Background: This workshop reviews what eating disorder professionals need to know about working with traumatized individuals with PTSD. Dr. Brewerton will review issues around etiology, assessment, diagnosis, and treatment approaches. Ms. Schaefer will discuss her personal experience with trauma and PTSD and how this important condition was missed, misdiagnosed and mistreated.
I. Introductions
II. Meet audience; decipher knowledge level
III. Dr. Brewerton
What is PTSD and partial PTSD (pPTSD)?
- History of the concept
- DSM-5 classification and diagnostic criteria
How common is PTSD/pPTSD?
- General population prevalence
- Higher in women
- Prevalence in eating disordered populations
Why is PTSD/pPTSD so important to recognize and treat?
- Long-term course
- Chronicity
- Relationship to EDs and other psychiatric disorders
- Relationship to medical disorders and major causes of death
What do we know about etiology of PTSD/pPTSD?
- Genetic and environmental aspects
- Predisposing factors
- Changes in the body and in the brain
- Epigenetic aspects: how trauma may be transmitted across generations
How is PTSD/pPTSD treated?
- Psychotherapeutic approaches: CBT-PE, CPT, EMDR
- Pharmacologic approaches: antidepressants, anticonvulsants, antipsychotics
- Alternative approaches
How and why do professionals fall short?
- Lack of education, training and supervision
- The research-practice gap
- Collusion and avoidance
- Vicarious traumatization
IV. Ms. Schaefer
My timeline
- Anorexia nervosa (binge/purge type): evolution of disorder, seeking treatment, symptom improvement
- Trauma incident: development of PTSD symptoms, exacerbation of ED
- Long-term ED recovery
- Keeping PTSD at bay: avoiding triggers
- Development of full-blown PTSD
- Seeking PTSD treatment
Uniformed treatment approaches
- Mistakes made by well-meaning professionals
- Assumption that child abuse must exist due to ED history (e.g. a search to “find the trauma”)
- Missed opportunities regarding the actual trauma incident: lack of awareness regarding how trauma impacts individuals differently
- Misdiagnosis of PTSD by a succession of well-meaning providers
- Bad advice–bad outcome
- Staying stuck
Finding the right professionals to do the right thing
- Long-term ED recovery despite PTSD development
- Importance of evidence-based treatment approaches (CBT-PE, CPT, and EMDR for PTSD)
- Incorporating alternative and pharmacologic approaches
- Applying ED recovery lessons to PTSD recovery
My mission, my story
- Sharing experience with PTSD for the first time in an effort to prevent misdiagnosis and prolonged pain and suffering
- Connecting the relationship between EDs and PTSD
- Healing is possible
V. Follow-up discussion
VI. Q&A
Eating disorders (EDs) and posttraumatic stress disorder (PTSD) are debilitating conditions that co-occur frequently. While a significant number of women and men with eating disorders report a history of trauma, research suggests that it is PTSD, not the trauma itself that best predicts the development of the ED. Particularly, PTSD is more common among those with bulimia nervosa (BN) and other EDs characterized by bulimic symptoms. Data indicate that 37-45% of adults with BN and 22-26% of those with binge eating disorder (BED) have a lifetime prevalence of PTSD—compared to 5-12% without an ED. Moreover, when partial or subthreshold PTSD (pPTSD) is added to the mix, then the majority of those with BN have histories of PTSD or pPTSD. Such individuals are theorized to use maladaptive food behaviors as a way to self-medicate the condition’s devastating symptoms. Clinical experience and evidence to date suggest that PTSD/pPTSD may predict a poorer response to evidence-based treatments (e.g., CBT-E) and a longer duration of illness. The purpose of this workshop is to review what ED professionals need to know about working with traumatized individuals with PTSD/pPTSD. Dr. Brewerton will examine issues around etiology, assessment, diagnosis, and treatment. He will shed light not only on the life-threatening aspects of EDs but also how trauma and PTSD predicts a greater likelihood of developing one or more of the leading causes of death. Ms. Schaefer, an author and recovered patient with an ED history, will share her personal experience with trauma and PTSD and how her condition was missed, misdiagnosed and mistreated by well-meaning but uninformed professionals. She will discuss the importance of evidence-based therapeutic and pharmacologic approaches as well as alternative interventions. Within this workshop, participants will learn major risk factors for eating and related comorbid disorders, including genetic, environmental and epigenetic factors and their interaction with a particular emphasis on the role of stress, trauma and PTSD/pPTSD. Systematic, evidence-based assessment and treatment approaches of EDs complicated by PTSD/pPTSD and psychiatric comorbidity will be addressed. Combining research and clinical knowledge with a patient’s perspective, this unique, interactive workshop is for novice and seasoned clinicians.
Timothy D. Brewerton, MD, DFAPA, FAED, DFAACAP, HCEDS is Executive Medical Director of the Hearth Center for Eating Disorders in Columbia, SC, and Clinical Professor of Psychiatry & Behavioral Sciences at the Medical University of South Carolina in Charleston, where he is also in private practice. He is triple board certified in general, child/adolescent and forensic psychiatry and has received numerous awards recognizing his accomplishments, including the 2013 Craig Johnson Award for Clinical Practice and Training by NEDA and the Honorary Certified Eating Disorder Specialist award by IAEDP.
Chair of the Ambassadors Council of the National Eating Disorders Association, Jenni Schaefer is a bestselling author and internationally known speaker. She has appeared on shows like Today and Dr. Oz, as well as in publications ranging from Cosmopolitan to The New York Times. Jenni’s books include Goodbye Ed, Hello Me and her latest with Harvard Medical School, Almost Anorexic: Is My (or My Loved One’s) Relationship with Food a Problem? Her first book, Life Without Ed, which launched her as a leading light in the recovery movement, has been released in a tenth anniversary edition and audiobook. Visit JenniSchaefer.com.
