Posttraumatic stress disorder and eating disorders: maintaining mechanisms and treatment targets
Posttraumatic stress disorder and eating disorders: maintaining mechanisms and treatment targets
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DOI：
10.1080/10640266.2020.1869369
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发表时间：
2021-01-09
期刊：
影响因子：
3.3
通讯作者：
Cooper, Zafra
中科院分区：
文献类型：
--
作者：
Mitchell, Karen S.;Scioli, Erica R.;Cooper, Zafra
许多有饮食失调(EDS)终生病史的人报告称，他们暴露在人际关系创伤和创伤后应激障碍(PTSD)中。然而，这种关系还没有被很好地理解，也没有确定的循证疗法来同时治疗EDS和PTSD。本文就创伤暴露和/或创伤后应激障碍与创伤后应激障碍的相关机制进行综述。从文献中确定的创伤-ED关联的可能机制包括自我批评、低自我价值感、内疚、羞愧、抑郁、焦虑、情绪失调、愤怒和冲动/强迫。ED行为可作为处理创伤后应激障碍症状和负性情绪的应对策略。通过暴饮暴食、排泄和/或限制来避免过度觉醒症状，可能有助于维持ED和PTSD。鉴于抑郁症和创伤后应激障碍之间存在双向关系的证据，我们描述了一个整合的认知行为理论，该理论可以解释并发的创伤后应激障碍和创伤后应激障碍的持久性。综合模型是基于支持现有的创伤后应激障碍和勃起功能障碍循证治疗的理论模型，并结合了迄今为止强调的许多潜在机制。该模型的主要目的是确定潜在的治疗目标，并阐明未来的研究方向。
Many individuals with lifetime histories of eating disorders (EDs) report exposure to interpersonal trauma and posttraumatic stress disorder (PTSD). However, this relationship is not well-understood, and there are no established, evidence-based therapies for the concurrent treatment of EDs and PTSD. This review focuses on studies of the mechanisms associating trauma exposure and/or PTSD with EDs. Possible mechanisms of the trauma-ED association identified from the literature include self-criticism, low self-worth, guilt, shame, depression, anxiety, emotion dysregulation, anger, and impulsivity/compulsivity. ED behaviors may be used as coping strategies to manage PTSD symptoms and negative affect. Avoidance of hyperarousal symptoms by engaging in binge eating, purging, and/or restriction may serve to maintain both the ED as well as the PTSD. Given the evidence of the bidirectional relationship between EDs and PTSD, we describe an integrated cognitive behavioral theory that may account for the persistence of comorbid PTSD and EDs. The integrated model is based on the theoretical models that underpin existing evidence-based treatments for PTSD and ED and incorporates many of the potential mechanisms highlighted to date. The primary aim of the model is to identify potential treatment targets as well as elucidate future directions for research.