ABSTRACT

Many individuals with lifetime histories of eating disorders (EDs) report exposure to interpersonal trauma and posttraumatic stress disorder (PTSD). However, this relationship is not well-understood, and there are no established, evidence-based therapies for the concurrent treatment of EDs and PTSD. This review focuses on studies of the mechanisms associating trauma exposure and/or PTSD with EDs. Possible mechanisms of the trauma-ED association identified from the literature include self-criticism, low self-worth, guilt, shame, depression, anxiety, emotion dysregulation, anger, and impulsivity/compulsivity. ED behaviors may be used as coping strategies to manage PTSD symptoms and negative affect. Avoidance of hyperarousal symptoms by engaging in binge eating, purging, and/or restriction may serve to maintain both the ED as well as the PTSD. Given the evidence of the bidirectional relationship between EDs and PTSD, we describe an integrated cognitive behavioral theory that may account for the persistence of comorbid PTSD and EDs. The integrated model is based on the theoretical models that underpin existing evidence-based treatments for PTSD and ED and incorporates many of the potential mechanisms highlighted to date. The primary aim of the model is to identify potential treatment targets as well as elucidate future directions for research.

摘要

许多有饮食失调（ED）终生史的人都报告了人际交往和创伤后应激障碍（PTSD）的暴露。然而，这种关系尚不为人所理解，并且尚无既定的循证疗法同时治疗EDs和PTSD。这篇综述着重于研究创伤暴露和/或PTSD与ED相关的机制。从文献中确定的创伤-ED关联的可能机制包括自我批评，低自我价值，内gui，羞耻，沮丧，焦虑，情绪失调，愤怒和冲动/强迫性。ED行为可用作应对PTSD症状和负面影响的应对策略。通过暴饮暴食，清除和/或限制饮食来避免过度兴奋的症状可能有助于维持ED和PTSD。给定ED与PTSD之间存在双向关系的证据，我们描述了一种综合的认知行为理论，该理论可能解释了PTSD与ED合并症的持续存在。集成模型基于理论模型，这些模型为PTSD和ED的现有循证治疗奠定了基础，并纳入了迄今为止突出的许多潜在机制。该模型的主要目的是确定潜在的治疗目标，并阐明未来的研究方向。集成模型基于理论模型，这些模型为PTSD和ED的现有循证治疗奠定了基础，并纳入了迄今为止突出的许多潜在机制。该模型的主要目的是确定潜在的治疗目标，并阐明未来的研究方向。集成模型基于理论模型，这些模型为PTSD和ED的现有循证治疗奠定了基础，并纳入了迄今为止突出的许多潜在机制。该模型的主要目的是确定潜在的治疗目标，并阐明未来的研究方向。