Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb;57(2):450-457.
doi: 10.1002/eat.24106. Epub 2023 Dec 1.

The treatment of dissociative identity disorder in an eating disorder residential treatment setting

Timothy D Brewerton  1   2   3 , Molly M Perlman  3   4 , Ismael Gavidia  3 , Giulia Suro  3
Affiliations

The treatment of dissociative identity disorder in an eating disorder residential treatment setting

Timothy D Brewerton et al. Int J Eat Disord. 2024 Feb.

Abstract

Objective: Child maltreatment, dissociation and dissociative disorders have been noted in relationship to eating disorders (EDs) for decades, and their co-occurrence generally is associated with greater morbidity, self-harm and mortality. The concomitant presentation of dissociative identity disorder (DID) with an ED (ED + DID) is especially challenging, and there is limited information on approaches to and the effects of integrated treatment for this serious comorbidity, especially in higher levels of care. There are also limited treatment resources for such patients, since they are often turned away from specialty units due to lack of expertise with or bias toward one or the other disorder.

Method: We report our experience with a case series of 18 patients with DSM-5 defined ED + DID (mean age (SD) = 32.6 (11.8) years) admitted to residential treatment (RT) and assessed using validated measures for symptoms of ED, major depression (MD), PTSD, state-trait anxiety, quality of life (QOL), age of ED onset, and family involvement during treatment. All patients received integrated, multimodal, trauma-focused approaches including those based on DID practice guidelines, principles of cognitive processing therapy (CPT), and other evidence-based approaches. Fifteen of 18 patients also completed discharge reassessments, which were compared to admission values using paired t-tests.

Results: Following integrated, trauma-focused RT, patients with ED + DID demonstrated statistically significant improvements in all measures, with medium (anxiety) to high (ED, PTSD, MD, QOL) effect sizes.

Discussion: These results provide positive proof of concept that patients with ED + DID can be effectively treated in a specialty, trauma-focused ED program at higher levels of care.

Public significance: EDs and dissociative identity disorder (DID) are related conditions, but little is known about treating patients with both conditions. We describe the clinical features and integrated treatment of 18 such patients, 15 of whom completed discharge assessments. Significant clinical improvements were found in multiple domains (ED, PTSD, mood, anxiety, quality of life), which demonstrate positive proof of concept that ED + DID can be effectively treated in a specialty, trauma-focused ED program.

Keywords: PTSD; depression; dissociative identity disorder; eating disorders; residential treatment.

PubMed Disclaimer

References

REFERENCES

    1. American College of Cardiology/American Heart Association Task Force on Practice Guidelines, O. E. P. (2014). Executive summary: Guidelines (2013) for the management of overweight and obesity in adults: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society published by the Obesity Society and American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Based on a systematic review from the The Obesity Expert Panel, 2013. Obesity (Silver Spring), 22(Suppl 2), S5-S39. https://doi.org/10.1002/oby.20821
    1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. American Psychiatric Press. https://doi.org/10.1176/appi.books.9780890425596
    1. American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders, fifth edition, text revision. American Psychiatric Press.
    1. Andersen, A. E., Morse, C., & Santmyer, K. S. (1985). Inpatient treatment for anorexia nervosa. In D. M. Garner & P. E. Garfinkel (Eds.), Handbook of psychotherapy for anorexia nervosa and bulimia (pp. 311-343). The Guilford Press.
    1. Berger, D., Saito, S., Ono, Y., Tezuka, I., Shirahase, J., Kuboki, T., & Suematsu, H. (1994). Dissociation and child abuse histories in an eating disorder cohort in Japan. Acta Psychiatrica Scandinavica, 90(4), 274-280. https://doi.org/10.1111/j.1600-0447.1994.tb01593.x

LinkOut - more resources