Leading the way by integrating trauma treatment with eating disorder programs
Traditional beliefs in the eating disorder field recommend delaying trauma work until outpatient treatment. This is often due to limited trauma expertise and unfounded concerns about exacerbating the eating disorder. Our recent research supports concurrent, integrated treatment for both conditions by the same providers in residential settings, leading to sustained improvements post-discharge.
We are the first to provide evidence-based trauma treatment and groundbreaking research showing that clients’ improvements last.
45% of admitted adults have PTSD
Almost half (45%) of adults admitted to residential eating disorder treatment have posttraumatic stress disorder (PTSD). In response to high rates of trauma, we developed an integrated trauma treatment program.
Improvement in EDEQ scores
We are the first to provide evidence-based trauma treatment (CPT) in parallel with eating disorder treatment that complements cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) in higher levels of care. The results showed reductions in eating disorder questionnaire scores in both clients with and without PTSD.
Key take aways
More about Cognitive Processing Therapy (CPT)
Beyond trauma informed care
At Monte Nido, 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.
Our clients get well and stay well
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.
81% of patients with PTSD at admission had reductions in trauma symptom scores from admission to discharge with 73% continuing to show lower scores from admission to 6 months after discharge.
About the study
We studied clinical outcomes in clients with and without PTSD, outcomes at discharge and 6 months. This has not been previously studied extensively in clients admitted to higher levels of care, such as residential treatment. Of the 609 clients who participated, 96% were female, the mean age and standard deviation of 26 + 8.8 years, and 25% of the group identified as LGBTQAI+. 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.
More of our trauma research results
Nearly half of adults diagnosed with eating disorders and admitted to residential treatment met the criteria for PTSD and demonstrated more severe eating disorder symptoms
We examined the age of eating disorder onset in adults admitted to residential eating disorder treatment. Clients who reported an onset of their illness during childhood or adolescence also demonstrated higher rates of traumatic life events, higher current PTSD prevalence, higher BMIs, increased severity of their eating disorder, depression, and state-trait anxiety symptoms.
39% of a sample of clients 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.
35.4% of sampled adolescent clients in residential eating disorder treatment met the criteria for PTSD, demonstrating significantly higher scores on all measures, including eating disorder symptoms, major depression, and anxiety disorders, as well as significantly higher rates of all forms of childhood trauma.
LGBTQ+ clients experienced significantly higher rates of high-impact lifetime traumas and frequency of PTSD diagnoses, as well as more significant eating disorder and comorbid symptom severity when compared to non-LGBTQ+ individuals. These findings underscore the need to develop and implement interventions targeting this underserved population's treatment needs.
Staff Co-Authors
Dr. Molly Perlman is Chief Medical Officer for Monte Nido, overseeing psychiatric and medical care for all programs. 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. She is a Certified Eating Disorder Specialist, a Fellow of the American Psychiatric Association, and a member of the Alpha Omega Alpha Medical Honors Society. Dr. Perlman serves as Assistant Professor at Florida International University Herbert Wertheim College of Medicine, Secretary of the Board of Directors of the Coalition Representing Eating Disorder Care (REDC), co-chair of the REDC Standards Committee, and is a member of the International Association of Eating Disorder Professionals (iaedp) Credentialing Committee. Additionally, she oversees MN’s 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.
Giulia Suro, Ph.D., CEDS is the Director of Research and Clinical Outcomes for Monte Nido 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 is the Clinical Outcomes & Research Manager for Monte Nido 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.
Timothy D. Brewerton, MD, DLFAPA, FAED, DFAACAP, CEDS-S is an Affiliate Professor of Psychiatry & Behavioral Sciences at the Medical University of South Carolina in Charleston, SC, and Senior Research Advisor for Monte Nido. He is a Distinguished Life Fellow of the American Psychiatric Association; a Distinguished Fellow of the American Academy of Child and Adolescent Psychiatry; a Founding Fellow of the Academy of Eating Disorders and a 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.