LEADING THE WAY BY INTEGRATING TRAUMA TREATMENT WITH EATING DISORDER PROGRAMS
Monte Nido & Affiliates is the first to provide evidence-based trauma treatments and groundbreaking research showing that clients’ improvements last.
Our continued research represents our commitment to personalized treatment planning.
The data we collect allows leadership to track program effectiveness and identify areas for development. As a company, we are dedicated to providing the most effective and evidence-based interventions to our clients. Additionally, we collect and study this data to contribute to a growing body of research and help the eating disorders field continue to move forward.
For the last five years, a major focus of research at Monte Nido & Affiliates is at the intersection of trauma and eating disorder treatment.
LATEST TRAUMA RESEARCH PUBLISHED IN THE JOURNAL OF EATING DISORDERS
“Eating Disorder Patients With and Without PTSD Treated in Residential Care: Discharge And 6-month Follow-up Results,” was recently published in the Journal of Eating Disorders. This 5-year comprehensive and statistically significant study is peer-reviewed and approved by an Institutional Review Board.
This is the culmination of many years of work and will undoubtedly help further our field’s understanding that trauma can be treated at higher levels of care. This is also another proof point that our small milieu and warm, home-like environment create a safe space for clients as they engage in life-changing treatment.
Our clients get better.
KEY FINDINGS & INSIGHTS
About our Overall Research Program
Almost half (45%) of adults admitted to residential eating disorder treatment have posttraumatic stress disorder (PTSD). Clients with significant traumatic histories and/or PTSD have more severe eating disorder symptoms, more suicidality, more anxiety and depressive symptoms.
Discharge & 6-Month Follow-Up
We studied clinical outcomes in clients with and without PTSD. Using an integrated clinical approach including cognitive processing therapy (CPT) and other evidence-based treatments, clients improved significantly and remained improved 6 months following discharge compared to admission.
81% of patients with PTSD at admission had reductions in trauma symptom scores from admission to discharge and 73% from admission to follow-up (6 months later).
Symptom improvements made during treatment were maintained 6 months after discharge. Clients treated at Monte Nido & Affiliates get well and stay well long-term.
According to the journal, “Posttraumatic stress disorder (PTSD) is common in clients with eating disorders and is associated with higher severity of symptoms and worse outcomes. However, this has not been studied extensively in clients admitted to higher levels of care, such as residential treatment. Using an integrated clinical approach based upon principles of cognitive processing therapy (CPT) and other evidence-based treatments, we studied outcomes at discharge and 6 months following discharge in 609 clients (96% female; mean age (+ SD) = 26.0 + 8.8 years; 25% LGBTQ+) with and without PTSD.”
Our post-discharge outcomes data show that we are not only treating clients’ mental health illnesses, but we’re also providing them with the tools and coping skills to self-manage symptoms and maintain recovery.
Informing Changes to Treatment Best Practices
The conventional thinking in the eating disorder field is that it’s best to refrain from trauma work while in intensive treatment settings and defer this to later outpatient treatment. This is often driven by a lack of expertise in trauma assessment and treatment and by fears of making the eating disorder worse.
However, this research tells us that “concurrent, parallel, but interwoven, approaches to treatment, one for the eating disorder and one for PTSD, can be delivered during the same treatment course by the same providers/therapists.”
Integrated treatment approaches that address PTSD and related problems can be successfully delivered in residential treatment and are associated with sustained improvements at 6 months following discharge.
We are hopeful that these findings may help others in the eating disorder field to tailor more effective and integrated treatment approaches for individuals with PTSD who are admitted to higher levels of care for eating disorder treatment.
BEYOND TRAUMA INFORMED CARE
At Monte Nido & Affiliates, we go beyond trauma-informed care by being the first to provide evidence-based trauma treatments. We integrate cognitive processing therapy (CPT), one of the three gold standard trauma treatments, in parallel with eating disorder treatment that complements cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT).
This is how we continue to be able to provide robust research that informs our programs.
Clients’ Sentiments about CPT
• “If I never started CPT, I don’t know if I would have gotten to a point in my life where my trauma didn’t consume me. Now I have the skills it takes to sit through it, manage it and move on from it.”
• “I 10 out of 10 recommend CPT.”
• “I have never addressed my trauma before. I was either too scared or told it wasn’t the right time, or both. I’ve been in and out of treatment for my eating disorder and kept relapsing. I continued to be told that I was too unstable in my eating disorder to begin the trauma work, but I know my trauma is at the root of all my issues.”
Therapists’ Feedback on CPT
• “I have been able to witness miraculous shifts in the way that clients navigate their lives because of CPT.”
• “Client’s don’t always want to get better from their eating disorder, but they usually want to feel relief in regards to their PTSD symptoms. CPT motivates them to work harder in therapy.”
• “One client realized it was not about feeling skinny, it was about feeling empty.”
PAST RESEARCH STUDYING TRAUMA
We are proud to be the first eating disorder treatment company to publish data on trauma and eating disorders. Below are links to additional research.
The association of traumatic events and posttraumatic stress disorder with greater eating disorder and comorbid symptom severity in residential eating disorder treatment centers
• 49.3% of a sample of 642 adults diagnosed with eating disorders and admitted to residential treatment met criteria for PTSD.
• These patients demonstrated more severe symptoms across multiple domains of mental health, including eating disorder symptoms, anxiety and depression, and reported poorer quality of life than patients diagnosed with eating disorders, but not PTSD.
Eating disorder onset during childhood is associated with higher trauma dose, provisional PTSD, and severity of illness in residential treatment
• The age of eating disorder onset was examined in a sample of 1,283 adults admitting to residential eating disorder treatment.
• In general, earlier eating disorder onset was associated with poorer outcomes. Patients who reported an onset of their illness during childhood or adolescence demonstrated higher rates and doses of traumatic life events, higher current PTSD prevalence, higher BMIs, increased severity of their eating disorder, depression and state-trait anxiety symptoms; worse quality of life, and, more prior inpatient and residential admissions for ED treatment.
Headache, eating disorders, PTSD, and comorbidity: implications for assessment and treatment
• 39% of a sample of 1,461 adult eating disorder patients in residential eating disorder treatment endorsed frequent headaches (“often” or “always”) occurring.
• These patients with headaches and eating disorders had significantly higher rates of PTSD (64%) and higher scores on all measures, including eating disorder symptoms, major depression, anxiety disorders and quality of life.
Provisional posttraumatic stress disorder is associated with greater severity of eating disorder and comorbid symptoms in adolescents treated in residential care
• 35.4% of a sample of 647 adolescent patients admitted to residential eating disorder treatment met criteria for PTSD.
• These patients demonstrated significantly higher scores on all measures, including eating disorder symptoms, major depression, anxiety disorders and quality of life, as well as significantly higher rates of all forms of childhood trauma. Additionally, adolescent patients with PTSD exhibited a significantly higher percent median body mass index for age and sex and a lower propensity toward anorexia nervosa, restricting type.
Sexual and gender minority individuals report higher rates of lifetime traumas and current PTSD than cisgender heterosexual individuals admitted to residential eating disorder treatment
• Nearly 24% of a sample of 542 adults admitting to residential eating disorder treatment identified as LGBTQ+.
• These patients presented with significantly higher rates of high impact lifetime traumas and frequency of PTSD diagnoses, as well as greater eating disorder and comorbid symptom severity, when compared to non-LGBTQ+ individuals.
• These findings underscore the need for the development and implementation of interventions targeting the treatment needs of this underserved population.
To request full-text copies of the above papers, please click here.
The following people co-authored the latest research as well as much of our past research, and we’re honored that they are part of our Monte Nido & Affiliates family.
Molly Perlman, MD, MPH, CEDS
Molly M. Perlman, MD, MPH, CEDS, FAPA is Chief Medical Officer of Monte Nido & Affiliates, overseeing psychiatric and medical care at over 50 facilities across the nation. She is double board certified in psychiatry and addiction medicine, graduated from Duke University and the University of Miami, and has trained in psychoanalytic psychotherapy. During residency in psychiatry, Dr. Perlman served as Chief Resident and was awarded the Laughlin Fellowship, which is bestowed annually on 12 elite residents for outstanding leadership and significant achievements in psychiatry. Dr. Perlman is on the Board of Directors of the Eating Disorders Coalition, served as Vice President of the Board from 2018 through 2022, and advocates on Capitol Hill regularly for increasing eating disorder education and access to treatment. Additionally, she oversees Monte Nido & Affiliates IRB-approved research study on clinical outcomes as Co-Principal Investigator and has co-authored several papers in peer-reviewed research journals on PTSD and eating disorders.
Timothy D. Brewerton, MD, DLFAPA, FAED, DFAACAP, CEDS-S
Timothy D. Brewerton, MD, DLFAPA, FAED, DFAACAP, CEDS-S is Affiliate Professor of Psychiatry & Behavioral Sciences at the Medical University of South Carolina in Charleston, SC, and Director of Clinical Outcomes and Research for Monte Nido & Affiliates. He is Distinguished Life Fellow of the American Psychiatric Association; Distinguished Fellow of the American Academy of Child and Adolescent Psychiatry; Founding Fellow of the Academy of Eating Disorders and former president of the Eating Disorders Research Society. He has authored over 180 articles and book chapters, has edited two books, and has presented over 250 scientific presentations at national and international conferences. Dr. Brewerton is also Executive Producer of a documentary about child maltreatment, eating disorders and dissociative identity disorders. Dr. Brewerton has been instrumental in exploring the overlaps between trauma, PTSD and eating disorders, and promoting integrated treatment approaches for eating and related comorbid disorders. His research profile can be viewed here, where any of his publications can be downloaded or requested.
Giulia Suro, Ph.D., CEDS
Giulia Suro, Ph.D., CEDS is the Associate Director of Research and Clinical Outcomes for Monte Nido & Affiliates directing the day-to-day operations of a nationwide, IRB-approved research program in capturing the treatment outcomes of individuals diagnosed with a range of eating disorder diagnoses across all levels of care. As a member of the broader research program, she helps translate this data to meaningful findings that may inform treatment and improve the field of eating disorders. Prior to this position, she served as a Postdoctoral Resident, Primary Therapist and Clinical Director at the Oliver-Pyatt Centers. She is also a passionate student and practitioner of Acceptance and Commitment Therapy (ACT). In 2019, she published an ACT workbook titled “Learning to Thrive,” which was the first ACT text of its kind written for a general audience.
Ismael Gavidia, MSc
Ismael Gavidia, MSc is the Clinical Outcomes & Research Manager for Monte Nido & Affiliates responsible for the data collection of the IRB-approved research program for the treatment outcomes of individuals across all levels of care and eating disorders diagnoses nationwide. Ismael conducts statistical analysis to interpret the data into findings that provide feedback to clinical treatment, which are contributing to the advancement of the eating disorders field. He has worked as a biostatistician for more than 20 years in the psychological, medical, and social work fields, and holds degrees from Universidad Simon Bolivar in Venezuela.