Can Integrated Treatment Help People with Eating Disorders and PTSD?

What you need to know

• Many people with eating disorders also struggle with posttraumatic stress disorder (PTSD)
• Researchers tested a new therapy that combines treatments for both conditions
• The integrated therapy led to greater improvements in PTSD symptoms compared to standard eating disorder treatment
• Both treatments were safe and helped reduce anxiety and depression

Background on eating disorders and PTSD

Eating disorders and posttraumatic stress disorder (PTSD) often occur together. PTSD develops after experiencing or witnessing a traumatic event, leading to symptoms like flashbacks, nightmares, and severe anxiety. When someone has both an eating disorder and PTSD, the conditions can interact and make each other worse.

For example, someone might use disordered eating behaviors like bingeing or restricting food as a way to cope with trauma symptoms. Or PTSD symptoms could trigger eating disorder urges. Because of this interplay, treating just one condition may not be enough for full recovery.

Traditionally, eating disorders and PTSD have been treated separately. However, some experts have suggested that integrating treatments for both conditions could lead to better outcomes. This study is the first to test that idea in a randomized controlled trial - considered the gold standard for medical research.

Testing an integrated treatment approach

The researchers recruited 42 people who had both an eating disorder and PTSD. All participants had already completed an intensive hospital-based program focused on stabilizing their eating and weight.

The participants were randomly assigned to one of two treatment groups:

1. Standard cognitive-behavioral therapy (CBT) for eating disorders
2. Integrated CBT that combined treatments for eating disorders and PTSD

Both treatments involved 16 therapy sessions over 14 weeks. The integrated CBT combined elements of two evidence-based therapies:

• Enhanced CBT for eating disorders
• Cognitive processing therapy for PTSD

The integrated treatment addressed how the eating disorder and PTSD symptoms interacted and maintained each other. It also included writing about the traumatic experience, which is an important part of PTSD treatment.

Comparing the treatments

The main goal was to see if the integrated CBT led to greater improvements in PTSD symptoms compared to standard eating disorder treatment. The researchers assessed participants’ symptoms before treatment, right after treatment ended, and at 3-month and 6-month follow-ups.

Some key findings:

• The integrated CBT led to significantly greater reductions in PTSD symptoms compared to standard treatment
• These improvements in PTSD were maintained at the 3-month and 6-month follow-ups
• Both treatments led to improvements in anxiety and depression symptoms
• There were no significant differences between the treatments in terms of eating disorder symptoms

Importantly, the integrated treatment did not lead to any worsening of eating disorder symptoms. This addresses a common concern that trauma-focused therapy could potentially trigger eating disorder behaviors.

Treatment safety and satisfaction

Another goal was to assess whether the integrated treatment was safe and acceptable to patients. The results were encouraging:

• There were no suicide attempts or psychiatric hospitalizations during the study
• One participant in the integrated CBT group went to the emergency room for suicidal thoughts while writing about their trauma, but was not admitted and went on to complete treatment successfully
• 97% of participants were at least somewhat satisfied with their treatment
• 90% were very or completely satisfied
• All participants said they would recommend their treatment to others

Interestingly, 87% of participants said they would prefer integrated treatment over separate treatments for eating disorders and PTSD. And 93% of those who received the integrated CBT felt it would help their eating disorder recovery.

Conclusions

• Integrating treatments for eating disorders and PTSD appears to be safe and effective
• The integrated approach led to greater improvements in PTSD symptoms compared to standard eating disorder treatment alone
• Both treatments helped reduce anxiety and depression
• Patients expressed a strong preference for integrated treatment addressing both conditions together
• More research is needed to determine if integrated treatment leads to better long-term eating disorder outcomes

This study provides initial evidence supporting integrated treatment for people struggling with both eating disorders and PTSD. The researchers hope these findings will lead to more clinics and treatment programs offering trauma-informed care as part of eating disorder treatment.

For patients and families, these results suggest it may be beneficial to seek out providers who can address both eating disorders and trauma/PTSD together, rather than treating them completely separately. However, more studies are still needed to confirm the long-term benefits of this integrated approach.