Table 2.
Summary of studies examining posttraumatic stress disorder in relation to eating disorder outcomes
| Author and Year | N | Participant Characteristics | Level of Care | Type of ED Treatment | ED Criteria | ED Diagnoses Included | PTSD Assessment | Psychological Outcome | Quality Assessment | Results |
|---|---|---|---|---|---|---|---|---|---|---|
| Cook et al. (2022) | 272 | Mage= 29.07 (SD = 10.57); 87.3% female; race/ethnicity and SES information NR | Stepped care (residential, partial hospitalization, and intensive outpatient) | Unspecifieda | DSM-5 | AN, BN, BED, ARFID, OSFED | PCL-5 used as presumptive positive current PTSD diagnosis | Eating Disorder Examination Questionnaire (EDE-Q) | Weak | Less improvement in eating disorder symptoms was observed after treatment in participants with PTSD in 2020 as compared to participants in 2019 |
| Hazzard et al. (2021) | 112 | Mage= 39.7 (SD = 13.4); 82.1% cisgender women; 91.1% Caucasian; 68.8% college degree | Outpatient | Integrative Cognitive‐ Affective Therapy (ICAT) or guided self‐help CBT | DSM-5 | BED | Lifetime diagnosis | Eating Disorder Examination (EDE) | Moderate | PTSD predicted greater objective binge‐eating episode frequency at end of treatment; moderate/severe childhood abuse predicted greater objective binge‐eating episode frequency at 6‐month follow‐up only for the PTSD group; ns for global eating pathology |
| Hicks (2016) | 61 | Mage = 15.2 (SD = 1.73); 91.8% female, 8.2% male (assessed as sex assigned at birth); 85.2% White; SES information NR | Outpatient | Program included Family-Based Therapy (FBT), Dialectical Behavior Therapy (DBT), and CBT | DSM IV-TR | AN | Diagnosis (unknown timeframe) | Weight restoration | Weak | ns |
| Masson et al. (2007) | 186 | Mage = 26.5 (SD = 9.4); 93% women; race/ethnicity information NR; 20% high school diploma, 29% some college or university, 19% undergraduate degree | Inpatient | Based on a cognitive behavioral approach incorporating psychodynamic, and psychoeducational treatment options. | DSM-IV | AN, BN, EDNOS | Current diagnosis | Treatment dropout | Weak | ns |
| K. S. Mitchell, Singh, et al. (2021) | 2,809 | Mage = 25.14 (SD = 10.99); 100% female; 80.5% White, 2.1% Black, 2.3% Asian or Pacific Islander, 0.5% Native American, 3.5% multiracial, 2.2% other races; 6.1% Latinx; SES information NR for the sample as a whole | Residential | Unified Treatment Model (based on CBT) | DSM-5 | AN-R, AN-BP, BN, OSFED/UFED, BED, ARFID | Current diagnosis | Eating Disorder Examination Questionnaire (EDE-Q), behavioral outcomes, treatment dropout | Moderate | ns |
| Scharff, Ortiz, Forrest, Smith, et al. (2021) | 1055 | Mage = 24.73 (SD = 10.72); 100% women/girls; 80.9% White; SES information NR | Residential | Unified Treatment Model (based on CBT) | DSM-5 | AN-R, AN-BP, BN, BED, OSFED | Current diagnosis | Eating Disorder Examination Questionnaire (EDE-Q) | Moderate | PTSD was associated with more substantial symptom reductions from admission to discharge, yet also a steeper rate of symptom recurrence from discharge to follow‐up. |
| Trottier (2020) | 151 | Mage = 28.1 (SD = 8.6); 94.7% female; 4.6% male; 0.7% transgendered; race/ethnicity and SES information NR | Partial Hospital | CBT | DSM-5 | BN, OSFED | PCL-5 used as presumptive positive current PTSD diagnosis | Non-completion of treatment | Strong | PTSD predicted a greater risk of premature termination |
Note. Participant characteristics are included in this table as reported in the source paper. Assessment of sex and gender was not described unless otherwise specified. AN = anorexia nervosa; AN-BP = anorexia nervosa, binge-eating/purging subtype; AN-R = anorexia nervosa, restricting subtype; ARFID = avoidant/restrictive food intake disorder; BN = bulimia nervosa; BED = binge eating disorder; CBT = cognitive behavioral therapy; DSM = Diagnostic and Statistical Manual; ED = eating disorder; EDNOS = eating disorder not otherwise specified; ns = difference not supported; OSFED = other specified feeding and eating disorders; PCL-5 = Posttraumatic Stress Disorder Checklist for DSM-5; PTSD = posttraumatic stress disorder; UFED = unspecified feeding or eating disorder.
Treatment was described as “an integrated and adaptive model that includes specialized evidence-based practices in therapy, nutrition, medical, movement/exercise, and relational components of eating disorder care” (Cook et al., 2022).