Binging and Purging Behaviors in Women Affected by PTSD

Bulimia nervosa (BN) is often present in women who have experienced a childhood trauma. History of childhood sexual abuse (CSA), domestic violence, emotional abuse, or neglect can all increase the risk for BN and other eating issues in people, but especially in women. Other comorbid conditions that often exist in women with BN include substance abuse, depression, anxiety, and other mood problems. Posttraumatic stress (PTSD) is one condition that commonly co-occurs with eating issues. However, the relationship between PTSD and BN is unclear.

Trisha M. Karr of the Department of Clinical Research at the Neuropsychiatric Research Institute in North Dakota wanted to shed more light on how PTSD affects emotional regulation in women with BN. Both positive and negative affect are critical to the development and maintenance of symptoms in BN. The ability with which women can regulate these emotions directly affects symptom frequency and severity. Therefore, Karr conducted a recent study on 99 women with BN and 20 with BN and PTSD to determine if there were differences in affect, emotional regulation, and purging behaviors.

Karr found that both groups of women had similar levels of affect before and after purging. Specifically, they both experienced dramatic increases in negative affect and decreases in positive affect prior to purging. After purging, both groups of women saw decreases in negative affect and increases in positive affect. However, the women with BN and PTSD had more rapid changes in affect. In other words, their negative affect increased more quickly than those with BN only. Likewise, the level of negative affect decreased more quickly for women with PTSD and BN than for those with BN only. Karr believes that the oversensitivity to emotional arousal and perceptions of criticism, fear, rejection, and threat could cause less emotional regulation in women with PTSD. This in turn would lead to a faster escalation of negative affect. Also, the BN and PTSD group binged and purged more frequently than the BN group, again suggesting a hyperarousal to emotional stimuli. In sum, the results presented here show a subtle, yet important, difference in emotional regulation in BN for women with and without PTSD. Karr added, “These findings highlight the importance of recognizing PTSD when interpreting the emotion-behavior relationship in individuals with BN.”

Karr, Trisha M., et al. (2013). Posttraumatic stress disorder as a moderator of the association between negative affect and bulimic symptoms: An ecological momentary assessment study. Comprehensive Psychiatry 54.1 (2013): 61-9. ProQuest. Web.

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  • Tori

    April 9th, 2013 at 11:20 AM

    This is such an important aspect of eating disorders for anyone in the therapy field to pay attention to. You may have a client with whom you are working for some some past experience and not realize the multiple ways that this could be affecting their lives. How many of us would naturally think that a traumatic event could lead to problems with one’s eating behaviors, and yet here is strong evidence that it could indeed play a roe in the development of such behavioral patterns. Great information to keep all of us looking for the numerous ways that one’s life could be impacted byt their lives that they knew before they found their way to treatment.

  • mike h

    April 9th, 2013 at 9:43 PM

    its scary to even imagine a binge and purge cycle. mist he so tough on those affected; not just physically but mentally too. and with regard o the difference between presence and absence of ptsd its important that clinicians keep an eye on that. not only does ptsd presence increase symptoms but should also raise a red flag for help with the ptsd itself. that can really be threatening if left unchecked.

  • carinna s

    April 10th, 2013 at 3:57 AM

    It is bad enough for someone to wrestle with PTSD and the ramifications of that illness.
    To add to that the dangers of an eating disorder is doubly frightening.

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