Eating Disorders, Complex PTSD, Dissociative Subtype of PTSD and Dissociative Disorders

Abstract
The presenter combines his 40 plus years of clinical research experience and knowledge of the relevant peer-reviewed scientific data to present a synthesis that supports the major premises of the talk, including the contention that 1) EDs are linked to child maltreatment, other traumas and trauma-related comorbid disorders, including PTSD, complex PTSD (cPTSD), the dissociative subtype of PTSD (DPTSD), and dissociative disorders (DDs); 2) integrated treatment strategies that go beyond currently accepted sequential approaches are required to adequately address the complexity of ED presentations, especially in higher levels of care. Dr. Brewerton will discuss the Adverse Childhood Experiences (ACEs) pyramid and its purported mechanisms through which child maltreatment and other forms of interpersonal violence influence the health and well-being of individuals who develop EDs throughout the life span. Relevant findings on PTSD/CPTSD/DPTSD/DDs will be highlighted when applicable. At every level of the pyramid, it will be shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide. These cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. Previously published treatment guidelines do not adequately address the assessment and treatment approaches of ED patients with PTSD/CPTSD/DPTSD/DDs and other trauma-related disorders. The result is a lack of integration between ED and PTSD/CPTSD/DPTSD/DDs treatment providers, which often leads to fragmented, incomplete, uncoordinated and ineffective care of severely ill patients with ED + complex trauma. This presentation will address these gaps and present a rational, clinical research based integrated guideline for addressing these complexities. The evaluation of patients (including children, adolescents, and adults) with EDs and trauma-related comorbidity using reliable and validated assessment instruments will be briefly reviewed. An integrated set of principles used in treatment planning of PTSD/DPTSD/DPTSD/DDs and trauma-related disorders is recommended in the context of intensive ED therapy. These principles and strategies are borrowed from several relevant evidence-based approaches. Evidence suggests that continuing with traditional single-disorder focused, sequential treatment models that do not prioritize integrated, trauma-focused treatment approaches are short-sighted and often inadvertently perpetuate this dangerous multimorbidity.