Traumatic Event Exposure May Affect Eating Disorder Treatment Adherence, Outcomes

Individuals with eating disorders with exposure to traumatic events, including with posttraumatic stress syndrome (PTSD), may be more likely to drop out of treatment, according to findings from a systematic review published in the International Journal of Eating Disorders.

Researchers from San Diego State University searched publication databases through September 2022 for studies evaluating the effect of exposure to trauma or the presence of PTSD on eating disorder treatment outcomes.

A total of 18 articles were included in the review, with a total of 5713 patients, overall, the majority of whom were women and girls.

For the interaction between traumatic events and eating disorder treatment outcomes, 11 studies evaluated symptom outcomes after treatment. The majority of studies reported improvements in eating pathology, regardless of trauma exposure. Study findings suggested that trauma exposure throughout life did not affect beneficial outcomes from eating disorder treatment. However, 1 study found that childhood sexual abuse moderated the effect of treatment.

At follow-up, 2 studies reported no difference in treatment effects based on sexual assault trauma. However, 4 studies reported that traumatic childhood events associated with a decreased likelihood of achieving symptom remission and an increased likelihood of relapse.

Dropout from treatment was evaluated in 4 studies, of which 2 reported a greater dropout rate among individuals with childhood traumatic events or any traumatic event prior to onset of eating disorder. Another study reported that dropout rates depended on both diagnosis and traumatic event exposure, in which patients with anorexia nervosa, binge-eating/purging subtype with childhood trauma were more likely to have treatment dropout compared with that of patients without a history of trauma or those with anorexia nervosa, restricting subtype and trauma.

All 5 studies reported significant treatment effects on eating disorder symptoms among patients with PTSD. However, 1 study found a significant relationship between PTSD and binge episode frequency posttreatment. Another study reported that patients with PTSD had greater eating disorder symptom reductions during treatment but also had greater recurrence at 6 months. One of the 3 studies reported a higher rate of premature treatment termination among patients with PTSD.

The findings of the review may not be generalizable as the majority of the patient populations of the studies included White women or girls.

Authors of the review concluded, “Future researchers are encouraged to further examine traumatic events and PTSD as predictors or moderators of treatment in the interest of greater confidence in the current findings.”