Complex Trauma Presentations in Eating Disorder Patients Across Scotland and Perceptions of Trauma-informed Care

Abstract

Understanding the role trauma and post-traumatic stress disorder have in the severity of eating disorders (ED) is important for achieving the best outcomes for those accessing ED treatment yet there is a lack of guidance for ED services across Scotland regarding best practice. Trauma-informed care sets out to make services more accessible to those with a trauma history, offering guidance on establishing a safe environment and adapting therapeutic approaches to accommodate the needs of service users who have experienced trauma. This study aimed to understand interpretations of trauma-informed care from the perspective of professional key informants, service users with a lived experience of complex trauma, and therapists delivering ED treatment in order to inform future ED service development. A convergent mixed methods design was used. Framework analysis was employed to manage and analyse the qualitative data. The study was split into four phases and included: semi-structured telephone interviews with six key informants with expertise in psychological trauma; a focus group with two service users with a lived experience of complex trauma; a survey of 44 ED patients gathering data on prevalence rates of trauma and PTSD and their association with ED symptoms; and a focus group with four ED therapists. The survey results indicated a high prevalence of complex trauma in ED outpatients, with half also having active PTSD symptoms. Qualitative data highlighted the value of a thorough assessment, and the use of routine inquiry when asking about trauma history was of high importance, as was the role of the therapeutic relationship to foster trust and provide a validating experience for both patients and therapists. In addition, phase-based interventions were highlighted as a way of integrating trauma-specific interventions into ED therapy, requiring training and education for some therapists. The role of supervision and care of the wider team was flagged to protect against the risks of vicarious trauma.