Trauma and eating disorders: an integrated umbrella and scoping review

This comprehensive mixed-method review synthesised the trauma-eating disorder (trauma-ED) research across six objectives addressing; prevalence and risk, covariates, clinical characteristics, theories, lived experience, and intervention.

An umbrella review of systematic reviews, a scoping review of narrative summaries, and quality assessments were conducted.

One hundred and ninety-nine publications were identified. Higher prevalence rates of childhood, later life, and marginalisation traumas were evident in ED samples compared to healthy controls. Dependant on trauma type, trauma rates in those with ED were higher or comparable to psychiatric controls. More consistent findings, larger effect sizes, and higher prevalence rates of trauma were evident in binge-purge, rather than restrictive, ED presentations. Overall, individuals experiencing trauma-ED present with greater emotional and behavioural dysregulation and more complex illness and treatment course. Several theories explaining the trauma-ED intersection received some empirical support. Few investigations examined mechanisms and treatment; no evidence on lived experience perspectives on treatment and no trauma-ED clinical practice guidelines were identified.

The positive association between trauma and ED and the negative impact of co-existing trauma on ED illness and treatment, have been established. The clinical relevance, need, and urgency of addressing co-existing trauma in ED treatment are evident. Qualitative and intervention research is urgently needed to understand trauma-ED, elucidate lived experience perspectives on treatment, test novel treatments, and provide clinical guidance.