Women who have ever experienced symptoms of posttraumatic stress disorder (PTSD) are more than twice as likely to have a food addiction than those with no such history, new research shows.
The earlier the onset of PTSD, the greater the propensity to be addicted to food, investigators report.
"Our findings tell us that PTSD symptoms may be accompanied by problematic eating behaviors that are distressing," lead author Susan Mason, PhD, MPH, assistant professor of epidemiology and community health, University of Minnesota School of Public Health, Minneapolis, told Medscape Medical News.
"And if clinicians providing mental health care are aware that PTSD is sometimes accompanied by problematic eating behaviors, then they may be able to offer better and more tailored care to their patients."
The study was published online September 17 in JAMA Psychiatry.
Recently published findings from 2 of Dr. Mason's coauthors indicated that weight gain trajectories accelerate after onset of PTSD symptoms (JAMA Psychiatry. 2014:71:44-51).
Those findings were based on analyses of the Nurses' Health Study II cohort, which included 49,908 women aged 25 to 42 years living in the United States at the time of recruitment in 1989.
Using the same cohort in the current report, Dr. Mason and colleagues ascertained exposure to lifetime trauma and PTSD symptoms in 2008 and current food addiction status in 2009 among these women. Food addiction was defined as having 3 or more clinically significant symptoms on a modified version of the Yale Food Addiction Scale.
Of the 49,408 women included in the main analysis, 81% reported experiencing at least 1 traumatic event, and of these, 34% reported no symptoms of PTSD.
In contrast, 39% reported 1 to 3 symptoms of PTSD; 17% reported 4 to 5 symptoms; and 10% reported 6 to 7 symptoms. "The single greatest trauma reported was caring for patients with traumatic injuries," Dr. Mason observed.
However, having cared for patients with traumatic injuries was actually not strongly linked to having PTSD symptoms — "so most of the PTSD symptoms we observed were triggered by other traumas," she added.
On average, women with PTSD symptoms reported that their first symptom occurred at age 30.5 years.
The prevalence of food addiction in the overall cohort was 8%, but this varied from 6% among women who reported no lifetime PTSD symptoms to almost 18% among women with 6 to 7 symptoms of PTSD.
In age-adjusted analyses, PTSD symptoms were associated with the prevalence of food addiction in a dose-response manner.
Table. Adjusted Prevalence of Food Addiction by PTSD Symptoms
|PTSD Symptoms||Prevalence Ratios for Food Addiction|
|Trauma but no PTSD||0.95|
|1 to 3 symptoms of PTSD||1.22|
|4 to 5 symptoms of PTSD||1.73|
|6 to 7 Symptoms of PTSD||2.68|
"At this stage, we don't know that PTSD leads to food addiction," Dr. Mason cautioned. However, their hypothesis is that women who have experienced PTSD symptoms may use food as a way of coping and to blunt trauma-associated distress.
Certainly, the literature has frequently shown that there is an elevated risk for drug and alcohol use among those with PTSD, as Dr. Mason pointed out. This suggests that at least some individuals with PTSD use food to cope in the way that others may use alcohol and drugs.
"Anecdotally, I have talked to clinicians working with eating-disordered patients who see a lot of patients with a history of trauma," Dr. Mason observed.
"And while the published evidence on PTSD and obesity initially motivated our research, it has been validating to hear clinicians say that they see in their patients what we are seeing in our research," she said. "If we understand the underlying factors linking PTSD symptoms and disordered eating behaviors, then we will be able to develop even better treatments that effectively address both issues."
Asked to comment on the study, Mary Dallman, PhD, professor emerita of physiology, University of California, San Francisco, told Medscape Medical News that the authors' ranking of the type of trauma and number of PTSD symptoms experienced in response to the trauma "absolutely convinced" her that the 2 are causally linked.
For example, traumatic symptoms in response to physical abuse in childhood showed the strongest association with food addiction overall.
On the other hand, the type of trauma reported as the worst the individual had experienced did not have a clear influence on the magnitude of the PTSD–food addiction association, as the authors themselves point out.
"Earlier studies have shown that there is indeed a relationship between addictive eating and trauma, but the ranking [of trauma and number of PTSD symptoms] in this study is terribly convincing," Dr. Dallman said.
Dr. Dallman also felt that knowing there is an association between PTSD and disordered eating, healthcare professionals could try to make patients aware of the association and then counsel them to substitute their craving for food with healthier behaviors, such as going for a walk, to cope with their feelings.
The study was funded by grants from the National Institutes of Health. Neither Dr. Mason nor Dr. Dallman have reported any relevant financial relationships.
JAMA Psychiatry. Published online September 17, 2014. Abstract
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Cite this: PTSD Linked to Food Addiction - Medscape - Sep 23, 2014.