Subthreshold and Threshold PTSD Linked to Binge Eating

Subthreshold and threshold posttraumatic stress disorder (PTSD) may be related to increased binge eating symptoms in both men and women, according to study results published in the Journal of Clinical Psychiatry.

The study, conducted by Joel Braun, MD, from the Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada, and colleagues, drew data from the 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions. Adults were categorized into 3 groups: trauma-exposed with no or few PTSD symptoms, subthreshold PTSD, and threshold PTSD. Investigators compared the groups on trauma exposure, PTSD, and binge eating symptoms based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, using structured clinical interviews.

Participants were aged 18 years and older and were not institutionalized or on active military duty. Covariates included sociodemographic factors (age, race/ethnicity, income, education, and marital status), as well as other mental illnesses.

The total sample (N=36,309) was predominantly white, married/cohabiting, and educated to a postsecondary level. Both men and women in the subthreshold and threshold PTSD groups reported elevated binge eating symptoms compared with the trauma-exposed group who had no or few PTSD symptoms (men: unstandardized coefficient [B] range, 0.39-0.92; women: B range, 0.33-0.81; both: P <.001).

Compared with witnessing trauma, combat-related traumas in men were associated with fewer binge eating symptoms (unstandardized coefficient [B], −0.62; standard error [SE], 0.17; P <.001), and child maltreatment in women was associated with elevated binge eating symptoms (B, 0.28; SE, 0.12; P =.028).

Overall, in men and women, negative emotions and mood symptoms of PTSD were linked to a greater number of binge eating symptoms (men: B, 0.09; women: B, 0.10; both: SE, 0.03; P =.001). In men only, arousal and reactivity alterations were correlated with binge eating symptoms (B, 0.09; SE, 0.03; P =.005).

In post hoc analyses, symptoms of persistent, exaggerated negative beliefs (B, 0.36; SE, 0.07; P <.001) and hypervigilance (B, 0.20; SE, 0.07; P =.009) were independently associated with greater binge eating symptoms in men. There were no significant associations for women.

The cross-sectional design of the study limited investigators’ ability to establish a causal relationship between PTSD and binge eating.

The investigators stated, “the current study has clinical implications in encouraging health care providers to screen for binge eating symptoms among trauma-exposed adults.” They suggested that adults may use binge eating as a form of self-medication to alleviate PTSD symptoms and distress.

Reference

Braun J, El-Gabalawy R, Sommer JL, Pietrzak RH, Mitchell K, Mota N. Trauma exposure, DSM-5 posttraumatic stress, and binge eating symptoms: results from a nationally representative sample. J Clin Psychiatry. 2019;80(6):19m12813.