Underdiagnosis of PTSD in eating disorders?

In the recently published paper by Hubel and colleagues entitled, "Comorbid Posttraumatic Stress Disorder Complicates Eating Disorder Treatment: A Nationwide Study," the authors reported that among a large sample of 8906 adult inpatients and outpatients (96% female) with eating disorders (EDs), the current rates of traumatic experiences and current PTSD were only 16% and 4%, respectively. However, these are unusually low numbers when compared to other existing data in nationally representative samples and in clinical samples of eating disorder patients. In this commentary several possible explanations that may explain these lower-than-expected results are reviewed, particularly in reference to use of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) in acutely ill eating disorder patients. Sociocultural factors and clinical features of traumatized ED patients are also considered as possible factors in explaining these differences.