Complex PTSD as defined by the PTSD checklist for DSM-5 (PCL-5) in patients with eating disorders

Posttraumatic stress disorder (PTSD) is associated with eating disorders (EDs) and serves as a marker of higher severity and comorbidity. However, the role of complex PTSD (CPTSD) in EDs has been relatively unexplored. Recently, a PTSD Checklist for DSM-5 (PCL-5) total score ≥51 has been reported to be a reliable indicator of probable CPTSD. Participants were 2390 patients (91% female) admitted to residential treatment for a DSM-5 defined ED who gave written informed consent. Patients completed self-report assessments for symptoms of EDs, depression, state-trait anxiety, PTSD, and quality of life. Three trauma groups were compared based on PCL-5 total scores: 1) PCL-5 < 33 (no PTSD, n = 1104), 2) ≥33 and <51 (provisional PTSD, n = 651), and 3) ≥51 (probable CPTSD, n = 635). Groups were compared using multivariant analyses of variance with age, admission BMI, gender, race, and ED diagnosis as covariates. There were significant differences between trauma groups in all measures (p ≤ .001). Post-hoc comparisons revealed significant differences between all trauma groups for all assessments. Patients with probable CPTSD (27%) showed earliest ED onset and highest trauma dose and symptom severity followed by those with provisional PTSD (27%), then those with no PTSD (46%). Probable CPTSD occurred in 27% of patients with EDs and was associated with significantly greater ED-related psychopathology and younger age of ED onset compared to provisional PTSD and no PTSD groups. These results support the clinical utility of diagnosing probable CPTSD and emphasize the importance of thorough assessment procedures and integrated treatment approaches that address the full spectrum of trauma-related symptoms.