Associations among Intimate Partner Violence,Posttraumatic Stress Disorder Symptoms,and Disordered Eating among Women Intimate Partner Violence Survivors Residing in Shelter

Abstract

Previous research has not assessed the association between intimate partner violence (IPV) and disordered eating (DE), nor the potential indirect effect through posttraumatic stress disorder (PTSD) symptoms, among residents of IPV shelters. Among 212 IPV survivors, this study examined these and the differential associations by PTSD symptom cluster and types of DE. In the current sample, 67.9% met criteria for probable PTSD, 20.3% met criteria for a probable eating disorder, and 18.4% had probable comorbid diagnoses. Consistent with escape theory, there was an indirect effect of IPV on DE through PTSD symptoms. Additionally, there was an indirect effect of IPV on weight/shape concerns and binge symptoms through PTSD symptoms. Although there was a significant total effect of IPV on compensatory behaviors, there was no indirect effect through PTSD symptoms. When PTSD symptom clusters were examined concurrently, the only indirect effect of IPV on weight/shape concerns was via the PTSD symptom cluster of negative alterations in cognition and mood. Although there was an indirect effect of IPV on binge symptoms via PTSD symptoms overall, no specific PTSD symptom cluster drove this association. Implications highlight the need for attention to DE within this population. Consistent with escape theory, survivors’ DE might serve to distract from psychological distress.

Keywords

intimate partner violence posttraumatic stress disorder eating disorders comorbidity escape theory

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References

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed. Text Revision). Author.

American Psychiatric Association . 2013. Diagnostic and statistical manual of mental disorders, (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Arditte Hall

K. A.

Bartlett

B. A.

Iverson

K. M.

Mitchell

K. S.

(2018). Eating disorder symptoms in female veterans: The role of childhood, adult, and military trauma exposure. Psychological Trauma: Theory, Research, Practice, and Policy, 10(3), 345–351. https://doi.org/10.1037/tra0000301

Armour

Tsai

Durham

T. A.

Charak

Biehn

T. L.

Elhai

J. D.

Pietrzak

R. H.

(2015). Dimensional structure of DSM–5 posttraumatic stress symptoms: Support for a hybrid anhedonia and externalizing behaviors model. Journal of Psychiatric Research, 61, 106–113. https://doi.org/10.1016/j.jpsychires.2014.10.012

Bartlett

B. A.

Iverson

K. M.

Mitchell

K. S.

(2018). Intimate partner violence and disordered eating among male and female veterans. Journal of Psychiatric Research, 260, 98–104. https://doi.org/10.1016/j.psychres.2017.11.056

Berg

K. C.

Crosby

R. D.

Cao

Crow

S. J.

Engel

S. G.

Wonderlich

S. A.

Peterson

C. B.

(2015). Negative affect prior to and following overeating-only, loss of control eating only, and binge eating episodes in obese adults. The International Journal of Eating Disorders, 48(6), 641–653. https://doi.org/10.1002/eat.22401

Berg

K. C.

Frazier

Sherr

(2009). Change in eating disorder attitudes and behavior in college women: Prevalence and predictors. Eating Behaviors, 10(3), 137–142. https://doi.org/10.1016/j.eatbeh.2009.03.003

Blackburn

Johnston

Blampied

Popp

Kallen

(2006). An application of escape theory to binge eating. European Eating Disorders Review, 14(1), 23–31. https://doi.org/10.1002/erv.675

Bohon

Stice

(2015). Eating disorder diagnostic scale. In Wade

(Ed.), Encyclopedia of feeding and eating disorders (pp. 1–4).

10.

Bovin

M. J.

Marx

B. P.

Weathers

F. W.

Gallagher

M. W.

Rodriguez

Schnurr

P. P.

Keane

T. M.

(2016). Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental disorders–fifth edition (PCL-5) in veterans. Psychological Assessment, 28(11), 1379–1391. https://doi.org/10.1037/pas0000254

11.

Brewerton

T. D.

(2007). Eating disorders, trauma, and comorbidity: Focus on PTSD. The Journal of Treatment and Prevention, 15(4), 285–304. https://doi.org/10.1080/10640260701454311

12.

Brewerton

T. D.

Brady

(2014). The role of stress, trauma, and PTSD in the etiology and treatment of eating disorders, addictions, and substance use disorders. In Brewerton

T. D.

Dennis

A. B.

(Eds.), Eating disorders, addictions and substance use disorders: Research, clinical and treatment perspectives (pp. 379-404). Springer-Verlag.

13.

Bundock

Howard

L. M.

Trevillion

Malcolm

Feder

Oram

(2013). Prevalence and risk of experiences of intimate partner violence among people with eating disorders: A systematic review. Journal of Psychiatric Research, 47(9), 1134–1142. https://doi.org/10.1016/j.jpsychires.2013.04.014

14.

Dansky

B. S.

Brewerton

T. D.

O’Neil

P. M.

Kilpatrick

D. G.

(1997). The national women’s study: Relationship of crime victimization and PTSD to bulimia nervosa. International Journal of Eating Disorders, 21(3), 213–228. http://doi.org/10.1002/(sici)1098-108x(199704)21:3<213::aid-eat2>3.0.co;2-n

15.

Downey

R. G.

King

C. V.

(1998). Missing data in likert ratings: A comparison of replacement methods. The Journal of General Psychology, 125(2), 175. https://doi.org/10.1080/00221309809595542

16.

Dubosc

Capitaine

Franko

D. L.

Bui

Brunet

Chabrol

Rodgers

R. F.

(2012). Early adult sexual assault and disordered eating: The mediating role of posttraumatic stress symptoms. Journal of Traumatic Stress, 25(1), 50–56. https://doi.org/10.1002/jts.21664

17.

Farber

S. K.

(2008). Dissociation, traumatic attachments, and self-harm: Eating disorders and self-mutilation. Clinical Social Work Journal, 36(1), 63–72. https://doi.org/10.1007/s10615-007-0104-6

18.

Ford-Gilboe

Wathen

C. N.

Varcoe

(2016). Development of a brief measure of intimate partner violence experiences: The Composite Abuse Scale (Revised)—Short Form (CASR-SF). British Medical Journal Open, 6(12), e012824. http://dx.doi.org/10.1136/bmjopen-2016-012824

19.

Franko

D. L.

Becker

A. E.

Thomas

J. J.

Herzog

D. B.

(2007). Cross-ethnic differences in eating disorder symptoms and related distress. International Journal of Eating Disorders. 40(2), 156–164. https://doi.org/10.1002/eat.20341

20.

Fuemmeler

B. F.

Dedert

McClernon

F. J.

Beckham

J. C.

(2009). Adverse childhood events are associated with obesity and disordered eating: Results from a US population based survey of young adults. Journal of Traumatic Stress, 22(4), 329–333. https://doi.org/10.1002/jts.20421

21.

Galano

M.M.

Hunter

E. C.

Howell

K. H.

Miller

L. E.

Graham-Bermann

S. A.

(2013). Predicting shelter residence in women experiencing recent intimate partner violence. Violence Against Women, 19(4), 518–535. https://doi.org/10.1177/1077801213487056

22.

Hayes

A. F.

(2018). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Press.

23.

Heatherton

T. F.

Baumeister

R. F.

(1991). Binge eating as escape from self-awareness. Psychological Bulletin, 110(1), 86. https://doi.org/10.1037/0033-2909.110.1.86

24.

Hegarty

Sheehan

Schonfeld

(1999). A multidimensional definition of partner abuse: Development and preliminary validation of the Composite Abuse Scale. Journal of Family Violence, 14(4), 399–415. https://doi.org/10.1023/A:1022834215681

25.

Higgins Neyland

M. K.

Bardone-Cone

A. M.

(2017). Tests of escape theory of binge eating among Latinas. Cultural Diversity and Ethnic Minority Psychology, 23(3), 373–381. https://doi.org/10.1037/cdp0000130

26.

Holzer

S. R.

Uppala

Wonderlich

S. A.

Crosby

R. D.

Simonich

(2008). Mediational significance of PTSD in the relationship of sexual trauma and eating disorders. Child Abuse & Neglect, 32(5), 561–566. https://doi.org/10.1016/j.chiabu.2007.07.011

27.

Huston

J. C.

Grillo

A. R.

Iverson

K. M.

Mitchell

K. S.

(2019). Associations between disordered eating and intimate partner violence mediated by depression and posttraumatic stress disorder symptoms in a female veteran sample. General Hospital Psychiatry, 58, 77–82. https://doi.org/10.1016/j.genhosppsych.2019.03.007

28.

Johnson

D. M.

Palmieri

P. A.

Jackson

A. P.

Hobfoll

S. E.

(2007). Emotional numbing weakens abused inner-city women’s resiliency resources. Journal of Traumatic Stress, 20(2), 197–206. https://doi.org/10.1002/jts.20201

29.

Jones

Hughes

Unterstaller

(2001). Post-traumatic stress disorder (PTSD) in victims of domestic violence: A review of the research. Trauma, Violence, & Abuse, 2(2), 99–119. https://doi.org/10.1177/1524838001002002001

30.

Krause

E. D.

Kaltman

Goodman

Dutton

M. A.

(2006). Role of distinct PTSD symptoms in intimate partner reabuse: A prospective study. Journal of Traumatic Stress, 19(4), 507–516. https://doi.org/10.1002/jts.20136

31.

Lucea

M. B.

Francis

Sabri

Campbell

J. C.

Campbell

D. W.

(2012). Disordered eating among African American and African Caribbean women: The influence of intimate partner violence, depression, and PTSD. Issues in Mental Health Nursing, 33(8), 513–521. https://doi.org/10.3109/01612840.2012.687037

32.

Malinauskiene

Malinauskas

(2018). Lifetime traumatic experiences and disordered eating among university students: The role of posttraumatic stress symptoms. BioMed Research International, 2018, 1–10. https://doi.org/10.1155/2018/9814358

33.

Marques

Alegria

Becker

A. E.

Chen

Fang

Chosak

Diniz

J. B.

(2011). Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders. International Journal of Eating Disorders, 44(5), 412–420. https://doi.org/10.1002/eat.20787

34.

McShane

J. M.

Zirkel

(2008). Dissociation in the binge–purge cycle of bulimia nervosa. Journal of Trauma & Dissociation, 9(4), 463–479. https://doi.org/10.1080/15299730802225680

35.

Micali

Martini

M. G.

Thomas

J. J.

Eddy

K. T.

Kothari

Russell

Treasure

(2017). Lifetime and 12-month prevalence of eating disorders amongst women in mid life: A population-based study of diagnoses and risk factors. BioMed Central Medicine, 15(1), 1–10. https://doi.org/10.1186/s12916-016-0766-4

36.

Mitchell

K. S.

Mazzeo

S. E.

Schlesinger

M. R.

Brewerton

T. D.

Smith

B. N.

(2012). Comorbidity of partial and subthreshold PTSD among men and women with eating disorders in the national comorbidity survey: A replication study. International Journal of Eating Disorders, 45(3), 315. https://doi.org/10.1002/eat.20965

37.

Mitchell

K. S.

Porter

Boyko

E. J.

Field

A. E.

(2016). Longitudinal associations among posttraumatic stress disorder, disordered eating, and weight gain in military men and women. American Journal of Epidemiology, 184(1), 33–47. https://doi.org/10.1093/aje/kwv291

38.

Mulders-Jones

Mitchison

Girosi

Hay

(2017). Socioeconomic correlates of eating disorder symptoms in an Australian population-based sample. PLoS One, 12(1), Article e0170603. https://doi.org/10.1371/journal.pone.0170603

39.

Muyan

Chang

E. C.

Jilani

(2015). Predicting eating disturbances in Turkish adult females: Examining the role of intimate partner violence and perfectionism. Eating Behaviors, 19, 102–105. https://doi.org/10.1016/j.eatbeh.2015.07.004

40.

National Center for PTSD . (n.d). Using the PTSD checklist for DSM-5 (PCL-5). https://www.ptsd.va.gov/professional/assessment/documents/using-PCL5.pdf

41.

Parent

M. C.

(2013). Handling item-level missing data: Simpler is just as good. The Counseling Psychologist, 41(4), 568–600. https://doi.org/10.1177/0011000012445176

42.

Perez

Johnson

D. M.

Wright

C. V.

(2012). The attenuating effect of empowerment on IPV-related PTSD symptoms in battered women living in domestic violence shelters. Violence Against Women, 18(1), 101–117. https://doi.org/10.1177/1077801212437348

43.

Polivy

Herman

C. P.

(2002). Causes of eating disorders. Annual Review of Psychology, 53(1), 187–213. https://doi.org/10.1146/annurev.psych.53.100901.135103

44.

Powell-Jones

Simpson

(2020). Drunkorexia: An investigation of symptomatology and early maladaptive schemas within a female, young adult Australian population. Australian Psychologist, 55(5), 559–571. https://doi.org/10.1111/ap.12462

45.

Saunders

D. G.

(1994). Posttraumatic stress symptom profiles of battered women: A comparison of survivors in two settings. Violence and Victims, 9(1), 31–34.

46.

Solmi

Hotopf

Hatch

S. L.

Treasure

Micali

(2016). Eating disorders in a multi-ethnic inner-city UK sample: Prevalence, comorbidity and service use. Social Psychiatry and Psychiatric Epidemiology, 51(3), 369–381. https://doi.org/10.1007/s00127-015-1146-7

47.

Stice

(n.d.). Oregon Research Institute: Measures created or modified. http://www.ori.org/sticemeasures/

48.

Stice

Marti

C. N.

Rohde

(2013). Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal of Abnormal Psychology, 122(2), 445–457. https://doi.org/10.1037/a0030679

49.

Stice

Telch

C. F.

Rizvi

S. L.

(2000). Development and validation of the Eating Disorder Diagnostic Scale: A brief self-report measure of anorexia, bulimia, and binge-eating Disorder. Psychological Assessment, 12(2), 123–131. https://doi.org/10.1037/1040-3590.12.2.123

50.

Tabachnick

B. G.

Fidell

L. S.

Ullman

J. B.

(2019). Using multivariate statistics, 7, Pearson.

51.

Thompson

K. M.

Wonderlich

S. A.

(2004). Child Sexual Abuse and Eating Disorders. In Thompson

J. K.

(Ed.), Handbook of eating disorders and obesity (pp. 679-694). John Wiley & Sons, Inc.

52.

Thornley

Vorstenbosch

Frewen

(2016). Gender differences in perceived causal relations between trauma-related symptoms and eating disorders in online community and inpatient samples. Traumatology, 22(3), 222–232. https://doi.org/10.1037/trm0000071

53.

Weathers

F. W.

Litz

B. T.

Keane

T. M.

Palmieri

P. A.

Marx

B. P.

Schnurr

P. P.

(2013). The PTSD checklist for DSM–5 (PCL-5). The National Center for PTSD.

54.

Wong

S. P. Y.

Chang

J. C.

(2016). Altered eating behaviors in female victims of intimate partner violence. Journal of Interpersonal Violence, 31(20), 3490–3505. https://doi.org/10.1177%2F0886260515585535