PTSD, complex PTSD and the dissociative subtype of PTSD in patients with ultraprocessed food addiction

Higher rates of lifetime traumatic events and resulting symptoms of posttraumatic stress disorder (PTSD) have been reported in individuals with ultra-processed food addiction (UPFA). However, the role of complex PTSD (CPTSD) and the dissociative subtype of PTSD (DPTSD) in UPFA remains unexplored. Participants were patients (59% female) admitted to a higher level of care (residential, partial hospital or intensive outpatient) for treatment of a DSM-5 defined eating disorder (ED), substance use disorder (SUD), PTSD, and/or mood disorder. Patients completed self-report assessments within 72 hours of admission, including the modified Yale Food Addiction Scale (mYFAS 2.0), Eating Disorder Examination Questionnaire; Life Events Checklist for DSM-5; PTSD Checklist for DSM-5; International Trauma Questionnaire; Dissociative Subtype of PTSD Scale; Alcohol Use Disorder Identification Test; Drug Abuse Screening Test-10; Patient Health Questionnaire-9; Spielberger State Trait Anxiety Scale short form, and the World Health Organization Quality of Life Abbreviated Scale. Patients with (n=151) and without UPFA (n=571) were compared using multivariant analyses of variance and age, admission BMI, sex at birth, gender, and ED diagnosis as covariates. Patients who met mYFAS 2.0 criteria for UPFA had significantly higher rates of self-reported types of traumatic events, provisional DSM-5 PTSD (72% v. 51%) and DPTSD (53% v. 32%), provisional ICD-11 PTSD (40% v. 25%) and CPTSD (37% v. 20%), major depression (86% v. 68%), any ED (78% v. 24%), and BMI >30 (46% v. 30%) compared to those without UPFA (p<.001). In patients with UPFA, those with DPTSD and/or CPTSD had significantly higher symptom scores for PTSD, depersonalization-derealization, loss of awareness, psychogenic amnesia, and disturbances of self-organization. They were also more likely to have an ED. In addition, there was significant overlap between the diagnoses of CPTSD and DPTSD with 26% of those with UPFA meeting criteria for both disorders. PTSD, CPTSD and DPTSD are common in patients with UPFA and indicate more complex psychiatric comorbidity, particularly for those that meet both CPTSD and DPTSD. These results emphasize the importance of thorough assessment and the need for integrated treatment that directly addresses the full spectrum of trauma-related symptoms in treatment-seeking patients. Ultra-processed food addiction (UPFA) has been associated with high rates of trauma exposure and symptoms of posttraumatic stress disorder (PTSD) and related comorbid disorders, yet links to complex PTSD (CPTSD) and the dissociative subtype of PTSD (DPTSD) have been unexplored in clinical research. We studied 722 patients admitted to residential, partial hospital, and intensive outpatient treatment for eating, substance use, and/or mood disorders who were assessed for UPFA, PTSD, CPTSD, DPTSD, eating disorders, substance use disorders, symptoms of associated psychiatric comorbidity, and quality of life. Patients with UPFA (n = 151), as determined by the modified Yale Food Addiction Scale 2.0, had significantly higher rates of both DSM-5 (72% vs. 51%) and ICD-11-defined PTSD (40% vs. 25%) in comparison to patients without UPFA (n = 571). They also had higher rates of CPTSD (37% vs. 20%), DPTSD (53% vs. 32%), eating disorders (78% vs. 24%), depression (86% vs. 68%), and body mass indices (BMI’s) in the obesity range (>30) (46% vs. 30%). Patients with UPFA who had CPTSD and/or DPTSD experienced more severe trauma-related symptoms, including feelings of detachment from themselves or their surroundings, reduced awareness, memory gaps, and difficulties with emotional regulation and self-perception. More than one quarter of patients with UPFA met criteria for both conditions. These findings highlight the importance of comprehensive trauma assessment and the development of integrated, individualized treatment plans for patients with UPFA, particularly those experiencing complex or dissociative PTSD symptoms alongside eating disorders and other psychiatric conditions.