From shared mechanisms to treatment gaps: a review of the comorbidity between eating disorders and PTSD

Eating disorders (EDs), including anorexia nervosa, bulimia nervosa, and binge eating disorder, are severe psychiatric illnesses marked by disordered eating patterns and psychological disturbances. Post-traumatic stress disorder (PTSD), a common response to trauma, is characterized by re-experiencing, avoidance, negative alterations in cognition and mood, and hyperarousal. The prevalence of PTSD is significantly higher among individuals with EDs than in the general population. This comorbidity is associated with more severe clinical presentations, greater functional impairment, higher treatment dropout rates, and poorer prognoses. Despite increasing recognition of this co-occurrence, the underlying biological and psychological mechanisms remain inadequately understood. This review explores potential shared pathways from a biopsychological perspective, including dysregulation of the hypothalamic-pituitary-adrenal axis, immune system alterations, gut microbiota imbalances, emotional dysregulation, and dissociation. Current treatment strategies are reviewed, highlighting the lack of specific clinical guidelines for this population. There is an urgent need for integrated, trauma-informed interventions to enhance outcomes for individuals affected by the dual burden of EDs and PTSD. Eating disorders, such as anorexia nervosa, bulimia nervosa, and binge-eating disorder, are serious mental illnesses that harm both physical and psychological health. A substantial proportion of people with eating disorders have experienced trauma, and many go on to develop post-traumatic stress disorder (PTSD). PTSD can cause people to relive the trauma through flashbacks, avoid anything that reminds them of it, and feel constantly on edge. When an eating disorder and PTSD occur together, they make each other worse and recovery much harder. People struggling with both conditions often have more intense symptoms, are more likely to drop out of treatment, and generally have a tougher time getting better. This review explores the possible reasons behind the common co-occurrence of eating disorders and PTSD. We discuss how problems with the HPA axis (hypothalamic-pituitary-adrenal axis, our body’s stress-response system), changes in the immune system, imbalances in gut health, and difficulties in managing emotions may contribute to this connection. We also look at the current treatments and point out the lack of clear guidelines for treating both conditions at the same time. Our findings highlight the urgent need for combined, trauma-sensitive treatments to improve recovery and quality of life for this vulnerable population.