Childhood abuse and neglect appear to more common among those with eating disorders (EDs) than in the general population, and ED patients with childhood trauma (CT) more often present with higher ED severity, psychiatric comorbidity, and suicidality compared to non-trauma ED patients. Successful treatment outcomes for ED with late effects of CT are scarce, since evidence-based ED treatments are lacking. To date, there is no guidance for the clinical integration of ED and trauma treatments and little is known about patients’ treatment experiences.

Author: Malin Olofsson

Malin Olofsson is a clinical psychologist specialized in clinical psychology for adults, with specialist education in eating disorders and linguistics. Malin’s areas of interest include eating and trauma disorders, psychotherapy, micro-processes in psychotherapy and mixed-methods design.

About the Project

This patient-as-expert research project was situated within a randomised controlled trial comparing inpatient cognitive behavioural therapy (CBT) with compassion-focused therapy (CFT) for Eds.

Objectives

Primary data consisted of post-treatment interviews and concerned a) variation s and common features related to how ED patients with CT conceptualise their disorder, b) their therapeutic change processes or lack thereof in relation to favourable or less favourable long-term outcomes and c) experiences of patient-therapist micro-processes for poor long-term outcomes, elicited through video-assisted recall.

Results

• Paper I highlighted the multifaceted role of the Eating Disorder (ED), portraying it as a mechanism for protection, self-preservation, and emotion regulation.
• Paper II indicated positive long-term outcomes in ED treatment were associated with addressing trauma, fostering patient agency, and focusing on patient-therapist relational dynamics.
• In Paper III, patients with poor long-term outcomes exhibited covert self-effacement strategies, showing a preference for specific interaction styles and reflective interventions.
• Key Contributions:
  • Suggested reframing EDs with late effects of Childhood Trauma (CT) as Complex Post-Traumatic Stress Disorder (CPTSD) with ED for some individuals.
  • Positive long-term outcomes correlated with the freedom to explore experiences, while poor outcomes were linked to constant navigation of the patient-therapist relationship.
  • Uncovering covert self-effacement strategies and promoting patient agency emerged as crucial for maintaining positive changes.
  • Emphasized the therapist’s regulatory role in determining optimal arousal levels and preventing experiential avoidance during trauma exposure.

Background

The project is a doctoral research project that began in 2018 and finished up in 2022. The project used data from the Unit for Eating Disorders at Modum Bad. The department offers cognitive-behaviour therapy and compassion-focused therapy with persistent eating and trauma disorders. The treatment is inpatient and lasts approximately 12 weeks.

Funding

The project was funded by University of Oslo.

Contact Information

Project Manager: KariAnne Vrabel, PhD, Clinical Psychologist Specialist and Research leader

Project contact: Malin Olofsson, specialist in clinical psychology, Ph.D (m.e.olofsson@psykologi.uio.no)

You can also reach us through the Modum Bad telephone service: 32 74 97 00.

Project participants

Asle Hoffart, senior researcher, specialist in clinical psychology

Hanne Weie Oddli, professor in Psychology, University of Oslo, Clinical Psychologist Specialist

Publications

Olofsson, M. E., Oddli, H. W., Hoffart, A., Eielsen, H. P., & Vrabel, K. R. (2020). Change processes related to long-term outcomes in eating disorders with childhood trauma: An explorative qualitative study. Journal of Counseling Psychology, 67(1), 51. (https://doi.org/10.1186/s40337-022-00566-1)

Olofsson, M. E., Oddli, H. W., Hoffart, A., Eielsen, H. P., & Vrabel, K. R. (2020). Change processes related to long-term outcomes in eating disorders with childhood trauma: An explorative qualitative study. Journal of Counseling Psychology, 67(1), 51. (https://doi.org/10.1037/cou0000375) (pdf)

Olofsson, M. E., Oddli, H. W., Vrabel, K. A. R., & Hoffart, A. (2021). «In solitude is safeness»: a patient perspective on eating disorders in the context of multiple childhood trauma. Nordic psychology, 73(1), 29-42. (https://doi.org/10.1080/19012276.2020.1762714)