Eating disorders, trauma, and comorbidity: focus on PTSD.

This paper reviews the relationships among eating disorders (EDs), trauma, and comorbid psychiatric disorders, with a particular focus on posttraumatic stress disorder (PTSD). There have been a number of significant conclusions in the literature, applicable to clinical practice, which are essential to the understanding of the relationships between EDs and trauma. These are summarized as follows: a) childhood sexual abuse (CSA) is a nonspecific risk factor for EDs; b) the spectrum of trauma linked to EDs has been extended from CSA to include a variety of other forms of abuse and neglect; c) trauma is more common in bulimic EDs compared to nonbulimic EDs; d) findings linking EDs with trauma have been extended to children and adolescents with EDs; e) findings linking EDs with trauma have been extended to boys and men with EDs; f) multiple episodes or forms of trauma are associated with EDs; g) trauma is not necessarily associated with greater ED severity; h) trauma is associated with greater comorbidity (including and often mediated by PTSD) in ED subjects; i) partial or subthreshold PTSD may also be a risk factor for BN and bulimic symptoms; and j) the trauma and PTSD or its symptoms must be expressly and satisfactorily addressed in order to facilitate full recovery from the ED and all associated comorbidity.