创伤后应激障碍与进食障碍

创伤后应激障碍（创伤后应激障碍）和饮食失调经常同时发生。患有饮食失调的人可能有其他心理健康状况，例如万博手机客户端generalized anxiety disorder, social anxiety disorder, or强迫症（强迫症）。事实上，许多患有饮食失调的人也有一种或多种焦虑症，通常早于饮食失调。

What Is PTSD?

在最新版的精神障碍诊断和统计手册，第5版（DSM-5），PTSD被列入DSM的焦虑障碍类别。2013年，创伤后应激障碍的诊断被转移到一个新的疾病类别，称为创伤和应激相关疾病。

A diagnosis of PTSD is made when a person experiences a traumatic event and then has great difficulty in the aftermath of that event. The traumatic incident continues to dominate their daily life. A PTSD diagnosis requires a person to have symptoms that can include upsetting and intrusive memories, nightmares, avoidance of reminders of the event, negative thoughts or feelings related to the event, difficulty concentrating, constant anxiety, and increased physiological arousal since the event. These symptoms must persist for a month or more.

什么是饮食失调？

饮食失调是复杂affec的条件t eating and can seriously impair health and social functioning. The most common eating disorders are:

• Binge-eating disorder(BED):吃大量食物而感觉失控
• 神经性贪食症:吃大量的食物与旨在抵消这种饮食影响的行为交替进行
• 神经性厌食:由于害怕体重增加而吃得不够以满足能量需求

These are also the three types of eating disorders that have most often been studied in relation to PTSD.

什么是创伤？

创伤指的是广泛的经验。虽然最初人们经常研究饮食失调，认为它与儿童期性虐待有关，但创伤的定义已经扩大到包括许多其他形式的伤害，包括其他儿童时期的来源，如情感虐待、情感和身体忽视、戏弄和欺凌，以及成人经历，如强奸，性骚扰和攻击。它还可以包括自然灾害、机动车辆事故和战斗。

How PTSD Relates to Trauma

Anyone can develop PTSD at any age. Not every person who experiences trauma develops PTSD—in fact, most people will manage to process a traumatic event and move on without developing the disorder. Others will exhibit some behaviors or transient symptoms of PTSD but never develop the disorder.

Certain factors can increase a person’s likelihood of developing PTSD following trauma—these can include the type of trauma, number of traumas experienced, prior problems withanxiety and depression, poor social support, and genetic predisposition.

饮食失调与创伤后应激障碍

创伤, including childhood sexual abuse, is a “nonspecific” risk factor for eating disorders—nonspecific because it can also precede a number of other psychiatric disorders. In the U.S., the lifetime prevalence of PTSD is estimated to be at 6.4 percent. Rates of PTSD among people with eating disorders are less clear because there are few studies. What studies do exist show the following rates for lifetime PTSD:

• Women with bulimia nervosa:37-40%
• 带床女士：21-26%
• 神经性厌食症妇女：16%
• Men with bulimia nervosa:66%
• 带床男士：24%

在有暴饮暴食和净化症状的进食障碍患者中，包括厌食症暴饮暴食/净化亚型患者，PTSD的发病率通常较高。

有不同的理论认为进食障碍患者的PTSD发病率较高。一种理论认为创伤直接影响body image或自我意识，并导致一个人试图改变自己的身体形状，以避免未来的伤害。

Another is that trauma exposure leads to emotional dysregulation (difficulty managing emotional reactions), which in turn can increase the risk for various types of psychopathology, including PTSD,边缘型人格障碍，和物质使用障碍. In this model, binge eating and purging are believed to be an attempt by the affected person to manage or numb their intense PTSD symptoms. When they succeed in doing so, the eating disorder behaviors are reinforced.

Psychological Treatment

在任何情况下，当多种精神疾病同时发生，治疗变得更加复杂。这在创伤后应激障碍和饮食失调中肯定是正确的。患有创伤后应激障碍的进食障碍患者可能更难相信他们的提供者或让他人来指导治疗。饮食失调的治疗通常包括接受direction around eating, so an unwillingness on the part of a patient with PTSD to trust the caregiver can be problematic.

对于治疗PTSD和饮食失调的患者，很少有具体的临床指南。幸运的是，有有效的治疗方法。

心理治疗是创伤后应激障碍的主要治疗方法。创伤后应激障碍的一些主要循证疗法包括：

• Cognitive Processing Therapy (CPT)teaches how to reframe your maladaptive beliefs about the trauma.
• 长期暴露疗法（PE）teaches how to face feelings and involves talking about the trauma.
• 创伤-Focused CBT (TF-CBT)is designed for children and adolescents, and teaches how to understand, process, and cope with trauma.
• 眼动脱敏和再加工（EMDR）在引导眼球运动的同时帮助人们处理和理解创伤。这种治疗方法往往更具争议性，因为目前尚不清楚眼球运动是否有助于患者在相关暴露过程之外的改善。

心理治疗也是饮食失调的一线治疗。强化认知疗法（CBT-E）是治疗成人饮食障碍最有效的方法。它专注于改变行为，这反过来又有助于挑战问题思维。

In the treatment of co-occurring eating disorders and PTSD, there is no consensus on whether treatment should be sequential (with eating disorder treatment first or PTSD treatment first), or concurrent/integrated (treatment for the eating disorder and PTSD provided at the same time).

如果一个病人由于饮食失调而在医学上不稳定，饮食失调应该首先治疗，直到这些问题得到改善。有时，治疗一种疾病可以使治疗另一种疾病更有效。例如，如果患者使用饮食失调行为来避免负面情绪，那么创伤后应激障碍暴露治疗可能没有那么有效。

然而，序贯治疗的问题之一是，治疗一种疾病有时会使另一种疾病恶化。这会导致一个自我延续的循环，阻止两种疾病的恢复。如果进食障碍患者面对痛苦的创伤记忆，他们可能会增加行为以避免感受到负面情绪，这种回避有助于维持他们的创伤后应激障碍。相比之下，同时治疗可以有效地同时解决这两个问题，但没有综合治疗方案存在创伤后应激障碍和进食障碍。

治疗计划中的另一个决定是应该使用上述基于证据的创伤后应激障碍治疗。四种治疗方法的结果非常相似，没有研究表明哪种方法对患有创伤后应激障碍和进食障碍的人最有效。一些专业人士指出，CPT可能是与CBT-E最密切相关的，因此综合治疗可以将两者结合起来。

For patients with more problems with emotion dysregulation and high-risk behaviors, a form of辨证行为疗法(DBT), a protocol for treating PTSD, is DBT-PE. This treatment combines prolonged exposure with DBT. It is a new protocol and there are not yet any studies on DBT-PE with patients with eating disorders, but some professionals believe it could be a good option for patients with eating disorders and PTSD.

对于饮食失调的患者，关于何时开始PTSD治疗，建议采用以下标准：

• 病人表示准备好了。
• 患者营养充足，能够处理信息。
• 进食障碍症状相对可控。
• 病人有足够的能力忍受负面情绪。

患有PTSD和进食障碍的患者应进行全面评估。一些患者在治疗初期可能不愿意透露创伤性事件，因此评估应该是一个持续的过程。他们的治疗师应该制定一个案例，帮助他们理解进食障碍和创伤后应激障碍之间的关系，并且可以帮助指导何时以及以何种方式处理不同的障碍。

A Word From Verywell

如果你有进食障碍的症状和外伤史，要知道你并不孤单！重要的是要寻求帮助，并尝试与你的供应商开放。虽然这可能会很可怕，但这可能是复苏过程中重要的第一步。