Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span

Abstract

Background Multiple published sources from around the world have confirmed an association between an array of adverse childhood experiences (ACEs) and other traumatic events with eating disorders (EDs) and related adverse outcomes, including higher morbidity and mortality. Methods In keeping with this Special Issue’s goals, this narrative review focuses on the ACEs pyramid and its purported mechanisms through which child maltreatment and other forms of violence toward human beings influence the health and well-being of individuals who develop EDs throughout the life span. Relevant literature on posttraumatic stress disorder (PTSD) is highlighted when applicable. Results At every level of the pyramid, it is shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide. Conclusions The implications of these cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. This overview offers multiple opportunities at every level for the palliation and prevention of EDs and other associated trauma-related conditions, including PTSD.

Indicators of Co-occurrence of Mood Disorder with Chronic Medical Conditions: Evidence from an Administrative Claims Data Analysis

“…There likely are many possible causal or biological mechanisms driving the observed comorbidities. For instance, environmental pathogens, such as infective agents and socially adverse as well as naturally adverse experiences, can cumulatively cause excessive inflammatory responses that can lead to or exacerbate various chronic and mental diseases (Baltrusch et al 1991; von Kanel 2012; Stuller et al 2012; Nikiphorou et al 2019; Jackson and Jabbi, 2022; Brewerton 2022). Of note, four of the top 5 most likely comorbid medical conditions were the same for bipolar disorder and MDD.…”

“…Of note, four of the top 5 most likely comorbid medical conditions were the same for bipolar disorder and MDD. Such overlapping associations may echo shared mood disorders etiology in that psychological and environmentally adverse and stressful experiences can trigger emergent mood disorders and cardiovascular and other somatic conditions (Jabbi and Nemeroff, 2019; Baltrusch et al 1991; von Kanel, 2012; Stuller et al 2012; Nikiphorou et al 2019; Jackson and Jabbi, 2022; Brewerton, 2022). In addition, this idea aligns with a recent study showing that a history of mental stress, with and without conventional stress, was associated with a significantly increased risk for myocardial ischemia with cardiovascular events (Vaccarino et al, 2021).…”

Eating disorder patients with and without PTSD treated in residential care: discharge and 6-month follow-up results

“…Posttraumatic stress disorder (PTSD) is a common comorbid condition in eating disorder (ED) patients, occurring in up to 50% of adults admitted to residential treatment (RT) [1][2][3][4]. An abundance of data from meta-analyses, national representative samples, clinical and community samples, and case control studies, have confirmed undisputable links between traumatic events and EDs, particularly for those with binge-type features [5][6][7][8][9][10]. Evidence also supports the contention that patients with significant traumatic histories and/or PTSD have distinct clinical features, including more severe ED symptoms, more suicidality, more anxiety and depressive symptoms, more experiential avoidance, and lower mindfulness [3,4,9,11].…”

The treatment of dissociative identity disorder in an eating disorder residential treatment setting

“…Dissociative disorders (DDs) and their symptoms are related to overwhelming traumatic experiences, especially during childhood, and include derealization, depersonalization, time distortions, cognitive and memory alterations (including amnesia), identity alterations, and somatic sensations (American Psychiatric Association, 2022; Dorahy et al, 2015; Ogawa et al, 1997; Simeon & Putnam, 2022). Child maltreatment (CM) of all types is highly associated with eating disorders (EDs), particularly those characterized by earlier ED onset, more binge‐purge symptoms, and greater suicidality and psychiatric comorbidity (Brewerton, 2022; Molendijk et al, 2017). CM and associated traumatic experiences are also associated with comorbid PTSD, greater severity of ED, major depression (MD), state–trait anxiety symptoms, and worse quality of life (QOL) (Brewerton et al, 2020; Brewerton et al, 2021; Scharff et al, 2019).…”