Background: Dr. Brewerton presents his first case of dissociative identity disorder and binge eating that spawned his clinical research interest in trauma and EDs. Video clips from various stages during treatment illustrate the dissociative processes and the various "alters" identified. He illustrates how these “alters” take on specific adaptive functions and separate identities, which protect the self and are often archetypal in nature. Evolving concepts from psychotherapy theory and neuroscience are highlighted during the presentation. Next, he will present an overview of the current state of clinical science and practice regarding traumatized ED patients and advocate for trauma-informed care and practice.
Objectives:
- List 7 clinical features of traumatized patients with eating disorders.
- Recognize at least 2 possible therapeutic approaches to treating the traumatized ED patient with PTSD.
- Compare the adaptive functions of the various alters that are identified and described in this case presentation.
- Personal reflections
- Professional development and evolution
- Nature and history of dissociation, multiple personality disorder (MPD), and dissociative identity disorder (DID)
- DSM-5 diagnostic criteria for DID and other dissociative disorders
- Where neurobiology meets psychoanalysis
- My first case of MPD/DID
- Case presentation and course of treatment
- Illustrative video clips demonstrating full integration
- Archetypal aspects of alters
- Case discussion
- Prevalence of dissociative disorders
- Clinical and neuroscience research at the time and subsequently
- General principles in DID treatment
- Benefits of working with DID patients
Part 2:
- Historical perspectives
- SAMHSA’s definition of trauma and public health approach to trauma
- What is Trauma-informed care and a trauma-informed approach
- Six key principles of a trauma-informed approach
- Key Features of Trauma-informed care and practice systems
- Prevalence estimates of trauma types in the U.S.
- Childhood maltreatment and eating disorder pathology
- Trauma, PTSD and comorbidity
- PTSD in eating disorders: results from two national samples
- Eating disorder pathology and trauma-related symptoms in maltreated children and adolescents receiving forensic evaluation
- Neurobiology of PTSD
- PTSD and EDs share common risk factors
- Heightened perception of threat and reactivity to trauma in EDs
- Clinical characteristics of traumatized individuals with EDs
- Complex trauma and complex PTSD
- Multiple episodes or types of traumatic experiences are associated with EDs
- The case for Trauma‐informed Care (TIC) and a Trauma‐informed Approach (TIA) in eating and related disorders
- Lack of integrated treatment approaches
- Initial findings from Project Recover
- Common reasons why some providers avoid screening clients for trauma
- Assessment instruments for trauma exposure and PTSD
- Collaborative MI style
- Common adaptive functions found in EDs
- Exposure therapy
- Factors that interfere with processing
- EMDR, PE, CPT, TF-CBT
- Window of tolerance and the reconsolidation window
- DBT
- Old v. new treatment frameworks
- Guidelines for starting trauma treatment in ED patients
- Harm reduction therapy
- Countertransference, vicarious traumatization, and compassion fatigue
- Resilience and adversarial growth
In Part 2 Dr. Brewerton will segue into presenting an overview of the role of trauma and trauma-related disorders in the development and perpetuation of EDs. Those prone to develop EDs appear to be especially sensitive to stress and adversity. Individuals with EDs also report very high rates of lifetime traumatic events. In this presentation, participants will become familiar with the literature that describes the clinical characteristics of individuals with EDs and comorbid posttraumatic sequelae, including PTSD, Complex PTSD, and Dissociative Disorders. Understanding the clinical features of these individuals is extremely important to their successful management and treatment. He will also discuss Trauma Informed Care (TIC) for EDs and important principles for treating individuals with EDs and comorbid PTSD and other trauma-related disorders, including the necessity of moving beyond sequential treatment to the development of integrated treatment protocols. Integration of existing evidence-based treatments including CBT for EDs, DBT, Cognitive Processing Therapy (CPT) Prolonged Exposure (PE), and Eye Movement Desensitization Reprocessing (EMDR) are recommended. Recent research suggests that ED clinicians view integrated treatment for individuals with ED and PTSD as a top priority yet they have several concerns about administering such a treatment.
• Timothy D. Brewerton, MD, DFAPA, FAED, DFAACAP, HCEDS is Affiliate Professor of Psychiatry & Behavioral Sciences at the Medical University of South Carolina in Charleston, where he is also in private practice. He is board certified in general, child/adolescent and forensic psychiatry, as well as addiction medicine, 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. He has authored over 150 articles/chapters, has edited/co-edited two books, and serves on the editorial board of three major eating disorder journals.
