Trauma and multi-impulsivity in the eating disorders
Eating Disorders Service, South West London and St. George's Mental Health NHS Trust, United Kingdom. Eating Behaviors
(Impact Factor: 1.58).
02/2007; 8(1):23-30. DOI: 10.1016/j.eatbeh.2004.08.009
Multiple impulsive behaviours are common in the eating disorders, and multi-impulsive patients appear to do more poorly in treatment. However, comparatively little is known about the origins of multi-impulsivity in such cases. This study addresses the links between reported childhood trauma and multi-impulsivity in the eating disorders, examining whether specific types of trauma are predictive of specific impulsive behaviours in this population.
The sample consisted of 102 individuals who met strict criteria for an eating disorder, and who were interviewed regarding trauma history and comorbid impulsive behaviours.
Any reported history of childhood trauma was associated with a higher number of impulsive behaviours and with the presence of multi-impulsivity. Childhood sexual abuse was particularly important, and was associated with self-cutting, alcohol abuse, and substance abuse (amphetamines, cocaine, cannabis and 'other substances', including ketamine and benzodiazepines).
These findings indicate the importance of considering the psychological consequences of trauma during both assessment and treatment of the eating disorders. In particular, eating-disordered women who report a history of childhood sexual abuse should be examined for a pattern of comorbid impulsive behaviours.
Available from: William Haning
- "Piran and Robinson  showed high rates of stimulant use among women with eating disorders. Corstorphine et al  showed that women with eating disorders who were victims of childhood sexual assault were more likely to use alcohol, cocaine or amphetamines. Gender roles stressing the thin-ideal body image may exacerbate the problem, especially among white, Native American and Pacific Island women . "
[Show abstract] [Hide abstract]
ABSTRACT: Methamphetamine (MA) use during pregnancy is associated with many pregnancy complications, including preterm birth, small for gestational age, preeclampsia, and abruption. Hawaii has lead the nation in MA use for many years, yet prior to 2007, did not have a comprehensive plan to care for pregnant substance-using women. In 2006, the Hawaii State Legislature funded a pilot perinatal addiction clinic. The Perinatal Addiction Treatment Clinic of Hawaii was built on a harm-reduction model, encompassing perinatal care, transportation, child-care, social services, family planning, motivational incentives, and addiction medicine. We present the implementation model and results from our first one hundred three infants (103) seen over 3 years of operation of the program.
Referrals came from community health centers, hospitals, addiction treatment facilities, private physician offices, homeless outreach services and self-referral through word-of-mouth and bus ads. Data to describe sample characteristics and outcome was obtained prospectively and retrospectively from chart abstraction and delivery data. Drug use data was obtained from the women's self-report and random urine toxicology during the pregnancy, as well as urine toxicology at the time of birth on mothers, and urine and meconium toxicology on the infants. Post-partum depression was measured in mothers with the Edinburgh Post-Partum depression scale. Data from Path clinic patients were compared with a representative cohort of women delivering at Kapiolani Medical Center for Women and Children during the same time frame, who were enrolled in another study of pregnancy outcomes. Ethical approval for this study was obtained through the University of Hawaii Committee for Human Studies.
Between April 2007 and August 2010, 213 women with a past or present history of addiction were seen, 132 were pregnant and 97 delivered during that time. 103 live-born infants were delivered. There were 3 first-trimester Spontaneous Abortions, two 28-week intrauterine fetal deaths, and two sets of twins and 4 repeat pregnancies. Over 50% of the women had lost custody of previous children due to substance use. The majority of women who delivered used methamphetamine (86%), either in the year before pregnancy or during pregnancy. Other drugs include marijuana (59.8%), cocaine (33%), opiates (9.6%), and alcohol (15.2%). Of the women served, 85% smoked cigarettes upon enrollment. Of the 97 women delivered during this period, all but 4 (96%) had negative urine toxicology at the time of delivery. Of the 103 infants, 13 (12.6%) were born preterm, equal to the state and national average, despite having many risk factors for prematurity, including poverty, poor diet, smoking and polysubstance use. Overwhelmingly, the women are parenting their children, > 90% retained custody at 8 weeks. Long-term follow-up showed that women who maintained custody chose long-acting contraceptive methods; while those who lost custody had a very high (> 50%) repeat pregnancy rate at 9 months post delivery.
Methamphetamine use during pregnancy doesn't exist is isolation. It is often combined with a multitude of other adverse circumstances, including poverty, interpersonal violence, psychiatric comorbidity, polysubstance use, nutritional deficiencies, inadequate health care and stressful life experiences. A comprehensive harm reduction model of perinatal care, which aims to ameliorate some of these difficulties for substance-using women without mandating abstinence, provides exceptional birth outcomes and can be implemented with limited resources.
Available from: Kate Tchanturia
- "Escape theory states that binge eating is used as a management strategy employed to enable the individual to escape from emotional distress (Heatherton & Baumeister, 1991). Waller, Corstorphine and Mountford (2007) present an analysis of the emotional regulation of people with an ED who have experienced emotional abuse. Corstorphine, Waller, Lawson and Ganis (2007) state that in ED patients with childhood emotional abuse, impulsive behaviours are used to regulate affect. "
[Show abstract] [Hide abstract]
ABSTRACT: It is recognized that emotional problems lie at the core of eating disorders (EDs) but scant attention has been paid to specific aspects such as emotional recognition, regulation and expression. This study aimed to investigate emotion recognition using the Reading the Mind in the Eyes (RME) task and emotion regulation using the Difficulties in Emotion Regulation Scale (DERS) in 20 women with anorexia nervosa (AN) and 20 female healthy controls (HCs). Women with AN had significantly lower scores on RME and reported significantly more difficulties with emotion regulation than HCs. There was a significant negative correlation between total DERS score and correct answers from the RME. These results suggest that women with AN have difficulties with emotional recognition and regulation. It is uncertain whether these deficits result from starvation and to what extent they might be reversed by weight gain alone. These deficits may need to be targeted in treatment.
[Show abstract] [Hide abstract]
ABSTRACT: In deze studie wordt het verband tussen traumatische ervaringen en verscheidene aspecten van de eetstoornis, comorbide psychopathologie
en dissociatie nagegaan bij een klinische populatie vrouwelijke eetstoornispatiënten (n=298). De prevalentie van traumatische ervaringen ligt opmerkelijk hoog binnen de gehele onderzoeksgroep (71,8%). Binnen
de diagnostische groepen worden traumatische ervaringen het meest gerapporteerd door de anorexiapatiënten van het ‘gemengde’
type, op de voet gevolgd door de boulimiapatiënten. In deze groepen wordt ook het meest gestoorde beeld van de eetstoornis
vastgesteld; bij hen is sprake van meer symptomatologie, comorbiditeit en dissociatie dan bij anorexiapatiënten van het restrictieve
type. Ook worden de patiënten mét en zonder traumatisch verleden met elkaar vergeleken op de onderzochte klinische variabelen.
De resultaten wijzen overduidelijk aan dat de traumagroep bij opname over de hele lijn meer psychopathologie vertoont in vergelijking
met de non-traumagroep. Binnen de diagnostische subgroepen van de eetstoornissen komen dissociatie en algemene psychopathologie
als meest traumaspecifieke kenmerken naar voren.
In this study the relationship between traumatic experiences and different aspects of the eating disorder, comorbid psychopathology
and dissociation was examined in a clinical population of female eating disorder patients (n=298) by means of a series of self-report questionnaires administered upon admission to the hospital. In the entire group
of participants the prevalence of traumatic experiences was remarkably high (71,8%) in the diagnostic groups. Traumatic experiences
were reported the most frequently by the anorectic patients of the ‘binge eating/purging type’ and the bulimic patients. In
these groups, the eating disorder seemed to be the most severe; they showed more eating symptomatology, comorbidity and dissociation
than the group of anorectic patients of the ‘restricting type’. The patients reporting traumatic experiences were compared
to the non-trauma group. The results clearly showed that, during hospitalization, the trauma sample showed more psychopathology
than the latter. When comparing the different diagnostic ED subgroups, dissociation and general psychopathology seemed to
be the most trauma-specific related characteristics.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.