannous
- Translational Health Research Institute, School of Business, Western Sydney University, Penrith, NSW, Australia
| | - Scott J. Fatt
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
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Mendoza RR, Convertino AD, Blashill AJ. A longitudinal study of potentially traumatic events and binge-purge eating disorder onset in children. Appetite 2024; 193:107132. [PMID: 37995848 DOI: 10.1016/j.appet.2023.107132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023]
Abstract
Although the association between childhood trauma and subsequent binge-purge spectrum eating disorders (BP-EDs) is established in adult samples, little is known about the temporal association between potentially traumatic life events and BP-ED onset in children. Using longitudinal data from the U.S.-nationwide Adolescent Brain Cognitive Development (ABCD) study with children aged 9-10 at baseline, logistic regression with complex sampling assessed the longitudinal association of exposure to potentially traumatic events (PTEs) at baseline and meeting BP-ED criteria one year later. Children exposed to PTEs prior to baseline had 1.91 times greater odds of being diagnosed with a BP-ED one year later (95% CI: 1.26 - 2.90; p = .004), compared to those who had not experienced a PTE. The current study extends previous cross-sectional research to show a significant temporal association between childhood PTEs before ages 9-10 and the subsequent onset of BP-EDs one year later. Future research should consider specific timing of PTE exposure as well as examining children diagnosed with restrictive eating disorders.
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Affiliation(s)
- Rebecca R Mendoza
- Department of Psychology, College of Sciences, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Alexandra D Convertino
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA
| | - Aaron J Blashill
- Department of Psychology, College of Sciences, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA.
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12
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Isaksson M, Isaksson J, Schwab-Stone M, Ruchkin V. Longitudinal associations between community violence exposure, posttraumatic stress symptoms, and eating disorder symptoms. J Eat Disord 2024; 12:6. [PMID: 38212849 PMCID: PMC10785541 DOI: 10.1186/s40337-024-00965-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Eating disorder (ED) symptoms have been associated with different types of traumatic events, such as exposure to sexual and physical violence, and emotional abuse. However, the relation between ED symptoms and community violence exposure (CVE) is underexplored, despite the latter's adverse effects on many aspects of adolescent functioning. The primary aim of this study was to evaluate the relation between CVE and ED symptoms in adolescents, while also investigating the potential mediating and moderating roles of posttraumatic stress (PTS) symptoms, gender, and ethnicity. METHODS Data were collected longitudinally over two consecutive years in the city of New Haven, CT, in the United States. Participants were 2612 adolescent students from the public school system (1397 girls and 1215 boys) with an average age of 12.8 years (SD = 1.29). The students were comprised of several different ethnic groups, including Caucasians, African Americans and Hispanic Americans. Associations between CVE (no exposure, witnessing, and victimization) and PTS symptoms at year one, and ED symptoms (thoughts and compensatory behaviors) at year two, were assessed with self-rating instruments. Moderation and mediation analyses were conducted using a variant of linear regression (Hayes PROCESS macro). RESULTS ED symptoms at year two were significantly associated with both witnessing and being a victim of community violence at year one, with most or all of the relations being explained by PTS symptoms. Overall, neither gender nor ethnicity had a meaningful moderating effect in the observed relations. CONCLUSIONS The findings support the notion that assessing and addressing PTS symptoms might be beneficial when treating individuals with ED symptoms who have experienced community violence, irrespective of gender or ethnicity.
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Affiliation(s)
- Martina Isaksson
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, S-751 85, Uppsala, Sweden
| | - Johan Isaksson
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, S-751 85, Uppsala, Sweden
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Mary Schwab-Stone
- Child Study Center, Yale University School of Medicine, New Haven, USA
| | - Vladislav Ruchkin
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, S-751 85, Uppsala, Sweden.
- Child Study Center, Yale University School of Medicine, New Haven, USA.
- Sala Forensic Psychiatric Clinic, Sala, Sweden.
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Zelkowitz RL, Kehle-Forbes SM, Smith BN, Vogt DS, Mitchell KS. Associations between DSM-5 posttraumatic stress disorder Criterion E2 endorsement and selected self-destructive behaviors in recent-era veterans: A focus on disordered eating. J Trauma Stress 2023; 36:1001-1009. [PMID: 37485630 DOI: 10.1002/jts.22960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 04/28/2023] [Accepted: 04/30/2023] [Indexed: 07/25/2023]
Abstract
Revisions to the posttraumatic stress disorder (PTSD) criteria in the DSM-5 included a new criterion in the alterations in arousal and reactivity cluster (i.e., engagement in reckless and self-destructive behaviors; Criterion E2). Despite its clinical significance, little is known about how this symptom corresponds to engagement in specific direct and indirect self-harm behaviors. We examined associations between E2 and self-reported recent engagement in direct and indirect self-harm behaviors, including disordered eating, which is not included in the prototypical E2 symptom scope, in a trauma-exposed sample of 1,010 recent-era veterans (61.5% self-identified women, 38.5% self-identified men). We also tested whether gender moderated these associations. We repeated analyses in a subsample of participants with clinically elevated PTSD symptoms. Participants self-reported past-month PTSD symptoms (PCL-5) as well as past-month nonsuicidal self-injury, suicidal ideation, suicide planning, fasting, purging, binge eating, compulsive exercise, and problematic alcohol and drug use. We found no evidence for moderation by gender for any of the behaviors examined in the main sample. However, after controlling for gender and demographic covariates, weighted logistic regressions showed small, significant associations between E2 score and direct self-harm behaviors, substance use, purging, and binge eating, aORs = 1.30-1.91. Criterion E2 was linked to behaviors included in the typical symptom scope (self-directed violence, substance use) and those that are not (disordered eating behaviors). Comprehensive screening for self-destructive behaviors, including disordered eating, among veteran men and women who endorse Criterion E2 is indicated.
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Affiliation(s)
- Rachel L Zelkowitz
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Shannon M Kehle-Forbes
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Brian N Smith
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Dawne S Vogt
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Karen S Mitchell
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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14
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Ali M, Oble MJP, Sonia SN, George S, Shahi SR, Ali Z, Abaza A, Jamil A, Gutlapalli SD, Khan S. A Systematic Review of Quantitative and Qualitative Results of Randomized Controlled Trials Assessing the Effect of Yoga in Adult Women With Post-traumatic Stress Disorder: What Is Known So Far. Cureus 2023; 15:e47765. [PMID: 38021711 PMCID: PMC10676296 DOI: 10.7759/cureus.47765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Yoga has been increasingly practiced in recent years, with many of its practitioners being female. Adults may seek a complementary and alternative medicine (CAM) modality, such as yoga, to attempt to alleviate symptoms related to mental health conditions such as post-traumatic stress disorder (PTSD). Our goal for this systematic review was to collect and analyze all available data from quantitative and qualitative reports of randomized controlled trials (RCTs) conducted over the past 10 years on the impact of yoga on women diagnosed with PTSD. We included RCTs with the adult female population in which yoga was practiced for more than one week. We searched the databases PubMed, PubMed Central (PMC), and MEDLINE on June 11, 2022, Embase on June 12, 2022, and Science Direct on June 13, 2022, to find relevant articles. With the Cochrane RoB2 tool and Critical Appraisal Skills Programme (CASP) criteria, we checked for their quality, after which we selected 13 high-quality reports comprising seven original study designs and a total of 496 women. Of the 13 reports, nine evaluated effectiveness, four assessed feasibility, three explored acceptability, and four identified qualitative themes. We compared the results based on the assessed themes. Our results found yoga effective, feasible, acceptable, and a viable interoceptive pathway for emotional and personal growth. Limitations in our study include insufficient papers with large sample sizes and not including papers other than RCTs. With our research, we hope to present healthcare providers with research-based data on the effects of yoga so that they may better navigate its role in therapy as the trend of seeing more patients taking an interest in such alternative approaches rises.
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Affiliation(s)
- Marya Ali
- Psychiatry Clinical Research, Nishtar Medical University, Multan, PAK
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mrinal J P Oble
- Medicine, Kempegowda institute of Medical Sciences and Research Centre, Bengaluru, IND
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Shamsun Nahar Sonia
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Srushti R Shahi
- Medicine, St. Martinus University Faculty of Medicine (SMUFOM), Willemstad, CUW
| | - Zahra Ali
- Medicine, Bolan University of Medical and Health Sciences, Quetta, PAK
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Abdelrahman Abaza
- Pathology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aneeque Jamil
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sai Dheeraj Gutlapalli
- Internal Medicine, Richmond University Medical Center Affiliated With Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
- Internal Medicine Clinical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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15
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Hamatani S, Matsumoto K, Andersson G, Tomioka Y, Numata S, Kamashita R, Sekiguchi A, Sato Y, Fukudo S, Sasaki N, Nakamura M, Otani R, Sakuta R, Hirano Y, Kosaka H, Mizuno Y. Guided Internet-Based Cognitive Behavioral Therapy for Women With Bulimia Nervosa: Protocol for a Multicenter Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e49828. [PMID: 37725414 PMCID: PMC10548332 DOI: 10.2196/49828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/24/2023] [Accepted: 08/24/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Individual face-to-face cognitive behavioral therapy is known to be effective for bulimia nervosa (BN). Since foods vary considerably between regions and cultures in which patients live, cultural adaptation of the treatment program is particularly important in cognitive behavioral therapy for BN. Recently, an internet-based cognitive behavioral therapy (ICBT) program was developed for Japanese women with BN, adapted to the Japanese food culture. However, no previous randomized controlled trial has examined the effectiveness of ICBT. OBJECTIVE This paper presents a research protocol for strategies to examine the effects of guided ICBT. METHODS This study is designed as a multicenter, prospective, assessor-blinded randomized controlled trial. The treatment groups will be divided into treatment as usual (TAU) alone as the control group and ICBT combined with TAU as the intervention group. The primary outcome is the total of binge eating and purging behaviors assessed before and after treatment by an independent assessor. Secondary outcomes will include measures of eating disorder severity, depression, anxiety, quality of life, treatment satisfaction, and working alliances. Treatment satisfaction and working alliances will be measured post assessment only. Other measures will be assessed at baseline, post intervention, and follow-up, and the outcomes will be analyzed on an intention-to-treat basis. RESULTS This study will be conducted at 7 different medical institutions in Japan from August 2022 to October 2026. Recruitment of participants began on August 19, 2022, and recruitment is scheduled to continue until July 2024. The first participants were registered on September 8, 2022. CONCLUSIONS This is the first multicenter randomized controlled trial in Japan comparing the effectiveness of ICBT and TAU in patients with BN. TRIAL REGISTRATION University Hospital Medical Information Network UMIN000048732; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000055522. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/49828.
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Affiliation(s)
- Sayo Hamatani
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Division of Developmental Higher Brain Functions, United Graduate School of Child Development, University of Fukui, Fukui, Japan
- Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Fukui, Japan
| | - Kazuki Matsumoto
- Division of Clinical Psychology, Kagoshima University Hospital, Kagishima, Japan
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Science, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Yukiko Tomioka
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Shusuke Numata
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Rio Kamashita
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Atsushi Sekiguchi
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yasuhiro Sato
- Department of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Japan
| | - Shin Fukudo
- Department of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Japan
| | - Natsuki Sasaki
- Department of Psychiatry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Masayuki Nakamura
- Department of Psychiatry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Ryoko Otani
- Child Development and Psychosomatic Medicine Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Ryoichi Sakuta
- Child Development and Psychosomatic Medicine Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Yoshiyuki Hirano
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Hirotaka Kosaka
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Division of Developmental Higher Brain Functions, United Graduate School of Child Development, University of Fukui, Fukui, Japan
- Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Fukui, Japan
- Department of Neuropsychiatry, University of Fukui, Fukui, Japan
| | - Yoshifumi Mizuno
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Division of Developmental Higher Brain Functions, United Graduate School of Child Development, University of Fukui, Fukui, Japan
- Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Fukui, Japan
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16
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Hoover LV, Yu HP, Duval ER, Gearhardt AN. Investigating gender differences in the co-occurrence of PTSD and food addiction. Appetite 2023; 187:106605. [PMID: 37236363 DOI: 10.1016/j.appet.2023.106605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) commonly co-occurs with substance use disorders (SUDs). Past studies suggest PTSD is also associated with food addiction (compulsive intake of highly processed foods containing refined carbohydrates and/or added fat). However, research investigating gender differences has been limited (e.g., restricted samples) and mixed. We aim to investigate the risk of co-occurring PTSD and food addiction in a community sample for all participants and stratified by gender. Additionally, we conducted risk ratios for problematic substance use and obesity to allow for within-sample comparisons. METHOD We utilized a sample of 318 participants recruited from Amazon Mechanical Turk (mean age = 41.2, 47.8% men, 78.0% white) to address existing gaps in the literature on PTSD and food addiction. We calculated risk ratios (adjusted for sociodemographic covariates) using modified Poisson regression with 95% confidence intervals. Results were also gender stratified. RESULTS Risk of food addiction (Risk Ratio (RR) = 6.42, 95% CI [4.10, 10.07], problematic alcohol use (RR) = 3.86, 95% CI [2.25,6.62], problematic smoking (RR) = 3.93, 95% CI [2.22, 6.97], and problematic nicotine vaping (RR) = 5.41, 95% CI [2.41, 11.14] were higher for those meeting criteria for PTSD. Risk of problematic cannabis use, and risk of obesity were not significantly higher for those meeting criteria for PTSD. Gender-stratified results suggest risk of food addiction may be higher for men (RR) = 8.54, 95% CI [4.49, 16.25] compared to women (RR) = 4.32, 95% CI [2.16, 8.62]. DISCUSSION Food addiction, but not obesity, appears to co-occur with PTSD more strongly than other types of problematic substance use (alcohol, cannabis, cigarettes, nicotine vaping). This risk appears to be particularly high for men compared to women. Assessing for food addiction in those with PTSD, particularly in men, may assist in identifying high-risk groups.
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Affiliation(s)
- Lindzey V Hoover
- Department of Psychology, University of Michigan, Ann Arbor, USA.
| | - Hayley P Yu
- Department of Psychology, University of Michigan, Ann Arbor, USA
| | - Elizabeth R Duval
- Department of Psychology, University of Michigan, Ann Arbor, USA; Department of Psychiatry, University of Michigan, Ann Arbor, USA
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17
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Convertino AD, Mendoza RR. Posttraumatic stress disorder, traumatic events, and longitudinal eating disorder treatment outcomes: A systematic review. Int J Eat Disord 2023; 56:1055-1074. [PMID: 36916450 PMCID: PMC10247514 DOI: 10.1002/eat.23933] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Many individuals diagnosed with an eating disorder (ED) have been exposed to traumatic events, and some of these individuals are diagnosed with posttraumatic stress disorder (PTSD). Although theorized by researchers and clinicians, it is unclear whether traumatic event exposure or PTSD interferes with outcomes from ED treatment. The objective of the current study was to systematically review the literature on traumatic events and/or PTSD as either predictors or moderators of psychological treatment outcomes in EDs. METHOD A PRISMA search was conducted to identify studies that assessed the longitudinal association between traumatic events or PTSD and ED outcomes. Eighteen articles met the inclusion criteria for review. RESULTS Results indicated that traumatic event exposure was associated with greater ED treatment dropout, but individuals with a traumatic event history benefited from treatment similarly to their unexposed peers. Findings also indicated that traumatic events may be associated with greater symptom relapse posttreatment. DISCUSSION Given the limited number of studies examining PTSD, results are considered very tentative; however, similar to studies comparing trauma-exposed and nontrauma-exposed participants, individuals with PTSD may have similar treatment gains compared to individuals without PTSD, but individuals with PTSD may experience greater symptom relapse posttreatment. Future researchers are encouraged to examine whether trauma-informed care or integrated treatment for EDs and PTSD mitigates dropout from treatment and improves symptom remission outcomes. Furthermore, researchers are encouraged to examine how the developmental timing of traumatic events, self-perceived impact of trauma, and cumulative trauma exposure may be associated with differential ED treatment outcomes. PUBLIC SIGNIFICANCE Eating disorders (EDs), trauma, and posttraumatic stress disorder (PTSD) often co-occur. Individuals with traumatic event exposure and/or PTSD demonstrate greater ED symptoms; it is unclear whether these individuals benefit similarly in ED treatment to their peers. The current study found that individuals with traumatic event exposure are more likely to drop out of treatment but benefit from treatment with similar symptom remission. Traumatic history was associated with greater relapse posttreatment.
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Affiliation(s)
- Alexandra D. Convertino
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA
| | - Rebecca R. Mendoza
- Department of Psychology, College of Sciences, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
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18
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Sandhu D, Dougherty EN, Haedt-Matt A. PTSD symptoms as a potential mediator of associations between military sexual assault and disordered eating. Eat Disord 2023; 31:285-299. [PMID: 36239705 DOI: 10.1080/10640266.2022.2133586] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Despite increasing rates of sexual assault in the military and high rates of disordered eating and post-traumatic stress disorder (PTSD) among veterans, little is known about how these constructs are related. This study examined whether PTSD symptoms mediate the relation between military sexual assault and disordered eating among female veterans. United States female veterans (N = 98) completed self-report measures assessing military sexual assault, PTSD, and disordered eating. Results indicated that military sexual assault was associated with higher PTSD symptoms and disordered eating. PTSD symptoms did not mediate the relation between military sexual assault and overall levels of disordered eating. However, PTSD symptoms fully mediated the relation between military sexual assault and the Bulimia and Food Preoccupation subscale of the Eating Attitudes Test-26. Findings suggest that military sexual assault may contribute to the development of bulimia nervosa symptoms indirectly through PTSD symptoms. Thus, the findings do not support a global relationship between trauma and all facets of disordered eating, but demonstrate a relationship between PTSD and bulimia nervosa symptoms, with purging potentially functioning as an emotion regulation strategy. Future longitudinal studies are needed to establish temporal precedence of these associations.
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Affiliation(s)
- Danielle Sandhu
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
| | | | - Alissa Haedt-Matt
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
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19
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Nelson JD, Martin LN, Izquierdo A, Kornienko O, Cuellar AE, Cheskin LJ, Fischer S. The role of discrimination and adverse childhood experiences in disordered eating. J Eat Disord 2023; 11:29. [PMID: 36850009 PMCID: PMC9969653 DOI: 10.1186/s40337-023-00753-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/10/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND In clinical research, there has been a call to move beyond individual psychosocial factors towards identifying cultural and social factors that inform mental health. Similar calls have been made in the eating disorders (ED) field underscoring the need to understand larger sociocultural influences on EDs. Discrimination is a social stressor that may influence mental health in similar ways to traumatic or adverse childhood experiences (ACEs). Given the high rates of EDs and discrimination among marginalized groups, it is vital to understand the role of discrimination and ACEs as predictors of ED symptoms in these populations. The aim of this study is to examine how perceived discrimination predicts ED pathology when statistically adjusting for gender, race, and ACEs. METHODS The diverse study sample consisted of 331 undergraduate students from a longitudinal cohort study (ages 18-24; 66% female; 35% White/non-Hispanic). Participants completed measures of everyday discrimination, ACEs, and ED pathology. RESULTS Following adjustment for multiple statistical comparisons, the frequency of daily discrimination predicted all ED symptoms above and beyond history of ACEs. In follow-up analyses, number of reasons for discrimination predicted cognitive restraint and purging. Differences in ED symptomatology were found based on the reason for discrimination, gender, and race. Specifically, those who experienced weight discrimination endorsed higher scores on all ED symptoms, and those experiencing gender discrimination endorsed higher body dissatisfaction, cognitive restraint, and restriction. People of color endorsed higher restriction, while female participants endorsed higher scores on all ED symptom with the exception of cognitive restraint. CONCLUSION Discrimination is a salient risk factor for ED symptoms even when accounting for individuals' history of ACEs. Future research should utilize an intersectional approach to examine how perceived discrimination affects ED pathology over time. (Word count: 234).
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Affiliation(s)
- Jillian D Nelson
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA.
| | - Laura N Martin
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Alyssa Izquierdo
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Olga Kornienko
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Alison E Cuellar
- Department of Health Administration and Policy, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Lawrence J Cheskin
- Department of Nutrition and Food Studies, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Sarah Fischer
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
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20
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Sauer KS, Wendler-Bödicker C, Boos A, Niemeyer H, Palmer S, Rojas R, Hoyer J, Hitzler M. Treatment of Comorbid Disorders, Syndromes, and Symptoms of Posttraumatic Stress Disorder Related to Childhood Maltreatment with STAIR-NT. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2023. [DOI: 10.1026/1616-3443/a000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Abstract. Background: Early interpersonal traumatic events, such as childhood maltreatment, increase the risk of developing complex posttraumatic stress symptoms. The biphasic treatment program STAIR-NT (Skills Training for Affective and Interpersonal Regulation with Narrative Therapy), developed specifically for this patient group, combines interventions to improve emotion regulation and interpersonal skills with narrative therapy. Objective: Many affected patients with PTSD after childhood maltreatment also suffer from various comorbid mental disorders and symptoms that can affect and impede the course and outcome of treatment with STAIR-NT. Method: Based on experience from a current treatment study, we provide recommendations for integrating treatment of comorbid mental symptoms into STAIR-NT. Results / Conclusion: Training affective and interpersonal regulation skills in the first treatment phase offers various interventions to efficiently adapt transdiagnostic mechanisms such as emotion dysregulation. In cases of severe comorbid mental disorders or symptoms, adding disorder-specific interventions to STAIR-NT may be indicated.
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Affiliation(s)
- Karoline Sophie Sauer
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University of Mainz, Germany
| | | | - Anne Boos
- Psychotherapy Practice in Großhartau, Germany
| | - Helen Niemeyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Germany
| | - Sebastian Palmer
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Gießen, Germany
| | - Roberto Rojas
- University Psychotherapeutic Outpatient Clinic, Institute of Psychology and Education, Ulm University, Germany
| | - Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Melissa Hitzler
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Germany
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21
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Bonfada Collares Machado A, Teruya KI, Friedman R, Weydmann GJ, Remor E, Bizarro L. Gender differences in the pathway of childhood trauma, impulsivity and adult eating behaviour: a cross-sectional study. J Child Adolesc Ment Health 2023; 35:42-54. [PMID: 38638062 DOI: 10.2989/17280583.2023.2293904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Objective: The current cross-sectional study aimed to examine the association between childhood trauma, impulsivity, binge eating symptoms, and body mass index (BMI) in a sample of males and females. We also aimed to investigate the indirect association of childhood trauma with binge eating through impulsivity while controlling for BMI.Method: Participants were 410 young adults (mean age = 20.9 years, range 18-24; female = 73.9%) who completed online measures of childhood trauma, impulsivity, binge eating symptoms, and self-reported height and weight. Mediation models were tested using multi-group structural equation modelling.Results: Childhood trauma and impulsivity were associated with an increased risk of binge eating symptoms in females but not males, corroborating previous studies. There was a significant difference in the binge eating symptoms index between sexes, but not regarding the index of childhood trauma and impulsivity. Additionally, adverse childhood experiences were associated with impulsivity and the association of childhood trauma with binge eating was mediated by impulsivity in the female sample.Conclusions: Our results suggest sex-dependent patterns and risk factors that may impact binge eating symptoms. The implications of our results suggest that impulsivity might be a vulnerability factor for binge eating, especially for females.
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Affiliation(s)
- Antônio Bonfada Collares Machado
- Graduate Program in Psychology, Department of Developmental and Personality Psychology, Institute of Psychology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Katia Irie Teruya
- Graduate Program in Psychology, Department of Developmental and Personality Psychology, Institute of Psychology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rogério Friedman
- Programa de Pós-Graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Division of Endocrinology and Metabolism, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Gibson Juliano Weydmann
- Graduate Program in Psychology, Department of Developmental and Personality Psychology, Institute of Psychology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Eduardo Remor
- Graduate Program in Psychology, Department of Developmental and Personality Psychology, Institute of Psychology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Lisiane Bizarro
- Graduate Program in Psychology, Department of Developmental and Personality Psychology, Institute of Psychology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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22
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Holmes SC, King KC, Gonzalez A, Norton MK, Silver KE, Sullivan TP, Johnson DM. Associations among Intimate Partner Violence, Posttraumatic Stress Disorder Symptoms, and Disordered Eating among Women Intimate Partner Violence Survivors Residing in Shelter. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:NP2135-NP2158. [PMID: 35536767 PMCID: PMC9993353 DOI: 10.1177/08862605221098968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Previous research has not assessed the association between intimate partner violence (IPV) and disordered eating (DE), nor the potential indirect effect through posttraumatic stress disorder (PTSD) symptoms, among residents of IPV shelters. Among 212 IPV survivors, this study examined these and the differential associations by PTSD symptom cluster and types of DE. In the current sample, 67.9% met criteria for probable PTSD, 20.3% met criteria for a probable eating disorder, and 18.4% had probable comorbid diagnoses. Consistent with escape theory, there was an indirect effect of IPV on DE through PTSD symptoms. Additionally, there was an indirect effect of IPV on weight/shape concerns and binge symptoms through PTSD symptoms. Although there was a significant total effect of IPV on compensatory behaviors, there was no indirect effect through PTSD symptoms. When PTSD symptom clusters were examined concurrently, the only indirect effect of IPV on weight/shape concerns was via the PTSD symptom cluster of negative alterations in cognition and mood. Although there was an indirect effect of IPV on binge symptoms via PTSD symptoms overall, no specific PTSD symptom cluster drove this association. Implications highlight the need for attention to DE within this population. Consistent with escape theory, survivors' DE might serve to distract from psychological distress.
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Affiliation(s)
- Samantha C. Holmes
- Department of Psychology, College of Staten Island, City University of New York, Staten Island, NY, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Kiarra C. King
- Department of Psychology, University of Akron, Akron, OH, USA
| | | | | | | | - Tami P. Sullivan
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Dawn M. Johnson
- Department of Psychology, University of Akron, Akron, OH, USA
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Ten Napel-Schutz MC, Karbouniaris S, Mares SHW, Arntz A, Abma TA. Perspectives of underweight people with eating disorders on receiving Imagery Rescripting trauma treatment: a qualitative study of their experiences. J Eat Disord 2022; 10:188. [PMID: 36451217 PMCID: PMC9710063 DOI: 10.1186/s40337-022-00712-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The prognosis for underweight individuals with an eating disorder (ED) and posttraumatic stress disorder (PTSD) is worse than for their peers without these comorbid symptoms. This qualitative study explores the experiences of trauma-focused Imagery Rescripting (ImRs) therapy of underweight inpatients being treated for an ED. OBJECTIVE To test the feasibility and to improve ImRs by understanding the experiences and perspectives of people with an ED and PTSD who, when underweight, received ImRs as an adjunct to their inpatient ED treatment. METHOD To explore how underweight people with an ED experience and perceive ImRs, we used a qualitative study design involving semi-structured interviews with 12 participants. After analysis, the data were summarized and classified within a thematic framework that focused on experiences and improving the ImRs method. RESULTS The thematic analysis resulted in the following 6 main themes; (1) Expectations of ImRs; (2) Ability to participate in ImRs; (3) Effect of ImRs; (4) Experience of ImRs technique; (5) Conditions under which ImRs is given; (6) In depth-analysis. The results show that despite the fear of disappointment the participants appreciate addressing the PTSD and ED symptoms simultaneously. Further, results showed that it had been possible for them to attend ImRs but that the effects of ImRs were not uniformly perceived. Also, participants indicated that a caring context is important and that ImRs should not be scheduled immediately before a meal. Finally, the treatment generated hope. CONCLUSIONS The findings of this study demonstrated the feasibility of the integration of ImRs trauma treatment for individuals who are being treated in an ED inpatient treatment setting, and are in contrast to standard practice where the focus of inpatient treatment has been ED-symptom improvement without comprehensively addressing past traumatic experiences during an underweight phase. Trial registration International Clinical Trials Registry Platform (ICTRP) (NTR6094). Date of registration 09/23/2016. https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6094.
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Affiliation(s)
- Marieke C Ten Napel-Schutz
- Department of Eating Disorders (Amarum), GGNet Mental Health, Warnsveld, The Netherlands. .,Radboud Centre Social Sciences, Radboud University, Nijmegen, The Netherlands.
| | - Simona Karbouniaris
- Utrecht University of Applied Sciences, Utrecht, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Suzanne H W Mares
- Department of Eating Disorders (Amarum), GGNet Mental Health, Warnsveld, The Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Tineke A Abma
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
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Chu J, Raney JH, Ganson KT, Wu K, Rupanagunta A, Testa A, Jackson DB, Murray SB, Nagata JM. Adverse childhood experiences and binge-eating disorder in early adolescents. J Eat Disord 2022; 10:168. [PMID: 36384578 PMCID: PMC9670461 DOI: 10.1186/s40337-022-00682-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are common and linked to negative health outcomes. Previous studies have found associations between ACEs and binge-eating disorder (BED), though they have mainly focused on adults and use cross-sectional data. The objective of this study was to examine the associations between ACEs and BED in a large, national cohort of 9-14-year-old early adolescents in the US. METHODS We analyzed prospective cohort data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 10,145, 2016-2020). Logistic regression analyses were used to determine the associations between self-reported ACEs and BED based on the Kiddie Schedule for Affective Disorders and Schizophrenia at two-year follow-up, adjusting for sex, race/ethnicity, baseline household income, parental education, site, and baseline binge-eating disorder. RESULTS In the sample, (49% female, 46% racial/ethnic minority), 82.8% of adolescents reported at least one ACE and 1.2% had a diagnosis of BED at two-year follow-up. The mean number of ACEs was higher in those with a diagnosis of BED compared to those without (2.6 ± 0.14 vs 1.7 ± 0.02). The association between number of ACEs and BED in general had a dose-response relationship. One ACE (adjusted odds ratio [aOR] 3.48, 95% confidence interval [CI] 1.11-10.89), two ACEs (aOR 3.88, 95% CI 1.28-11.74), and three or more ACEs (aOR 8.94, 95% CI 3.01-26.54) were all associated with higher odds of BED at two-year follow-up. When stratified by types of ACEs, history of household mental illness (aOR 2.18, 95% 1.31-3.63), household violence (aOR 2.43, 95% CI 1.42-4.15), and criminal household member (aOR 2.14, 95% CI 1.23-3.73) were most associated with BED at two-year follow-up. CONCLUSIONS Children and adolescents who have experienced ACEs, particularly household challenges, have higher odds of developing BED. Clinicians may consider screening for ACEs and providing trauma-focused care when evaluating patients for BED.
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Affiliation(s)
- Jonathan Chu
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA
| | - Julia H Raney
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada
| | - Kelsey Wu
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA
| | - Ananya Rupanagunta
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA
| | - Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Stuart B Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA.
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25
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Brewerton TD. Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span. J Eat Disord 2022; 10:162. [PMID: 36372878 PMCID: PMC9661783 DOI: 10.1186/s40337-022-00696-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Multiple published sources from around the world have confirmed an association between an array of adverse childhood experiences (ACEs) and other traumatic events with eating disorders (EDs) and related adverse outcomes, including higher morbidity and mortality. METHODS In keeping with this Special Issue's goals, this narrative review focuses on the ACEs pyramid and its purported mechanisms through which child maltreatment and other forms of violence toward human beings influence the health and well-being of individuals who develop EDs throughout the life span. Relevant literature on posttraumatic stress disorder (PTSD) is highlighted when applicable. RESULTS At every level of the pyramid, it is shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide. CONCLUSIONS The implications of these cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. This overview offers multiple opportunities at every level for the palliation and prevention of EDs and other associated trauma-related conditions, including PTSD.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
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26
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Urban B, Knutson D, Klooster D, Soper J. Social and contextual influences on eating pathology in transgender and nonbinary adults. Eat Disord 2022; 31:301-319. [PMID: 36325725 DOI: 10.1080/10640266.2022.2135715] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Eating pathology (EP) is reported at alarmingly high rates among transgender and nonbinary (TNB) people. The present study investigates key associations between experiences that are common in TNB populations and EP. TNB individuals located within the United States (N = 212) who self-identified as currently experiencing disordered eating or an eating disorder were recruited from social media outlets and completed an online survey that included measures of EP, discrimination-based trauma symptoms, internalized transphobia, and gender dysphoria. The average age of participants was just over 27 years old (SD = 6.22) and the majority of participants (68.9%) were nonbinary. Data were analyzed using IBM SPSS version 28 and PROCESS 4.0. Discrimination trauma [β = .27, t(211) = 3.90, p < .001] and internalized transphobia [β = .21, t(211) = 3.03, p = .003] were significant predictors of EP in a multiple regression model. Additionally, internalized transphobia partially mediated the association between discrimination trauma and EP. Findings reinforce the need for trauma-informed and multiculturally competent provision of services for TNB populations presenting with eating concerns. Results also highlight the complex role that previously unexplored variables play in the etiology of EP for TNB populations. Implications and clinical recommendations are discussed.
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Affiliation(s)
- Bek Urban
- School of Community Health Sciences, Counseling & Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Douglas Knutson
- School of Community Health Sciences, Counseling & Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Dannie Klooster
- School of Community Health Sciences, Counseling & Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Jules Soper
- School of Community Health Sciences, Counseling & Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
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Holmes SC, Johnson NL, Johnson DM. Understanding the relationship between interpersonal trauma and disordered eating: An extension of the model of psychological adaptation. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2022; 14:1175-1183. [PMID: 31789533 PMCID: PMC7263979 DOI: 10.1037/tra0000533] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Interpersonal trauma is a nonspecific risk factor for disordered eating (DE). Studies have begun to examine mechanisms that explain the relationship; however, few have tested comprehensive theoretical models. The Model of Psychological Adaptation (McCann, Sakheim, & Abrahamson, 1988) posits that trauma exposure results in core schema disruptions that are associated with varying psychological response patterns, or psychological adaptations, that are also established predictors of DE, such as interpersonal and affective problems. The model has been successfully applied to symptoms of other psychological disorders, such as PTSD and depression, but has not previously been extended to predict DE. The current study addressed this gap in the literature by assessing an extension of the Model of Psychological Adaptation to DE. METHOD A sample of 371 undergraduate women completed an online survey. RESULTS Using structural equation modeling, the results of the current study demonstrated positive fit for a model that represents the extension of the Model of Psychological Adaptation to DE. CONCLUSION These findings corroborate the link between interpersonal trauma and DE, thus demonstrating the potential importance of assessing for DE symptoms among clients who have survived interpersonal trauma and attending to trauma history among clients who have DE. In addition, it highlights mechanisms that may be relevant to the conceptualization and treatment of DE among survivors of interpersonal trauma. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Samantha C. Holmes
- Yale School of Medicine, Department of Psychiatry
- University of Akron, Department of Psychology
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28
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Simpson LE, Raudales AM, Reyes ME, Sullivan TP, Weiss NH. Intimate Partner Violence and Posttraumatic Stress Symptoms: Indirect Effects Through Negative and Positive Emotion Dysregulation. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP14008-NP14035. [PMID: 33858266 DOI: 10.1177/08862605211006371] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Women who experience intimate partner violence (IPV) are at heightened risk for developing posttraumatic stress (PTS). Emotion dysregulation has been linked to both IPV and PTS, separately, however, unknown is the role of emotion dysregulation in the relation of IPV to PTS among women who experience IPV. Moreover, existing investigations in this area have been limited in their focus on negative emotion dysregulation. Extending prior research, this study investigated whether physical, sexual, and psychological IPV were indirectly associated with PTS symptom severity through negative and positive emotion dysregulation. Participants were 354 women who reported a history of IPV recruited from Amazon's MTurk platform (Mage = 36.52, 79.9% white). Participants completed self-report measures assessing physical (Conflict Tactics Scale), sexual (Sexual Experiences Scale), and psychological (Psychological Maltreatment of Women) IPV; negative (Difficulties in Emotion Regulation Scale) and positive (Difficulties in Emotion Regulation Scale-Positive) emotion dysregulation; and PTS symptom severity (PTSD Checklist for DSM-5) via an online survey. Pearson's correlation coefficients examined intercorrelations among the primary study variables. Indirect effect analyses were conducted to determine if negative and positive emotion dysregulation explained the relations between physical, sexual, and psychological IPV and PTS symptom severity. Physical, sexual, and psychological IPV were significantly positively associated with both negative and positive emotion dysregulation as well as PTS symptom severity, with the exception that psychological IPV was not significantly associated with positive emotion dysregulation. Moreover, negative and positive emotion dysregulation accounted for the relationships between all three IPV types and PTS symptom severity, with the exception of positive emotion dysregulation and psychological IPV. Our findings provide support for the potential underlying role of both negative and positive emotion dysregulation in the associations of IPV types to PTS symptom severity. Negative and positive emotion dysregulation may be important factors to integrate into interventions for PTS among women who experience IPV.
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29
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Malet-Karas A, Bernard D, Piet E, Bertin E. Disordered eating as a repercussion of sexual assault: a consequence to consider. Eat Weight Disord 2022; 27:2095-2106. [PMID: 35015284 DOI: 10.1007/s40519-021-01356-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/28/2021] [Indexed: 12/17/2022] Open
Abstract
PURPOSE This study aims at clarifying the links between sexual violence and disordered eating (DE). METHODS In a sample of 12,638 victims of self-reported sexual violence, we analyzed the situation of 546 victims that declared having developed DE. We assessed the characteristics of the assault (age, type of aggression) and the medical consequences (PTSD, depression, suicide attempts, anxiety disorders, etc.). RESULTS DE prevalence was 4.3% in the victim sample. The age of the first assault in DE victims was significantly lower than that of the whole population (12 years vs 16 years for median; p < 0.001). A much higher prevalence of sexual assault consequences was present in victims developing DE with odd ratios (OR) for: self-mutilation (OR = 11.5 [8.29-15.95], p < 0.001); depression (OR = 5.7 [4.81-6.86], p < 0.001); self-medication (OR = 5.3 [3.86-7.19], p < 0.001); suicide attempts (OR = 4.5 [3.59-5.67], p < 0.001); post-traumatic stress disorder (OR = 3.8 [2.99-4.78], p < 0.001); anxiety troubles (OR = 5.2 [4.11-6.47], p < 0.001); alcoholism (OR = 4.0 [2.81-5.58], p < 0.001). CONCLUSION This study confirms the link between DE and sexual violence, especially in childhood, leading to severe psychological consequences. In this context, DE should be envisaged as a coping strategy accompanying emotional dysregulation due to traumatic events, and be treated as such. LEVEL OF EVIDENCE Level IV: Evidence obtained from multiple time series analysis such as case studies.
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Affiliation(s)
| | - Delphine Bernard
- Association "Le Regard du Miroir", 5 Boulevard Foch BP 62732, 51100, Reims, France
| | - Emmanuelle Piet
- Association "Collectif féministe contre le viol (CFCV)", Paris, France
| | - Eric Bertin
- Clinical Nutrition Transversal Unit (UTNC) of Reims University Hospital and Performance, Health, Metrology, Society Laboratory (PSMS, EA 7507) of Reims Champagne-Ardenne University, Reims, France.
- Hôpital Robert Debré, Unité 63 Nutrition, 45 rue Cognacq Jay, 51092, Reims, France.
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30
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Chacko TP, Toole JT, Richman S, Spink GL, Reinhard MJ, Brewster RC, Costanzo ME, Broderick G. Mapping the network biology of metabolic response to stress in posttraumatic stress disorder and obesity. Front Psychol 2022; 13:941019. [PMID: 35959009 PMCID: PMC9362840 DOI: 10.3389/fpsyg.2022.941019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
The co-occurrence of stress-induced posttraumatic stress disorder (PTSD) and obesity is common, particularly among military personnel but the link between these conditions is unclear. Individuals with comorbid PTSD and obesity manifest other physical and psychological problems, which significantly diminish their quality of life. Current understanding of the pathways connecting stress to PTSD and obesity is focused largely on behavioral mediators alone with little consideration of the biological regulatory mechanisms that underlie their co-occurrence. In this work, we leverage prior knowledge to systematically highlight such bio-behavioral mechanisms and inform on the design of confirmatory pilot studies. We use natural language processing (NLP) to extract documented regulatory interactions involved in the metabolic response to stress and its impact on obesity and PTSD from over 8 million peer-reviewed papers. The resulting network describes the propagation of stress to PTSD and obesity through 34 metabolic mediators using 302 documented regulatory interactions supported by over 10,000 citations. Stress jointly affected both conditions through 21 distinct pathways involving only two intermediate metabolic mediators out of a total of 76 available paths through this network. Moreover, oxytocin (OXT), Neuropeptide-Y (NPY), and cortisol supported an almost direct propagation of stress to PTSD and obesity with different net effects. Although stress upregulated both NPY and cortisol, the downstream effects of both markers are reported to relieve PTSD severity but exacerbate obesity. The stress-mediated release of oxytocin, however, was found to concurrently downregulate the severity of both conditions. These findings highlight how a network-informed approach that leverages prior knowledge might be used effectively in identifying key mediators like OXT though experimental verification of signal transmission dynamics through each path will be needed to determine the actual likelihood and extent of each marker’s participation.
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Affiliation(s)
- Thomas P. Chacko
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
- Institute of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY, United States
| | - J. Tory Toole
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
- Institute of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY, United States
| | - Spencer Richman
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
| | - Garry L. Spink
- Rochester Regional Behavioral Health, Rochester, NY, United States
| | - Matthew J. Reinhard
- War Related Illness and Injury Study Center, United States Department of Veterans Affairs, Washington, DC, United States
| | - Ryan C. Brewster
- War Related Illness and Injury Study Center, United States Department of Veterans Affairs, Washington, DC, United States
| | - Michelle E. Costanzo
- War Related Illness and Injury Study Center, United States Department of Veterans Affairs, Washington, DC, United States
| | - Gordon Broderick
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
- *Correspondence: Gordon Broderick,
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31
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Wang N, Chung MC, Zhang J, Fang S. Network analysis on the relationship between posttraumatic stress disorder, psychiatric co-morbidity and posttraumatic growth among Chinese adolescents. J Affect Disord 2022; 309:461-470. [PMID: 35513114 DOI: 10.1016/j.jad.2022.04.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/14/2021] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study investigated the association between posttraumatic stress disorder (PTSD), psychiatric co-morbidity and posttraumatic growth (PTG) among Chinese adolescents using network analysis. METHODS 867 Chinese adolescents (male = 424, female = 443) were recruited from three secondary schools. They completed the Posttraumatic Stress Disorder Checklist for DSM-5, the Posttraumatic Growth Inventory, and the General Health Questionnaire-28. RESULTS Domains of each construct mainly clustered within their respective communities with several bridging edges identified. The prominent roles of bridging nodes and edges (positive and negative) were highlighted. Key bridging nodes were negative alterations in cognitions and mood for PTSD, anxiety and insomnia for psychiatric co-morbidity and appreciation of life for PTG. LIMITATIONS The cross-sectional nature of the present study may preclude the identification of real causal relationships between nodes. CONCLUSIONS Following a trauma, adolescents displayed posttraumatic stress along with general psychological disorder symptoms. These distress reactions could affect the way they appreciated life and their motivation to seek future life possibilities. Findings from the current study may provide some clue for the facilitation of posttraumatic growth among clinical patients.
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Affiliation(s)
- Na Wang
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong
| | - Man Cheung Chung
- Department of Psychology, Zayed University, Dubai, United Arab Emirates
| | - Jieting Zhang
- College of Psychology, Shenzhen University, Shenzhen, China
| | - Siqi Fang
- Department of Social and Behavioral Sciences, City University of Hong Kong, Hong Kong.
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32
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A network approach can improve eating disorder conceptualization and treatment. NATURE REVIEWS PSYCHOLOGY 2022; 1:419-430. [PMID: 36330080 PMCID: PMC9624475 DOI: 10.1038/s44159-022-00062-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Eating disorders are severe mental illnesses with the second highest mortality rate of all psychiatric illnesses. Eating disorders are exceedingly deadly because of their complexity. Specifically, eating disorders are highly comorbid with other psychiatric illnesses (up to 95% of individuals with an eating disorder have at least one additional psychiatric illness), have extremely heterogeneous presentations, and individuals often migrate from one specific eating disorder diagnosis to another. In this Perspective, we propose that understanding eating disorder comorbidity and heterogeneity via a network theory approach offers substantial benefits for both conceptualization and treatment. Such a conceptualization, strongly based on theory, can identify specific pathways that maintain psychiatric comorbidity, how diagnoses vary across individuals, and how specific symptoms and comorbidities maintain illness for one individual, thereby paving the way for personalized treatment.
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33
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Williamson MLC, Stickley MM, Armstrong TW, Jackson K, Console K. Diagnostic accuracy of the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) within a civilian primary care sample. J Clin Psychol 2022; 78:2299-2308. [PMID: 35763419 DOI: 10.1002/jclp.23405] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 05/24/2022] [Accepted: 06/09/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study aims to evaluate the diagnostic accuracy of the Primary Care Posttraumatic Stress Disorder (PTSD) Screen for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) (PC-PTSD-5) as a screening tool for the identification of PTSD among a civilian sample receiving behavioral health treatment within a primary care setting. Validation within a civilian sample will increase the generalizability of the PC-PTSD-5 as a brief screening measure to identify PTSD within primary care practices. METHOD The present study is a retrospective review of data (N = 198) collected as part of a patient registry for an integrated behavioral health consultation service within a primary care clinic. The PC-PTSD-5 was administered as part of a standardized set of brief screening measures and a standard clinical interview. Diagnostic validation was accomplished via a consensus model between a board-certified family medicine physician and a licensed psychologist along with medical/psychology trainees. RESULTS Fifty-two participants (26.26%) out of 198 who completed the PC-PTSD-5 were diagnosed with PTSD. The PC-PTSD-5 demonstrated excellent diagnostic accuracy (area under the curve = 0.933, 95% confidence interval [CI]: 0.901-0.965). A cutoff score of 4 maximized sensitivity (sensitivity% = 100) while maintaining acceptable specificity (specificity% = 85.2). This score also maximized efficiency (κ[0.5] = 0.77, SE = 0.05, 95% CI: 0.67-0.86) and maintained a good (≥0.60) quality index for specificity (κ[0] = 0.61). CONCLUSION The PC-PTSD-5 maintained strong diagnostic accuracy within a civilian primary care sample.
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Affiliation(s)
- Meredith L C Williamson
- Department of Primary Care & Population Health, Texas A&M Health Science Center, College of Medicine, Bryan, Texas, USA
| | - Mariah M Stickley
- Department of Psychiatry & Behavioral Sciences, Texas A&M Health Science Center, College of Medicine, Bryan, Texas, USA
| | - Trey W Armstrong
- Department of Psychiatry & Behavioral Sciences, Texas A&M Health Science Center, College of Medicine, Bryan, Texas, USA
| | - Kaylee Jackson
- Department of Psychiatry & Behavioral Sciences, Texas A&M Health Science Center, College of Medicine, Bryan, Texas, USA
| | - Katie Console
- Department of Psychiatry & Behavioral Sciences, Texas A&M Health Science Center, College of Medicine, Bryan, Texas, USA
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Walter KH, Levine JA, Madra NJ, Beltran JL, Glassman LH, Thomsen CJ. Gender differences in disorders comorbid with posttraumatic stress disorder among U.S. Sailors and Marines. J Trauma Stress 2022; 35:988-998. [PMID: 35218250 PMCID: PMC9306964 DOI: 10.1002/jts.22807] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/04/2022] [Accepted: 01/09/2022] [Indexed: 01/24/2023]
Abstract
Psychological comorbidity, the co-occurrence of mental health disorders, is more often the rule than the exception among individuals with posttraumatic stress disorder (PTSD). Research shows that prevalence estimates for specific psychological disorders differ by gender; however, little is known about whether these patterns persist in the presence of a comorbid PTSD diagnosis. This study examined gender differences in prevalence estimates for conditions comorbid with PTSD using medical records for 523,626 active duty U.S. Sailors and Marines who entered the military over an 8-year period. Using chi-square tests of independence, we detected statistically significant gender differences for specific comorbid conditions in the subsample of 9,447 service members with a PTSD diagnosis. Women were more likely than men to have PTSD with comorbid adjustment, OR = 1.35; depressive, OR = 1.71; and generalized anxiety or other anxiety disorders, OR = 1.16, with the largest effects for eating, OR = 12.60, and personality disorders, OR = 2.97. In contrast, women were less likely than men to have a diagnosis of PTSD with comorbid alcohol use, OR = 0.69, and drug use disorders, OR = 0.72, with the largest effects for insomnia, OR = 0.42, and traumatic brain injury, OR = 0.17. No significant gender differences emerged for comorbid bipolar, obsessive-compulsive, panic/phobic, psychotic, or somatoform/dissociative disorders, ps = .029-.314. The results show gender differences in conditions comorbid with PTSD generally align with internalizing and externalizing dimensions. Differences in comorbidities with PTSD between women and men could have implications for treatment development and delivery.
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Affiliation(s)
- Kristen H. Walter
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA
| | - Jordan A. Levine
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA,LeidosRestonVirginiaUSA
| | - Naju J. Madra
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA,LeidosRestonVirginiaUSA
| | - Jessica L. Beltran
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA,LeidosRestonVirginiaUSA
| | - Lisa H. Glassman
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA,LeidosRestonVirginiaUSA
| | - Cynthia J. Thomsen
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA
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Brewerton TD, Wang JB, Lafrance A, Pamplin C, Mithoefer M, Yazar-Klosinki B, Emerson A, Doblin R. MDMA-assisted therapy significantly reduces eating disorder symptoms in a randomized placebo-controlled trial of adults with severe PTSD. J Psychiatr Res 2022; 149:128-135. [PMID: 35272210 DOI: 10.1016/j.jpsychires.2022.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 02/24/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Eating disorders (EDs) and posttraumatic stress disorder (PTSD) are highly comorbid, yet there are no proven integrative treatment modalities for ED-PTSD. In clinical trials, MDMA-assisted therapy (MDMA-AT) has shown marked success in the treatment of PTSD and may be promising for ED-PTSD. METHODS Ninety individuals with severe PTSD received treatment in a double-blind, placebo-controlled pivotal trial of MDMA-AT. In addition to the primary (Clinician-Administered PTSD Scale) and secondary (Sheehan Disability Scale) outcome measures, the Eating Attitudes Test 26 (EAT-26) was administered for pre-specified exploratory purposes at baseline and at study termination. RESULTS The study sample consisted of 58 females (placebo = 31, MDMA = 27) and 31 males (placebo = 12, MDMA = 19) (n = 89). Seven participants discontinued prior to study termination. At baseline, 13 (15%) of the 89 individuals with PTSD had total EAT-26 scores in the clinical range (≥20), and 28 (31.5%) had total EAT-26 scores in the high-risk range (≥11) despite the absence of active purging or low weight. In completers (n = 82), there was a significant reduction in total EAT-26 scores in the total group of PTSD participants following MDMA-AT versus placebo (p = .03). There were also significant reductions in total EAT-26 scores in women with high EAT-26 scores ≥11 and ≥ 20 following MDMA-AT versus placebo (p = .0012 and p = .0478, respectively). CONCLUSIONS ED psychopathology is common in individuals with PTSD even in the absence of EDs with active purging and low weight. MDMA-AT significantly reduced ED symptoms compared to therapy with placebo among participants with severe PTSD. MDMA-AT for ED-PTSD appears promising and requires further study.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425-0742, USA.
| | - Julie B Wang
- MAPS Public Benefit Corporations, 3141 Stevens Creek Blvd #40547, San Jose, CA, 95117, USA
| | - Adele Lafrance
- Department of Psychology, Laurentian University, 935 Ramsey Lake Road, Sudbury, ON, P3E 2C6, Canada
| | - Chelsea Pamplin
- MAPS Public Benefit Corporations, 3141 Stevens Creek Blvd #40547, San Jose, CA, 95117, USA
| | - Michael Mithoefer
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425-0742, USA; MAPS Public Benefit Corporations, 3141 Stevens Creek Blvd #40547, San Jose, CA, 95117, USA
| | - Berra Yazar-Klosinki
- Multidisciplinary Association for Psychedelic Studies, 3141 Stevens Creek Blvd #40563, San Jose, CA, 95117, USA
| | - Amy Emerson
- MAPS Public Benefit Corporations, 3141 Stevens Creek Blvd #40547, San Jose, CA, 95117, USA
| | - Rick Doblin
- Multidisciplinary Association for Psychedelic Studies, 3141 Stevens Creek Blvd #40563, San Jose, CA, 95117, USA
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36
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Davidson KW, Barry MJ, Mangione CM, Cabana M, Chelmow D, Coker TR, Davis EM, Donahue KE, Jaén CR, Kubik M, Li L, Ogedegbe G, Pbert L, Ruiz JM, Silverstein M, Stevermer J, Wong JB. Screening for Eating Disorders in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement. JAMA 2022; 327:1061-1067. [PMID: 35289876 DOI: 10.1001/jama.2022.1806] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Eating disorders (eg, binge eating disorder, bulimia nervosa, and anorexia nervosa) are a group of psychiatric conditions defined as a disturbance in eating or eating-related behaviors that impair physical or psychosocial functioning. According to large US cohort studies, estimated lifetime prevalences for anorexia nervosa, bulimia nervosa, and binge eating disorder in adult women are 1.42%, 0.46%, and 1.25%, respectively, and are lower in adult men (anorexia nervosa, 0.12%; bulimia nervosa, 0.08%; binge eating disorder, 0.42%). Eating disorder prevalence ranges from 0.3% to 2.3% in adolescent females and 0.3% to 1.3% in adolescent males. Eating disorders are associated with short-term and long-term adverse health outcomes, including physical, psychological, and social problems. OBJECTIVE The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for eating disorders in adolescents and adults with a normal or high body mass index. Evidence limited to populations who are underweight or have other physical signs or symptoms of eating disorders was not considered. The USPSTF has not previously made a recommendation on this topic. POPULATION Adolescents and adults (10 years or older) who have no signs or symptoms of eating disorders (eg, rapid weight loss, weight gain, or pronounced deviation from growth trajectory; pubertal delay; bradycardia; oligomenorrhea; and amenorrhea). EVIDENCE ASSESSMENT The USPSTF concludes that the evidence is insufficient to assess the balance of benefits and harms of screening for eating disorders in adolescents and adults. The evidence is limited and the balance of benefits and harms cannot be determined. RECOMMENDATION The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for eating disorders in adolescents and adults. (I statement).
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Affiliation(s)
| | - Karina W Davidson
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York
| | | | | | | | | | | | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | | | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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Ten Napel-Schutz MC, Vroling M, Mares SHW, Arntz A. Treating PTSD with Imagery Rescripting in underweight eating disorder patients: a multiple baseline case series study. J Eat Disord 2022; 10:35. [PMID: 35264254 PMCID: PMC8908690 DOI: 10.1186/s40337-022-00558-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eating disorder patients with posttraumatic stress disorder have worse treatment results regarding their eating disorder than patients without posttraumatic stress disorder. Many eating disorder patients with co-morbid posttraumatic stress disorder symptoms are not treated for posttraumatic stress disorder symptoms during an underweight state. We propose that treatment of posttraumatic stress disorder is possible for underweight patients and that their trauma symptoms decrease with the use of Imagery Rescripting. We also investigated whether treatment of trauma influences eating disorder pathology in general and the process of weight gain specifically. METHOD Ten patients in clinical treatment (BMI 14-16.5) participated. A multiple baseline design was used, with baseline varying from 6 to 10 weeks, a 6-week treatment phase, a 3-week follow-up period and a 3-month follow-up measurement. Data were analysed with mixed regression. RESULTS Evidence was found that Imagery Rescripting had strong positive effects on posttraumatic stress disorder symptoms without interfering with eating disorder treatment. Positive effects were also found on a range of secondary emotional and cognitive measures. CONCLUSION Imagery Rescripting of traumatic memories is a possible and safe intervention for underweight eating disorder patients. It also had positive clinical effects. Trial registration Netherlands trial register (NTR) Trial NL5906 (NTR6094). Date of registration 09/23/2016. https://www.trialregister.nl/trial/5906 .
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Affiliation(s)
- Marieke C Ten Napel-Schutz
- Department of Eating Disorders (Amarum), GGNet Mental Health, Warnsveld, The Netherlands. .,Radboud Centre Social Science, Radboud University, Nijmegen, The Netherlands. .,Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
| | - Maartje Vroling
- Department of Eating Disorders (Amarum), GGNet Mental Health, Warnsveld, The Netherlands
| | - Suzanne H W Mares
- Department of Eating Disorders (Amarum), GGNet Mental Health, Warnsveld, The Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
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38
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Nelson JD, Cuellar AE, Cheskin LJ, Fischer S. Eating Disorders and Posttraumatic Stress Disorder: A Network Analysis of the Comorbidity. Behav Ther 2022; 53:310-322. [PMID: 35227406 DOI: 10.1016/j.beth.2021.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/10/2021] [Accepted: 09/18/2021] [Indexed: 11/02/2022]
Abstract
Eating disorders (EDs) and posttraumatic stress disorder (PTSD) commonly co-occur, but the mechanisms driving this co-occurrence are not well understood. The current study explored the relationships between symptoms of ED and PTSD in a sample of male and female undergraduate students in order to identify pathways that may maintain the comorbidity. Network analysis was conducted in a sample of 344 first-year undergraduates to visualize partial correlations between each symptom in the comorbidity. Core symptoms, bridge symptoms, and direct pathways between ED and PTSD symptoms were identified. The PTSD symptoms negative emotions (strength = 1.13) and negative beliefs (strength = 1.11) were the strongest symptoms in the network. The strongest bridge nodes were the ED symptoms restriction (bridge strength = 3.32) and binge eating (bridge strength = 2.63). The strongest edges between ED and PTSD nodes were between binge eating and concentration (part r = .16), restriction and sleep (part r = .14), and binge eating and positive emotions (part r = .11). Findings suggest that PTSD symptoms related to negative alterations in cognitions and mood may be highly influential in the ED-PTSD network due to their relatedness to all other symptoms. The pathway between binge eating and inability to experience positive emotions suggest that the comorbidity may be partially maintained through an affect regulation function of binge eating.
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Somma A, Krueger RF, Markon KE, Gialdi G, Boscaro L, Fossati A. Post-traumatic disorder symptom severity in the perspective of hierarchical taxonomy of psychopathology spectra and dysfunctional personality domains among trauma-exposed community-dwelling women. Personal Ment Health 2022; 16:47-58. [PMID: 34240811 DOI: 10.1002/pmh.1525] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 11/08/2022]
Abstract
To assess the relationships between post-traumatic stress disorder (PTSD) components, Hierarchical Taxonomy of Psychopathology (HiTOP) spectra, and dysfunctional personality domains, the Post-Traumatic Checklist for DSM-5 (PCL-5); the Personality Inventory for DSM-5-Brief Form+ (PID-5BF+); and self-report measures of HiTOP Internalizing, Thought Disorders, and Externalizing spectra were administered to 387 trauma-exposed Italian community-dwelling women. Before structural equation modeling (SEM), measurement components of models were assessed using confirmatory factor analyses. Both taxometric and Gaussian mixture analysis results were consistent with a dimensional representation of the PCL-5 scores. SEM results showed that PTSD components, at least as they were operationalized by the PCL-5 scores, were positively, significantly, and substantially associated with HiTOP Internalizing and Thought Disorder Spectra latent dimensions, as well as with Negative Affectivity, Detachment, and Psychoticism personality domains.
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Affiliation(s)
- Antonella Somma
- School of Psychology, Vita-Salute San Raffaele, Milan, Italy
| | - Robert F Krueger
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kristian E Markon
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Giulia Gialdi
- School of Psychology, Vita-Salute San Raffaele, Milan, Italy
| | - Linda Boscaro
- School of Psychology, Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Fossati
- School of Psychology, Vita-Salute San Raffaele, Milan, Italy
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40
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Goddard H, Hammersley R, Reid M. Schema Modes, Trauma, and Disordered Eating. J Cogn Psychother 2022; 36:70-95. [PMID: 35121680 DOI: 10.1891/jcpsy-d-20-00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Maladaptive schema modes may mediate between trauma and disordered eating, however there is little relevant evidence. This study aimed to predict disordered eating from modes, trauma, and age and gender. Also, to re-examine the factor structure of the Schema Mode Inventory for Eating Disorders, using an online cross-sectional survey of 612 volunteer participants aged 18 to 65, recruited from online eating disorder support groups, including people with and without diagnosed eating disorders. Measures were sociodemographic variables, the Schema Mode Inventory for Eating Disorders (Short Form; SMI-ED-SF), the Eating Disorder Examination Questionnaire (EDE-Q), and the Trauma History Questionnaire (THQ). Confirmatory factor analysis produced 16 factors similar to the 16 modes. Differences were that Vulnerable Child, Happy Child, and Healthy Adult appeared as a one factor, that all ED items appeared as one factor, and that Bully & Attack and Self-Aggrandizer modes appeared combined. In stepwise linear regression, EDE-Q scores was predicted by Total maladaptive mode score (37.3% of variance), Total adaptive mode score (1.5%) variance, Vulnerable Child (2.8%), Detached Self-Soother (1.5%). Other modes accounted for 1% or less of variance. Schema modes predicted EDE-Q, but the stable existence of discrete persona-like modes was less clear. Further research should refine the structure of SMI-ED-SF and relate modes to interpersonal traumas.
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Affiliation(s)
| | | | - Marie Reid
- University of Hull, Hull, United Kingdom
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41
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The relationship between emotional intelligence and eating disorders or disordered eating behaviors: A meta-analysis. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2021.111239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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42
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Rienecke RD, Johnson C, Mehler PS, Le Grange D, Manwaring J, Duffy A, McClanahan S, Blalock DV. Adverse childhood experiences among a treatment-seeking sample of adults with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2022; 30:156-167. [PMID: 35001471 DOI: 10.1002/erv.2880] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/16/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The purpose of the current study was to examine the prevalence of adverse childhood experiences (ACEs) among adults with eating disorders (EDs), to assess whether experiencing a greater number of ACEs is associated with more severe ED psychopathology, and to determine whether ACEs predict treatment outcome. METHOD Participants were 1819 patients (88.5% female, ages 18-72) admitted to one of two treatment facilities at inpatient, residential, or partial hospitalisation levels of care. The Adverse Childhood Experiences Survey and the Eating Pathology Symptom Inventory (EPSI) were completed at admission and the EPSI at discharge. RESULTS Female patients reported higher ACEs than males (p = 0.03), and all diagnoses except avoidant/restrictive food intake disorder had significantly higher ACEs than patients with anorexia nervosa-restricting type (AN-R) (p's < 0.01). Across diagnoses, higher ACEs were associated with decreases in binge eating scores during treatment, but were not associated with changes in purging or restricting. Within diagnoses, higher ACEs scores were associated with decreases in purging for patients with AN-R and increases in purging for patients with binge eating disorder. CONCLUSIONS Results partially supported the hypothesis that higher ACEs would be associated with more severe ED psychopathology.
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Affiliation(s)
- Renee D Rienecke
- Eating Recovery Center and Pathlight Mood and Anxiety Centers, Denver, Colorado, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Craig Johnson
- Eating Recovery Center and Pathlight Mood and Anxiety Centers, Denver, Colorado, USA
| | - Philip S Mehler
- Eating Recovery Center and Pathlight Mood and Anxiety Centers, Denver, Colorado, USA.,ACUTE at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado, Denver, Colorado, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, Colorado, USA.,Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Jamie Manwaring
- Eating Recovery Center and Pathlight Mood and Anxiety Centers, Denver, Colorado, USA
| | - Alan Duffy
- Eating Recovery Center and Pathlight Mood and Anxiety Centers, Denver, Colorado, USA
| | - Susan McClanahan
- Eating Recovery Center and Pathlight Mood and Anxiety Centers, Denver, Colorado, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA.,Rush University Medical Center, Chicago, Illinois, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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43
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Kritikos M, Clouston SAP, Huang C, Pellecchia AC, Mejia-Santiago S, Carr MA, Kotov R, Lucchini RG, Gandy SE, Bromet EJ, Luft BJ. Cortical complexity in world trade center responders with chronic posttraumatic stress disorder. Transl Psychiatry 2021; 11:597. [PMID: 34815383 PMCID: PMC8611009 DOI: 10.1038/s41398-021-01719-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/18/2021] [Accepted: 10/29/2021] [Indexed: 12/19/2022] Open
Abstract
Approximately 23% of World Trade Center (WTC) responders are experiencing chronic posttraumatic stress disorder (PTSD) associated with their exposures at the WTC following the terrorist attacks of 9/11/2001, which has been demonstrated to be a risk factor for cognitive impairment raising concerns regarding their brain health. Cortical complexity, as measured by analyzing Fractal Dimension (FD) from T1 MRI brain images, has been reported to be reduced in a variety of psychiatric and neurological conditions. In this report, we hypothesized that FD would be also reduced in a case-control sample of 99 WTC responders as a result of WTC-related PTSD. The results of our surface-based morphometry cluster analysis found alterations in vertex clusters of complexity in WTC responders with PTSD, with marked reductions in regions within the frontal, parietal, and temporal cortices, in addition to whole-brain absolute bilateral and unilateral complexity. Furthermore, region of interest analysis identified that the magnitude of changes in regional FD severity was associated with increased PTSD symptoms (reexperiencing, avoidance, hyperarousal, negative affect) severity. This study confirms prior findings on FD and psychiatric disorders and extends our understanding of FD associations with posttraumatic symptom severity. The complex and traumatic experiences that led to WTC-related PTSD were associated with reductions in cortical complexity. Future work is needed to determine whether reduced cortical complexity arose prior to, or concurrently with, onset of PTSD.
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Affiliation(s)
- Minos Kritikos
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Sean A P Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.
| | - Chuan Huang
- Department of Radiology, Renaissance School of Medicine at Stony Brook, Stony Brook, NY, USA
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Alison C Pellecchia
- World Trade Center Health and Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Stephanie Mejia-Santiago
- World Trade Center Health and Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Melissa A Carr
- World Trade Center Health and Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Roman Kotov
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Roberto G Lucchini
- Department of Environmental Health Sciences, Robert Stempel School of Public Health, Florida International University, Miami, FL, USA
| | - Samuel E Gandy
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry and Mount Sinai Alzheimer's Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evelyn J Bromet
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Benjamin J Luft
- World Trade Center Health and Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
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44
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Kjaersdam Telléus G, Lauritsen MB, Rodrigo-Domingo M. Prevalence of Various Traumatic Events Including Sexual Trauma in a Clinical Sample of Patients With an Eating Disorder. Front Psychol 2021; 12:687452. [PMID: 34489798 PMCID: PMC8417524 DOI: 10.3389/fpsyg.2021.687452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Eating disorder (ED) and trauma have often been associated, and there is evidence that early experiences of traumatic events are associated with subsequent ED. Research results point toward an increased prevalence of sexual trauma in individuals with ED, and it has been suggested that sexual trauma precedes and contributes to the development of ED. The aim of this study was to assess the prevalence of sexual trauma as well as other types of traumatic life events in a clinical sample of children, adolescents, and adults with ED. Method: Patients (N = 329), median age 16.9 [Interquartile Range (IQR):4.5], diagnosed with various EDs in a specialized ED unit were included. Results: The majority (67%) of patients with ED reported at least one traumatic life event at time of assessment such as bullying (32%), loss (24%), or accidents (11%). Nineteen per cent of the patients reported having been the victim of a sexual trauma or another sexual traumatic event distributed as follows in terms of severity: 13% had been the victim of a negative experience associated with sex; 57% reported having experienced sexual assault other than rape; and 30% had been the victim of severe forms of sexual assault. The median time between the sexual trauma and the ED diagnosis was 3.4 years (IQR: 6.6). The median time between the sexual trauma and the onset of ED symptoms was 0 years (IQR: 5). The study results imply that the sexual trauma could be experienced either prior to or after onset of ED symptoms. Conclusions: Sixty-seven per cent of the patients with an ED reported traumatic life events at time of assessment, whereby 19% reporting negative sexual experiences or sexual abuse. However, sexual trauma does not necessarily play a causal role in the development of EDs.
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Affiliation(s)
- Gry Kjaersdam Telléus
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Institute of Communication and Psychology, Psychology, Aalborg University, Aalborg, Denmark
| | - Marlene Briciet Lauritsen
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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45
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de Boer K, Gnatt I, Mackelprang JL, Williamson D, Eckel D, Nedeljkovic M. Phase-based approaches for treating complex trauma: a critical evaluation and case for implementation in the Australian context. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1080/00050067.2021.1968274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kathleen de Boer
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| | - Inge Gnatt
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| | | | - Danielle Williamson
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| | - David Eckel
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| | - Maja Nedeljkovic
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
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46
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Post-traumatic stress disorder may set the neurobiological stage for eating disorders: A focus on glutamatergic dysfunction. Appetite 2021; 167:105599. [PMID: 34271078 DOI: 10.1016/j.appet.2021.105599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 06/23/2021] [Accepted: 07/12/2021] [Indexed: 12/30/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a trauma and stress-related disorder which has been shown to be highly comorbid with, and commonly a precedent of, the eating disorders anorexia nervosa, bulimia nervosa, and binge eating disorder. The objective of this review is to discuss a potential overlapping neurobiological mechanism for this comorbidity. Alterations in glutamatergic neurotransmission have been observed in all four of the aforementioned disorders. Excessive excitation via glutamate contributes to excitotoxicity, and over-activation of the hypothalamic-pituitary-adrenal axis, both of which have implications for the deterioration of various brain structures. Prominent structures impacted include the hippocampus, hypothalamus, and prefrontal cortex, all of which are integral to the regulation of stress and eating. The current review suggests that altered glutamate function by trauma or extreme stress may facilitate PTSD and subsequent eating disorder onset, and that glutamatergic modulation may be a key treatment for individuals suffering from these conditions. This overlapping mechanism may help inform future research on individuals with comorbid PTSD and eating disorders, and it could also help inform ways to potentially prevent the onset of these conditions.
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47
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Mitchell KS, Singh S, Hardin S, Thompson-Brenner H. The impact of comorbid posttraumatic stress disorder on eating disorder treatment outcomes: Investigating the unified treatment model. Int J Eat Disord 2021; 54:1260-1269. [PMID: 33876442 DOI: 10.1002/eat.23515] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Many women with eating disorders (EDs) have comorbid posttraumatic stress disorder (PTSD). However, there have been few studies on how comorbid PTSD may impact ED treatment outcomes. METHOD Participants were 2,809 patients from residential ED treatment facilities who were treated using the Unified Treatment Model (UTM). We investigated whether PTSD diagnosis at admission was associated with changes in Eating Disorder Examination-Questionnaire (EDE-Q) scores, binge eating, self-induced vomiting, and restriction, across three time points, as well as clinically significant improvement and treatment drop-out. RESULTS Using latent growth models, with time modeled as a second-order polynomial, we found that EDE-Q scores and behavioral symptoms decreased from admission to discharge, but increased from discharge to 6-month follow-up. PTSD diagnosis was associated with higher baseline EDE-Q scores and restriction, and lower binge-eating frequency. PTSD diagnosis was not associated with symptom change over time, treatment dropout, or clinically significant change. DISCUSSION Although PTSD diagnoses were associated with higher ED symptom levels at admission, PTSD was not associated with worse treatment outcomes, suggesting the UTM is a promising treatment for patients with and without PTSD. Future studies should investigate the impact of ED treatment on PTSD symptoms in order to determine the need for integrated treatments for these comorbid conditions.
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Affiliation(s)
- Karen S Mitchell
- Women's Health Sciences Division, National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Simar Singh
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Sabrina Hardin
- Women's Health Sciences Division, National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA
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48
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Liebman RE, Becker KR, Smith KE, Cao L, Keshishian AC, Crosby RD, Eddy KT, Thomas JJ. Network Analysis of Posttraumatic Stress and Eating Disorder Symptoms in a Community Sample of Adults Exposed to Childhood Abuse. J Trauma Stress 2021; 34:665-674. [PMID: 33370465 DOI: 10.1002/jts.22644] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 11/08/2022]
Abstract
Posttraumatic stress disorder (PTSD) and eating disorders (EDs) are individually debilitating and highly comorbid conditions. Childhood abuse is a prominent risk factor for PTSD and ED symptoms both individually and as a comorbid syndrome (PTSD-ED). There may be a functional association between comorbid PTSD-ED symptoms whereby disordered eating behaviors are used to avoid trauma-related thoughts and feelings. The current study used a network analytic approach to examine key associations between PTSD and ED symptom subscales (i.e., PCL-5 and EPSI, respectively) in a community sample of 120 adults who endorsed at least one experience of childhood abuse (i.e., physical, sexual, or emotional abuse; witnessing domestic violence). Participants completed an anonymous online survey using Amazon's Mechanical Turk Prime. We used three network analysis indices (i.e., strength centrality, key players, and bridge symptoms) to identify symptoms that may maintain the comorbid PTSD-ED network. The results indicated that reexperiencing symptoms had the highest strength centrality in the PTSD-ED network and bridged the PTSD and ED clusters. For ED, cognitive restraint was a bridge to all PTSD symptoms. Hyperarousal, negative alterations in cognitions and mood (NACM), and purging were key players, indicating they are integral to the network structure. If replicated in prospective studies, these results may indicate that reexperiencing and cognitive restraint are core drivers of PTSD-ED comorbidity, whereas hyperarousal, NACM, and purging may be downstream consequences maintaining the comorbid condition. Concurrent treatments that address PTSD and ED symptoms simultaneously may result in the best outcomes.
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Affiliation(s)
- Rachel E Liebman
- Faculty of Health, York University, Toronto, Canada.,Department of Psychology, Ryerson University, Toronto, Canada
| | - Kendra R Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathryn E Smith
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, Los Angeles, California, USA
| | - Li Cao
- Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA
| | - Ani C Keshishian
- Department of Psychology, University of Louisville, Louisville, Kentucky, USA
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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49
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Stojek MM, Lipka J, Maples-Keller JM, Rauch SAM, Black K, Michopoulos V, Rothbaum BO. Investigating Sex Differences in Rates and Correlates of Food Addiction Status in Women and Men with PTSD. Nutrients 2021; 13:nu13061840. [PMID: 34072212 PMCID: PMC8228620 DOI: 10.3390/nu13061840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Food addiction (FA) is a dysregulated eating pattern characterized by difficulties in controlling the intake of certain foods. There is an overlap in physical and mental health correlates of FA and post-traumatic stress disorder (PTSD). The purpose of this study was to examine sex differences in the rates of positive FA status in individuals with threshold/subthreshold PTSD, and to examine sex differences in the physical and mental health correlates of FA. METHODS Post-9/11 veterans/service members seeking PTSD treatment were recruited. Participants were diagnosed with PTSD via the administration of a clinical interview. FA status was determined using Modified Yale Food Addiction Scale-2, binary sex and body mass index were assessed with demographics questions. RESULTS Nearly half (43%) of the sample were women. There were no sex differences in the rates of FA, with an overall FA prevalence of 18%. There were no sex differences in FA symptom count in the whole sample (M = 1.63) or those with FA status (M = 6.21). Individuals with FA reported higher frequency of disordered eating, higher severity of PTSD, and depression symptoms. CONCLUSIONS FA should be assessed in tandem with PTSD symptoms, as its prevalence in that sample is higher than in the general population, and it appears to affect both sexes at similar rates.
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Affiliation(s)
- Monika M. Stojek
- Department of Social Sciences, University of Silesia, 40-007 Katowice, Poland;
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329, USA; (J.M.M.-K.); (S.A.M.R.); (K.B.); (V.M.); (B.O.R.)
- Correspondence: or
| | - Justyna Lipka
- Department of Social Sciences, University of Silesia, 40-007 Katowice, Poland;
| | - Jessica M. Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329, USA; (J.M.M.-K.); (S.A.M.R.); (K.B.); (V.M.); (B.O.R.)
- Emory Healthcare Veterans Program, Emory University School of Medicine, Atlanta, GA 30329, USA
- Grady Trauma Project, Grady Memorial Hospital, Atlanta, GA 30303, USA
| | - Sheila A. M. Rauch
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329, USA; (J.M.M.-K.); (S.A.M.R.); (K.B.); (V.M.); (B.O.R.)
- Emory Healthcare Veterans Program, Emory University School of Medicine, Atlanta, GA 30329, USA
- Atlanta VA Healthcare System, Decatur, GA 30033, USA
| | - Kathryn Black
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329, USA; (J.M.M.-K.); (S.A.M.R.); (K.B.); (V.M.); (B.O.R.)
- Emory Healthcare Veterans Program, Emory University School of Medicine, Atlanta, GA 30329, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329, USA; (J.M.M.-K.); (S.A.M.R.); (K.B.); (V.M.); (B.O.R.)
- Grady Trauma Project, Grady Memorial Hospital, Atlanta, GA 30303, USA
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30322, USA
| | - Barbara O. Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329, USA; (J.M.M.-K.); (S.A.M.R.); (K.B.); (V.M.); (B.O.R.)
- Emory Healthcare Veterans Program, Emory University School of Medicine, Atlanta, GA 30329, USA
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50
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Zelkowitz RL, Zerubavel N, Zucker NL, Copeland WE. Longitudinal associations of trauma exposure with disordered eating: Lessons from the Great Smoky Mountains Study. Eat Disord 2021; 29:208-225. [PMID: 34010107 PMCID: PMC8373713 DOI: 10.1080/10640266.2021.1921326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Disordered eating is prevalent among trauma survivors, yet little is known about mechanisms underlying this relation. We explored cross-sectional and longitudinal associations of trauma exposure and posttraumatic stress disorder symptoms (PTSD) with disordered eating among 1,420 community-based youth participating in the Great Smoky Mountain Study. Participants were interviewed about trauma exposure, PTSD symptoms, and disordered eating at regular intervals throughout childhood, adolescence, and early adulthood. Our findings confirmed associations of all forms of trauma exposure (violent, sexual, and other) with disordered eating symptoms in childhood and adulthood, although the pattern of results varied by disordered eating symptom and trauma exposure type. Only non-sexual, non-violent trauma exposure in childhood had significant associations with any disordered eating symptoms in adulthood. Within childhood, trauma exposures but not PTSD symptoms showed significant longitudinal associations with bulimia nervosa symptoms and sustained appetite changes and preoccupation with eating. In adulthood, PTSD symptoms but not trauma exposures showed significant longitudinal associations only with bulimia nervosa symptoms. The association of specific PTSD clusters on bulimia nervosa symptoms was significant for reexperiencing, whereas hyperarousal symptoms trended toward significance. The impact of trauma exposures on disordered eating may vary by developmental period.
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Affiliation(s)
- Rachel L Zelkowitz
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, United States
| | - Noga Zerubavel
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States
| | - Nancy L Zucker
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States.,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, United States
| | - William E Copeland
- Department of Psychiatry, University of Vermont, Burlington, Vermont, United States
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