This case report describes patients who developed an eating disorder following a rape in two cases and a natural disaster in the other. In these cases an inverse relationship appeared to exist between posttraumatic imagery and distressing thoughts about weight and food. Similar psychological processes may occur in both posttraumatic stress disorders and eating disorders.
This case report examines the relationship between posttraumatic stress disorder, anorexia nervosa, and bulimia and suggests that these disorders share similar cognitive patterns. This has etiological implications for any eating disorder which is precipitated by a traumatic event.
A recent report of three cases of "post-traumatic anorexia nervosa" (Damlouji & Ferguson, 1985) suggested that anorexia nervosa following traumatic events was caused by real or perceived figure distortions following injury. However, no mention was made about the occurrence of posttraumatic imagery or other phenomena typical of posttraumatic stress disorder. This is an important omission because posttraumatic stress disorders (PTSD) and eating disorders have similar patterns of cognitive and affective disturbance. In particular, intrusive memories and afects, and their avoidance, are central elements of the phenomenology of PTSD (Brett & Ostroff, 1985). Although the pattern of cognition in anorexia nervosa has been conceptualized in a different way, there are many common features. Such patients have an intense and pervasive preoccupation with their weight which they attempt to decrease by the avoidance of food (Garner & Bemis, 1985). The patients' waking hours are often dominated by intrusive and unwanted thoughts about weight and food. This preoccupation, and the rigidity of their cognitive style (Garfinkel & Garner, 1982), are postu-