Trauma, Dissociation, and Eating Disorders
Background: Since the end of the twentieth century, the relationship between eating disorders and dissociation has been discussed, and in recent ten years, the number of papers reporting the relationship between eating disorders and trauma has increased. We need new therapeutic strategies for eating...
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| Published in | The Japanese Journal of Eating Disorders Vol. 3; no. 1; pp. 22 - 27 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japan Society for Eating Disorders
05.10.2023
日本摂食障害学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 2436-0139 |
| DOI | 10.50983/jjed.3.1_22 |
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| Abstract | Background: Since the end of the twentieth century, the relationship between eating disorders and dissociation has been discussed, and in recent ten years, the number of papers reporting the relationship between eating disorders and trauma has increased. We need new therapeutic strategies for eating disorders with trauma or dissociation because it is challenging to treat such diseases using existing treatments. Subjects and Methods: This study examined academic papers on the relationships between eating disorders and trauma or dissociation in these thirty years using PubMed to elucidate the psychopathology of comorbidity of these diseases and determine appropriate treatment strategies. Results: According to the literature, about twenty percent of patients with anorexia nervosa and thirty to sixty percent with bulimia nervosa also have post-traumatic stress disorder (PTSD), and three to nine percent of individuals without eating disorders have PTSD; specifically, bulimic symptoms and PTSD share a close relationship. Furthermore, people who have undergone abuse during childhood tend to suffer from eating disorders about three times as much as others. Numerous researchers have pointed out the relationships between trauma and overeating or vomiting, such as the relationship between sexual assault in adulthood and binge/purging, sexual abuse in childhood and disordered eating, and adverse experiences in childhood and emotional eating induced by stress. Generally, past traumatic experiences cause negative feelings, such as fear, shuddering, anger, guilt feeling, or shame; more frequent overeating leads to stronger negative feelings. Therefore, overeating could be a method to control emotions. As patients with eating disorders have an insecure type of attachment, they tend to have interpersonal anxiety, which could lead to difficulty in regulating feelings and a tendency to be dissociative. In order to treat eating disorders with trauma or dissociation or, it has been tried to integrate the cognitive behavioral therapy (CBT) for eating disorders and the CBT for PTSD, such as cognitive process therapy (CPT).Discussion: It can be challenging to treat eating disorders with PTSD or dissociation only by means of the existing CBT for eating disorders because the psychopathology of such eating disorders is too complexed. In any therapy, it is crucial to establish a relationship of mutual trust between therapist and patient, and create a secure therapeutic environment. |
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| AbstractList | Background: Since the end of the twentieth century, the relationship between eating disorders and dissociation has been discussed, and in recent ten years, the number of papers reporting the relationship between eating disorders and trauma has increased. We need new therapeutic strategies for eating disorders with trauma or dissociation because it is challenging to treat such diseases using existing treatments. Subjects and Methods: This study examined academic papers on the relationships between eating disorders and trauma or dissociation in these thirty years using PubMed to elucidate the psychopathology of comorbidity of these diseases and determine appropriate treatment strategies. Results: According to the literature, about twenty percent of patients with anorexia nervosa and thirty to sixty percent with bulimia nervosa also have post-traumatic stress disorder (PTSD), and three to nine percent of individuals without eating disorders have PTSD; specifically, bulimic symptoms and PTSD share a close relationship. Furthermore, people who have undergone abuse during childhood tend to suffer from eating disorders about three times as much as others. Numerous researchers have pointed out the relationships between trauma and overeating or vomiting, such as the relationship between sexual assault in adulthood and binge/purging, sexual abuse in childhood and disordered eating, and adverse experiences in childhood and emotional eating induced by stress. Generally, past traumatic experiences cause negative feelings, such as fear, shuddering, anger, guilt feeling, or shame; more frequent overeating leads to stronger negative feelings. Therefore, overeating could be a method to control emotions. As patients with eating disorders have an insecure type of attachment, they tend to have interpersonal anxiety, which could lead to difficulty in regulating feelings and a tendency to be dissociative. In order to treat eating disorders with trauma or dissociation or, it has been tried to integrate the cognitive behavioral therapy (CBT) for eating disorders and the CBT for PTSD, such as cognitive process therapy (CPT).Discussion: It can be challenging to treat eating disorders with PTSD or dissociation only by means of the existing CBT for eating disorders because the psychopathology of such eating disorders is too complexed. In any therapy, it is crucial to establish a relationship of mutual trust between therapist and patient, and create a secure therapeutic environment. Background: Since the end of the twentieth century, the relationship between eating disorders and dissociation has been discussed, and in recent ten years, the number of papers reporting the relationship between eating disorders and trauma has increased. We need new therapeutic strategies for eating disorders with trauma or dissociation because it is challenging to treat such diseases using existing treatments. Subjects and Methods: This study examined academic papers on the relationships between eating disorders and trauma or dissociation in these thirty years using PubMed to elucidate the psychopathology of comorbidity of these diseases and determine appropriate treatment strategies. Results: According to the literature, about twenty percent of patients with anorexia nervosa and thirty to sixty percent with bulimia nervosa also have post-traumatic stress disorder (PTSD), and three to nine percent of individuals without eating disorders have PTSD; specifically, bulimic symptoms and PTSD share a close relationship. Furthermore, people who have undergone abuse during childhood tend to suffer from eating disorders about three times as much as others. Numerous researchers have pointed out the relationships between trauma and overeating or vomiting, such as the relationship between sexual assault in adulthood and binge/purging, sexual abuse in childhood and disordered eating, and adverse experiences in childhood and emotional eating induced by stress. Generally, past traumatic experiences cause negative feelings, such as fear, shuddering, anger, guilt feeling, or shame; more frequent overeating leads to stronger negative feelings. Therefore, overeating could be a method to control emotions. As patients with eating disorders have an insecure type of attachment, they tend to have interpersonal anxiety, which could lead to difficulty in regulating feelings and a tendency to be dissociative. In order to treat eating disorders with trauma or dissociation or, it has been tried to integrate the cognitive behavioral therapy (CBT) for eating disorders and the CBT for PTSD, such as cognitive process therapy (CPT).Discussion: It can be challenging to treat eating disorders with PTSD or dissociation only by means of the existing CBT for eating disorders because the psychopathology of such eating disorders is too complexed. In any therapy, it is crucial to establish a relationship of mutual trust between therapist and patient, and create a secure therapeutic environment. はじめに：近年，摂食障害とトラウマや解離との関係についての報告が増えている。対象と方法：これらの関係について文献的に整理し，トラウマや解離を伴う摂食障害の適切な治療法について考察する。結果：神経性やせ症患者の約2割，神経性過食症の3～6割に心的外傷後ストレス症（posttraumatic stress disorder; PTSD）が合併しており，とくに過食症状とPTSDとの関連が強い。また，幼少期に虐待体験があると，約3倍摂食障害になりやすいという報告がある。トラウマから引き起こされる恐怖や怒りなどの否定的感情が，過食が多いほど強くなり過食のあとはしばらく安定することから，過食がひとつの感情制御法になっていることがわかる。解離も感情制御のための病的な反応という側面をもっている。PTSDや解離を合併した摂食障害の治療としては，摂食障害とPTSDそれぞれの認知行動療法を統合する方法が試みられている。考察：いずれの治療でも大事なのは，まず安全で安定した治療環境を確立することである。 |
| Author | Noma, Shun’ichi |
| Author_FL | 野間 俊一 |
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| Copyright | 2023 Japan Society for Eating Disorders |
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| References | 22) Hallings-Pott Ch, Waller G, Watson D, et al.: State dissociation in bulimic eating disorders: An experimental study. Int J Eat Disord 2005; 38: 37-41. 5) Mitchell KS, Mazzeo SE, Schlesinger MR, et al.: Comorbidity of partial and subthreshold ptsd among men and women with eating disorders in the national comorbidity survey-replication study. Int J Eat Disord 2012; 45: 307-315. 11) Castellini G, Lelli L, Cassioli E: Different outcomes, psychopathological features, and comorbidities in patients with eating disorders reporting childhood abuse: A 3-year follow-up study. Eur Eat Disord Rev 2018; 26: 217-229. 4) American Psychiatric Association: op. cit., pp. 289-290. 18) Mason TB, Lavender JM, Wonderlich SA, et al.: Comfortably numb: The role of momentary dissociation in the experience of negative affect around binge eating. J Nerv Ment Dis 2017; 205: 335-339. 2) World Health Organization: ICD-11 for mortality and morbidity statistics (version: 01/2023), 6B41 Complex post traumatic stress disorder. https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f585833559 26) Wonderlich SA, Peterson CB, Smith TL: Integrative Cognitive-affective Therapy for Bulimia Nervosa. Guilford Press, New York, 2015. 14) Longo P, Bertorello A, Panero M, et al.: Traumatic events and post-traumatic symptoms in anorexia nervosa. Eur J Psychotraumatol 2019; 10: 1682930. 17) La Mela C, Maglietta M, Castellini G, et al.: Dissociation in eating disorders: Relationship between dissociative experiences and binge-eating episodes. Compr Psychiatry 2010; 51: 393-400. 24) Brewerton TD: The integrated treatment of eating disorders, posttraumatic stress disorder, and psychiatric comorbidity: A commentary on the evolution of principles and guidelines. Front Psychiatry 2023; 14: 1149433. 29) International Society for the Study of Trauma and Dissociation: Guidelines for treating dissociative identity disorder in adults, 3rd rev. J Trauma Dissociation, 2011; 12: 115-187. 6) Tagay S, Schlottbohm E, Reyes-Rodriguez M, et al.: Eating disorders, trauma, PTSD and psychosocial resources. Eat Disord 2014; 22: 33-49. 19) Waller G, Babbs M, Wright F, et al.: Somatoform dissociation in eating-disordered patients. Behav Res Ther 2003; 41: 619-627. 8) Lev-ari L, Zohar AH, Bachner-Melman, R: Eating for numbing: A community-based study of trauma exposure, emotion dysregulation, dissociation, body dissatisfaction and eating disorder symptoms. PeerJ 2021; 9: e11899. 1) American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 5th ed., Text Revision. American Psychiatric Publishing, Arlington, VA, 2022（髙橋三郎，大野 裕監訳：DSM-5-TR精神疾患の診断・統計マニュアル．医学書院，東京，291-303，2023） 12) Brustenghi F, Mezzetti FAF, Di Sarno C: Eating disorders: The role of childhood trauma and the emotion dysregulation. Psychiatr Danub 2019; 31: 509-511. 16) Evers C, Stok FM, de Ridder, TD: Feeding your feelings: Emotion regulation strategies and emotional eating. 2010; 36: 792-804. 9) Caslini M, Bartoli F, Crocamo C: Disentangling the association between child abuse and eating disorders: A systematic review and meta-analysis. Psychosom Med 2016; 78: 79-90. 21) Backholm K, Isomaa R, Birgegård A: The prevalence and impact of trauma history in eating disorder patients. Eur J Psychotraumatol 2013; 4: 22482. 25) Forbes D, Bisson JI, Monson CM, et al. (eds.): Effective Treatments for PTSD. 3rd ed. Guilford Press, New York, 151-166, 2020. 27) Safer D, Telch CF, Chen EY: Dialectical Behavior Therapy for Binge Eating and Bulimia. Guilford Press, New York, 2009. 20) Nilsson D, Lejonclou A, Holmqvist R: Psychoform and somatoform dissociation among individuals with eating disorders. Nord J Psychiatry 2020; 74:1-8. 7) Trottier K, Monson CM, Wonderlich SA, et al.: Results of the first randomized controlled trial of integrated cognitive-behavioral therapy for eating disorders and posttraumatic stress disorder. Psychol Med 2022; 52: 587-596. 13) Gomez F, Kilpela LS, Middlemass KM, et al.: Sexual trauma uniquely associated with eating disorders: A replication study. Psychol Trauma 2021; 13: 202-205. 10) Guillaume S, Jaussent I, Maimoun L: Associations between adverse childhood experiences and clinical characteristics of eating disorders. Sci Rep 2016; 6: 35761. 3) World Health Organization: op. cit., Dissociative disorders. https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f108180424 15) Hasselle AJ, Howell KH, Dormois M, et al.: The influence of childhood polyvictimization on disordered eating symptoms in emerging adulthood. Child Abuse Negl 2017; 68: 55-64. 23) Caglar-Nazali HP, Corfield F, Cardi V, et al.: A systematic review and meta-analysis of ʻsystems for social processes’ in eating disorders. Neurosci Biobehav Rev 2014; 42: 55-92. 28) Hermann JL: Trauma and Recovery. rev. ed. Basic Books, New York, 1997（中井久夫訳：心的外傷と回復．増補版．みすず書房，東京，243-379，1999） |
| References_xml | – reference: 9) Caslini M, Bartoli F, Crocamo C: Disentangling the association between child abuse and eating disorders: A systematic review and meta-analysis. Psychosom Med 2016; 78: 79-90. – reference: 11) Castellini G, Lelli L, Cassioli E: Different outcomes, psychopathological features, and comorbidities in patients with eating disorders reporting childhood abuse: A 3-year follow-up study. Eur Eat Disord Rev 2018; 26: 217-229. – reference: 25) Forbes D, Bisson JI, Monson CM, et al. (eds.): Effective Treatments for PTSD. 3rd ed. Guilford Press, New York, 151-166, 2020. – reference: 3) World Health Organization: op. cit., Dissociative disorders. https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f108180424 – reference: 4) American Psychiatric Association: op. cit., pp. 289-290. – reference: 18) Mason TB, Lavender JM, Wonderlich SA, et al.: Comfortably numb: The role of momentary dissociation in the experience of negative affect around binge eating. J Nerv Ment Dis 2017; 205: 335-339. – reference: 6) Tagay S, Schlottbohm E, Reyes-Rodriguez M, et al.: Eating disorders, trauma, PTSD and psychosocial resources. Eat Disord 2014; 22: 33-49. – reference: 7) Trottier K, Monson CM, Wonderlich SA, et al.: Results of the first randomized controlled trial of integrated cognitive-behavioral therapy for eating disorders and posttraumatic stress disorder. Psychol Med 2022; 52: 587-596. – reference: 20) Nilsson D, Lejonclou A, Holmqvist R: Psychoform and somatoform dissociation among individuals with eating disorders. Nord J Psychiatry 2020; 74:1-8. – reference: 14) Longo P, Bertorello A, Panero M, et al.: Traumatic events and post-traumatic symptoms in anorexia nervosa. Eur J Psychotraumatol 2019; 10: 1682930. – reference: 28) Hermann JL: Trauma and Recovery. rev. ed. Basic Books, New York, 1997（中井久夫訳：心的外傷と回復．増補版．みすず書房，東京，243-379，1999）． – reference: 13) Gomez F, Kilpela LS, Middlemass KM, et al.: Sexual trauma uniquely associated with eating disorders: A replication study. Psychol Trauma 2021; 13: 202-205. – reference: 17) La Mela C, Maglietta M, Castellini G, et al.: Dissociation in eating disorders: Relationship between dissociative experiences and binge-eating episodes. Compr Psychiatry 2010; 51: 393-400. – reference: 19) Waller G, Babbs M, Wright F, et al.: Somatoform dissociation in eating-disordered patients. Behav Res Ther 2003; 41: 619-627. – reference: 2) World Health Organization: ICD-11 for mortality and morbidity statistics (version: 01/2023), 6B41 Complex post traumatic stress disorder. https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f585833559 – reference: 10) Guillaume S, Jaussent I, Maimoun L: Associations between adverse childhood experiences and clinical characteristics of eating disorders. Sci Rep 2016; 6: 35761. – reference: 27) Safer D, Telch CF, Chen EY: Dialectical Behavior Therapy for Binge Eating and Bulimia. Guilford Press, New York, 2009. – reference: 12) Brustenghi F, Mezzetti FAF, Di Sarno C: Eating disorders: The role of childhood trauma and the emotion dysregulation. Psychiatr Danub 2019; 31: 509-511. – reference: 16) Evers C, Stok FM, de Ridder, TD: Feeding your feelings: Emotion regulation strategies and emotional eating. 2010; 36: 792-804. – reference: 26) Wonderlich SA, Peterson CB, Smith TL: Integrative Cognitive-affective Therapy for Bulimia Nervosa. Guilford Press, New York, 2015. – reference: 24) Brewerton TD: The integrated treatment of eating disorders, posttraumatic stress disorder, and psychiatric comorbidity: A commentary on the evolution of principles and guidelines. Front Psychiatry 2023; 14: 1149433. – reference: 21) Backholm K, Isomaa R, Birgegård A: The prevalence and impact of trauma history in eating disorder patients. Eur J Psychotraumatol 2013; 4: 22482. – reference: 1) American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 5th ed., Text Revision. American Psychiatric Publishing, Arlington, VA, 2022（髙橋三郎，大野 裕監訳：DSM-5-TR精神疾患の診断・統計マニュアル．医学書院，東京，291-303，2023）． – reference: 22) Hallings-Pott Ch, Waller G, Watson D, et al.: State dissociation in bulimic eating disorders: An experimental study. Int J Eat Disord 2005; 38: 37-41. – reference: 15) Hasselle AJ, Howell KH, Dormois M, et al.: The influence of childhood polyvictimization on disordered eating symptoms in emerging adulthood. Child Abuse Negl 2017; 68: 55-64. – reference: 29) International Society for the Study of Trauma and Dissociation: Guidelines for treating dissociative identity disorder in adults, 3rd rev. J Trauma Dissociation, 2011; 12: 115-187. – reference: 23) Caglar-Nazali HP, Corfield F, Cardi V, et al.: A systematic review and meta-analysis of ʻsystems for social processes’ in eating disorders. Neurosci Biobehav Rev 2014; 42: 55-92. – reference: 5) Mitchell KS, Mazzeo SE, Schlesinger MR, et al.: Comorbidity of partial and subthreshold ptsd among men and women with eating disorders in the national comorbidity survey-replication study. Int J Eat Disord 2012; 45: 307-315. – reference: 8) Lev-ari L, Zohar AH, Bachner-Melman, R: Eating for numbing: A community-based study of trauma exposure, emotion dysregulation, dissociation, body dissatisfaction and eating disorder symptoms. PeerJ 2021; 9: e11899. |
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| SubjectTerms | dissociation eating disorders posttraumatic stress disorder trauma treatment トラウマ 心的外傷後ストレス症 摂食障害 治療 解離 |
| Title | Trauma, Dissociation, and Eating Disorders |
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