PTSD, complex PTSD and the dissociative subtype of PTSD in patients with eating disorders

Posttraumatic stress disorder (PTSD) and dissociation are associated with eating disorders (EDs) and serve as markers of higher severity and comorbidity. However, the role of complex PTSD (CPTSD) and the dissociative subtype of PTSD (DPTSD) in EDs remains relatively unexplored.

Participants were 635 patients (60% female) admitted to a higher level of care (residential, partial hospital or intensive outpatient) for treatment of a DSM-5 defined ED, substance use disorder (SUD), PTSD and/or mood disorder. In addition to a semi-structured interview, patients completed self-report assessments within 72 h of admission, including the Eating Disorder Examination Questionnaire; Life Events Checklist for DSM-5; PTSD Checklist for DSM-5; International Trauma Questionnaire; Dissociative Subtype of PTSD Scale; Alcohol Use Disorder Identification Test; Drug Abuse Screening Test-10; Patient Health Questionnaire-9; Spielberger State Trait Anxiety Scale short form, and the World Health Organization Quality of Life Abbreviated Scale. Patients with (n = 231) and without EDs (n = 404) were compared using multivariant analyses of variance and age, admission BMI, gender, race, sexual orientation and level of care as covariates.

In this highly comorbid group, patients with EDs had significantly higher rates of self-reported types of traumatic events (8 v. 7), provisional PTSD (68% v. 48%), DPTSD (50% v. 27%), and CPTSD (33% v. 19%) compared to those without EDs (p ≤ .01). Patients with DPTSD and/or CPTSD had significantly higher symptom scores for EDs, major depression, substance use, state and trait anxiety, and worse quality of life. In addition, there was significant overlap between the diagnoses of CPTSD and DPTSD with 25% of those with EDs meeting criteria for both disorders.

DPTSD and CPTSD are common in patients with EDs and indicate more complex psychiatric comorbidity associated with high doses of trauma. These results emphasize the importance of thorough assessment procedures and the need for integrated treatment approaches that directly address the full spectrum of trauma-related symptoms.