Threshold and subthreshold post-traumatic stress disorder in bulimic patients: prevalences and clinical correlates

Post-traumatic stress disorder (PTSD) is believed to impact the clinical presentation and treatment response in bulimia nervosa (BN), but available data do not clarify the clinical implications of subthreshold forms of PTSD, believed to affect a sizable proportion of bulimic women.

In 78 women with BN and 61 women who ate normally, we assessed lifetime rates of threshold and subthreshold PTSD, and examined clinical correlates.

Among bulimic women, rate of threshold PTSD was 17.9% and rate of a formally-defined, subthreshold PTSD syndrome was 41.0%. Bulimic women with subthreshold PTSD did not differ from women with threshold PTSD on any clinical indices (except generalized anxiety disorder) and both groups with a PTSD-spectrum syndrome displayed worse psychiatric symptoms than did bulimic women without PTSD symptoms.

Threshold and subthreshold variants of PTSD occur substantially more frequently among bulimic women than they do among normal-eater women. Intriguingly, bulimic women with subthreshold PTSD appear to be at similar risk for psychiatric morbidity as are those with threshold PTSD. The preceding suggests that formal, categorical concepts of PTSD may not fully reflect important trauma correlates seen in women with BN.