The impact of trauma exposure on psychiatric symptoms and treatment of eating disorders in adolescents.

Potentially traumatic experiences are associated with eating disorders (ED). This study characterizes trauma exposures in a clinical adolescent ED population, considering types and impact on clinical course. Adolescents admitted for inpatient or partial hospitalization ED treatment completed ED, anxiety and depression questionnaires at intake and discharge. At intake, a Trauma Screener was completed, and if positive, the Childhood Posttraumatic Symptom Scale (CPSS-5-SR) was also completed. Participants were grouped based on number of trauma exposures reported (none, single, multiple), and linear mixed effects models considered how trauma impacted treatment responses. Study participants (n = 407) were 15.11 ± 1.59 years old, primarily female (86.5%), white (76.7%), and not-Hispanic (60.7%). Most reported trauma exposures (none 40.2%; single 17.0%; multiple 42.8%) with vicarious (36.8%), medical (25.2%), and physical (23.9%) most frequent. However, adolescents more commonly associated their symptoms with emotional (30.5%), medical (19.7%), or sexual (16.8%) trauma exposures. At intake, those with multiple trauma exposures had significantly higher depression, anxiety, and EDE-Q total and subscale scores (all p ≤ 0.003), except for restraint. Irrespective of trauma exposures, depression, eating, and anxiety improved with treatment (all p ≤ 0.003). Interactions with time and trauma were significant for depression (p = 0.04) and eating symptoms (p < .02), except restraint. These findings confirm that childhood trauma exposures are both extremely common in ED and increase psychiatric symptoms at presentation. Clinicians should consider screening adolescents presenting with trauma exposures for disordered eating, as earlier interventions for ED are known to improve outcomes.