Trauma, Eating Disorders, and Complex PTSD: The Long and Winding Road to Recovery

Brewerton, Timothy

Thursday, March 22, 2012: 8:30 AM-10:30 AM

Opal One (The Charleston Marriott)

This workshop will teach clinicians how to approach, evaluate and treat traumatized individuals with eating disorders and comorbid PTSD or complex PTSD. The implementation and integration of empirically based psychotherapeutic and psychopharmacologic strategies found to be effective in the treatment of these common, challenging conditions will be reviewed in detail.

Common comorbid psychiatric disorders associated with DSM-IV-defined eating disorders and obesity
1. Working definitions for the CE workshop
  1. Definitions of trauma
2. Anorexia Nervosa (307.1) and Trauma
  1. General prevalence
  2. Comorbid psychiatric disorders
3. Bulimia Nervosa (307.51) and Trauma
  1. General prevalence
  2. Comorbid psychiatric disorders
4. Eating Disorders Not Otherwise Specified (EDNOS; 307.50) and Trauma
  1. Subthreshold disorders and Trauma
    1. General prevalance
    2. Comorbid psychiatric disorders
  2. Binge Eating Disorder and Trauma
    1. General prevalance
    2. Comorbid psychiatric disorders
5. Obesity and Trauma
  1. General prevalance
  2. Comorbid psychiatric disorders (see Tim’s chapter 22)
Comprehend available research, and that traumatic experiences are significant yet nonspecific risk factors in the development of psychiatric conditions
1. Research on Children, adolescents, adults
2. Putting a “face” on the dual diagnosis (ED/Trauma) patient
  1. General case descriptions
    1. Child/adolescent case
    2. Adult case
Basic Tools: Assessment and Evidence based Treatments
1. Assessment
  1. Interview-based Assessments
  2. Self-report Assessments
  3. Complete psychiatric evaluation and diagnosis
2. What treatments have evidence to support their efficacy among this population (ED/Trauma)?
  1. How to find: Practice Guideline Resources
    1. American Psychiatric Association
    2. National Institute for Clinical Excellence
  2. ED Treatment
    1. Normalize Brain Function
    2. Medical Evaluation
    3. CBT
      1. The transdiagnostic model and CBT-E
      2. ERP
    4. Family Based Therapy
    5. IPT
    6. Pharmacotherapy: List the role of psychopharmacologic agents in the treatment of anorexia nervosa, bulimia nervosa, and binge eating disorder with comorbidity
  3. Trauma Treatment
    1. CBT
      1. Briefly mention PE; CPT
      2. Psycho-ed; exposure and CR
      3. EMDR
    2. Pharmacotherapy
  4. Generally useful with both
    1. DBT
Introduction to Person’s evidence based Case Formulation approach
Four steps in Case Formulation Approach
1. 1. General hypotheses based on assessment (share with patient)
    1. Assessment
    2. Working hypotheses
    3. Strengths Assets
  2. Generate initial treatment plan
    1. Patient's self-identified goals
    2. Shared treatment goals
  3. Implement treatment plan with ongoing assessment
    1. Sequential vs Simultaneous treatments
  4. Review ongoing assessment
    1. Is treatment is working
    2. Determine modifications to hypotheses

This workshop will benefit clinicians who want to understand how trauma and PTSD influence and complicate the course and treatment of eating disorders. Estimates indicate that at least 1 in 3 women in the United States will experience physical or sexual violence in her lifetime, and traumatization is associated with the emergence or worsening of multiple psychiatric symptoms and diagnoses, including eating disorders. Thus, traumatized individuals are likely to present with complicated clinical presentations for which there is currently no single treatment of choice. The first part of this workshop will provide an overview of the research aimed at understanding the relationship between trauma, PTSD, eating disorders, and comorbidity. Taken together, these findings indicate that traumatic experiences and subsequent PTSD are important risk factors in the development of ED's, particularly bulimia nervosa (BN), anorexia nervosa, binge-purge type, (AN-BP), binge eating disorder (BED) and EDNOS with purging, as opposed to restricting anorexia nervosa (AN-R). ED patients with a history of maltreatment, especially during childhood, are also more likely to have comorbid psychiatric illnesses, including affective, anxiety, substance use, disruptive, somatoform, dissociative and personality disorders, as well as extreme obesity. The second part of the workshop will focus on elucidating an integrated treatment approach for the ED patient with comorbidity using available published practice guidelines. General principles useful in approaching the comorbid ED patient will be outlined and specific recommendations will be explained. In particular, Person’s case formulation approach for use in designing individualized empirically-based treatment plans for patients with complex psychiatric presentations that include trauma, eating disorders, and related psychopathology, will be explained. Treatment interventions integrated into individualized plans include dialectical-behavior therapy (DBT), cognitive-behavioral therapy (CBT), exposure/response prevention, family therapy, and pharmacotherapy.

Primary Presenter:

Timothy Brewerton, MD, DFAPA, FAED, DFAACAP

Timothy D. Brewerton, MD, DFAPA, FAED, DFAACAP is Clinical Professor of Psychiatry and Behavioral Sciences at the Medical University of South Carolina. He is triple board certified in general, child/adolescent and forensic psychiatry, Distinguished Fellow of the American Psychiatric Association and Founding Fellow of the Academy of Eating Disorders. He has authored >120 articles/chapters and edited the book, Clinical Handbook of Eating Disorders: An Integrated Approach. He serves on the editorial boards of the International Journal of Eating Disorders, Eating Disorders, and Current Food and Nutrition Science. He has received numerous awards recognizing his research, teaching and clinical accomplishments.

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