{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T15:15:54Z","timestamp":1786634154948,"version":"build-2736575974"},"reference-count":91,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T00:00:00Z","timestamp":1701388800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Eating Disorders"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Child maltreatment, dissociation and dissociative disorders have been noted in relationship to eating disorders (EDs) for decades, and their co\u2010occurrence generally is associated with greater morbidity, self\u2010harm and mortality. The concomitant presentation of dissociative identity disorder (DID) with an ED (ED\u2009+\u2009DID) is especially challenging, and there is limited information on approaches to and the effects of integrated treatment for this serious comorbidity, especially in higher levels of care. There are also limited treatment resources for such patients, since they are often turned away from specialty units due to lack of expertise with or bias toward one or the other disorder.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We report our experience with a case series of 18 patients with DSM\u20105 defined ED\u2009+\u2009DID (mean age (SD)\u2009=\u200932.6 (11.8) years) admitted to residential treatment (RT) and assessed using validated measures for symptoms of ED, major depression (MD), PTSD, state\u2013trait anxiety, quality of life (QOL), age of ED onset, and family involvement during treatment. All patients received integrated, multimodal, trauma\u2010focused approaches including those based on DID practice guidelines, principles of cognitive processing therapy (CPT), and other evidence\u2010based approaches. Fifteen of 18 patients also completed discharge reassessments, which were compared to admission values using paired <jats:italic>t<\/jats:italic>\u2010tests.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Following integrated, trauma\u2010focused RT, patients with ED\u2009+\u2009DID demonstrated statistically significant improvements in all measures, with medium (anxiety) to high (ED, PTSD, MD, QOL) effect sizes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>These results provide positive proof of concept that patients with ED\u2009+\u2009DID can be effectively treated in a specialty, trauma\u2010focused ED program at higher levels of care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Public Significance<\/jats:title><jats:p>EDs and dissociative identity disorder (DID) are related conditions, but little is known about treating patients with both conditions. We describe the clinical features and integrated treatment of 18 such patients, 15 of whom completed discharge assessments. Significant clinical improvements were found in multiple domains (ED, PTSD, mood, anxiety, quality of life), which demonstrate positive proof of concept that ED\u2009+\u2009DID can be effectively treated in a specialty, trauma\u2010focused ED program.<\/jats:p><\/jats:sec>","DOI":"10.1002\/eat.24106","type":"journal-article","created":{"date-parts":[[2023,12,2]],"date-time":"2023-12-02T16:50:16Z","timestamp":1701535816000},"page":"450-457","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The treatment of dissociative identity disorder in an eating disorder residential treatment setting"],"prefix":"10.1002","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9655-3600","authenticated-orcid":false,"given":"Timothy D.","family":"Brewerton","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Medical University of South Carolina  Charleston South Carolina USA"},{"name":"LLC  Mt. Pleasant South Carolina USA"},{"name":"Monte Nido and Affiliates  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6150-4999","authenticated-orcid":false,"given":"Molly M.","family":"Perlman","sequence":"additional","affiliation":[{"name":"Monte Nido and Affiliates  Miami Florida USA"},{"name":"Department of Psychiatry and Behavioral Health Florida International University College of Medicine  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2114-9152","authenticated-orcid":false,"given":"Ismael","family":"Gavidia","sequence":"additional","affiliation":[{"name":"Monte Nido and Affiliates  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4358-3417","authenticated-orcid":false,"given":"Giulia","family":"Suro","sequence":"additional","affiliation":[{"name":"Monte Nido and Affiliates  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,12]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/oby.20821"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425787"},{"key":"e_1_2_9_5_1","first-page":"311","volume-title":"Handbook of psychotherapy for anorexia nervosa and bulimia","author":"Andersen A. E.","year":"1985"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1994.tb01593.x"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/jts.22059"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/15299732.2013.828150"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/NMD.0b013e318288d2ee"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9781585625048.gg24"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/HRP.0000000000000100"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/15299732.2012.736929"},{"key":"e_1_2_9_13_1","unstructured":"Breuer J. &Freud S.(1893).On the psychical mechanism of hysterical phenomena: Preliminary communication from studies on hysteria.Standard edition of the complete psychological works of Sigmund Freud(Vol. II (1893\u20131895): Studies on Hysteria pp. 1\u201317)."},{"key":"e_1_2_9_14_1","first-page":"8","article-title":"On the psychical mechanisms of hysterical phenomena (1893)","volume":"37","author":"Breuer J.","year":"1956","journal-title":"The International Journal of Psychoanalysis"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40337-022-00696-6"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.1149433"},{"key":"e_1_2_9_17_1","volume-title":"Managing severe and enduring anorexia nervosa: A clinician's handbook","author":"Brewerton T. D.","year":"2015"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/erv.2892"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/erv.3035"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40337-023-00773-4"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/erv.2864"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.21767\/2471-8203.100010"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.23401"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40519-021-01222-4"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1080\/j.1440-1614.1999.00589.x"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781118093146"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1080\/10640260701454329"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/0145-2134(86)90049-9"},{"key":"e_1_2_9_29_1","volume-title":"Treating complex traumatic stress disorders: An evidence\u2010based guide","author":"Courtois C. A.","year":"2009"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0015224"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0027447"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/(sici)1099-0968(199612)4:4<232::Aid-erv145>3.0.Co;2-z"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.147.9.1184"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2014.10.008"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1080\/00332747.1996.11024766"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.20200"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/1098-108x(199503)17:2<127::aid-eat2260170204>3.0.co;2-b"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1002\/erv.2400030303"},{"key":"e_1_2_9_39_1","volume-title":"Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies","author":"Foa E. B.","year":"2009"},{"key":"e_1_2_9_40_1","volume-title":"Eating disorder inventory \u2013 2: Professional manual","author":"Garner D. M.","year":"1991"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.20146"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1111\/obr.12216"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1080\/15299732.2011.537247"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1037\/10597-000"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1037\/10008-000"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0031646"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1080\/15299732.2019.1647915"},{"key":"e_1_2_9_48_1","first-page":"101","volume-title":"Clinical perspectives on multiple personality disorder","author":"Kluft R. P.","year":"1993"},{"key":"e_1_2_9_49_1","first-page":"145","article-title":"The initial stages of psychotherapy in the treatment of multiple personality disorder patients","volume":"6","author":"Kluft R. P.","year":"1993","journal-title":"Dissociation"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.psychotherapy.1999.53.3.289"},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"e_1_2_9_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2009.09.008"},{"key":"e_1_2_9_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2013.03.024"},{"key":"e_1_2_9_54_1","doi-asserted-by":"publisher","DOI":"10.1002\/1098-108X(199303)13:2<235::AID-EAT2260130212>3.0.CO;2-#"},{"key":"e_1_2_9_55_1","doi-asserted-by":"publisher","DOI":"10.31887\/DCNS.2018.20.3\/rloewenstein"},{"key":"e_1_2_9_56_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpp.2517"},{"issue":"4","key":"e_1_2_9_57_1","first-page":"227","article-title":"Dissociative symptoms and disorders in patients with eating disorders","volume":"5","author":"McCallum K. E.","year":"1992","journal-title":"Dissociation"},{"key":"e_1_2_9_58_1","doi-asserted-by":"publisher","DOI":"10.56021\/9781421443591"},{"key":"e_1_2_9_59_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.23257"},{"key":"e_1_2_9_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2020.12.053"},{"key":"e_1_2_9_61_1","doi-asserted-by":"publisher","DOI":"10.1002\/(sici)1098-108x(199803)23:2<217::aid-eat13>3.0.co;2-x"},{"key":"e_1_2_9_62_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291716003561"},{"key":"e_1_2_9_63_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0005-7967(03)00161-X"},{"key":"e_1_2_9_64_1","doi-asserted-by":"publisher","DOI":"10.1080\/15299732.2014.949020"},{"key":"e_1_2_9_65_1","doi-asserted-by":"publisher","DOI":"10.1080\/20008198.2017.1344080"},{"key":"e_1_2_9_66_1","doi-asserted-by":"publisher","DOI":"10.1017\/s0033291799008557"},{"key":"e_1_2_9_67_1","doi-asserted-by":"publisher","DOI":"10.1080\/20008198.2022.2031594"},{"issue":"2","key":"e_1_2_9_68_1","first-page":"51S","article-title":"Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults\u2014The evidence report. National Institutes of Health","volume":"6","author":"NHLBI\u2010NIDDKD","year":"1998","journal-title":"Obesity Research"},{"key":"e_1_2_9_69_1","doi-asserted-by":"publisher","DOI":"10.1017\/s0954579497001478"},{"key":"e_1_2_9_70_1","doi-asserted-by":"publisher","DOI":"10.1038\/oby.2011.318"},{"key":"e_1_2_9_71_1","doi-asserted-by":"publisher","DOI":"10.1080\/15299732.2017.1304490"},{"key":"e_1_2_9_72_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.161.3.415b"},{"issue":"6","key":"e_1_2_9_73_1","first-page":"285","article-title":"The clinical phenomenology of multiple personality disorder: Review of 100 recent cases","volume":"47","author":"Putnam F. W.","year":"1986","journal-title":"The Journal of Clinical Psychiatry"},{"key":"e_1_2_9_74_1","doi-asserted-by":"publisher","DOI":"10.3390\/children7120274"},{"key":"e_1_2_9_75_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40337-022-00622-w"},{"key":"e_1_2_9_76_1","doi-asserted-by":"publisher","DOI":"10.1097\/NMD.0b013e318208314e"},{"key":"e_1_2_9_77_1","unstructured":"Ross C. A.(2013).The dissociative disorders interview schedule \u2013 DSM\u20105 Version.https:\/\/www.rossinst.com\/downloads\/DDIS-DSM-5.pdf"},{"issue":"3","key":"e_1_2_9_78_1","first-page":"169","article-title":"The dissociative disorders interview schedule: A structured interview","volume":"11","author":"Ross C. A.","year":"1989","journal-title":"Dissociation"},{"key":"e_1_2_9_79_1","doi-asserted-by":"publisher","DOI":"10.1080\/10640266.2019.1642035"},{"key":"e_1_2_9_80_1","doi-asserted-by":"publisher","DOI":"10.1080\/15299732.2022.2064580"},{"key":"e_1_2_9_81_1","volume-title":"Manual for the state\u2010trait anxiety inventory (STAI)","author":"Spielberger C. D.","year":"1983"},{"key":"e_1_2_9_82_1","doi-asserted-by":"publisher","DOI":"10.1300\/J229v07n01_05"},{"key":"e_1_2_9_83_1","doi-asserted-by":"publisher","DOI":"10.1002\/1098-108x(199504)17:3<305::aid-eat2260170312>3.0.co;2-f"},{"key":"e_1_2_9_84_1","doi-asserted-by":"publisher","DOI":"10.1080\/00029157.1986.10402697"},{"key":"e_1_2_9_85_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.psychotherapy.1990.44.3.357"},{"key":"e_1_2_9_86_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psc.2005.10.015"},{"key":"e_1_2_9_87_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejtd.2017.01.008"},{"key":"e_1_2_9_88_1","doi-asserted-by":"publisher","DOI":"10.1002\/1098-108x(199303)13:2<187::aid-eat2260130206>3.0.co;2-9"},{"key":"e_1_2_9_89_1","doi-asserted-by":"publisher","DOI":"10.1348\/014466501163878"},{"key":"e_1_2_9_90_1","unstructured":"Weathers F. W. Blake D. D. Schnurr P. P. Kaloupek D. G. Marx B. P. &Keane T. M.(2013).The Life Events Checklist for DSM\u20105 (LEC\u20105).www.ptsd.va.gov"},{"key":"e_1_2_9_91_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.physbeh.2020.112964"},{"key":"e_1_2_9_92_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40519-021-01293-3"}],"container-title":["International Journal of Eating Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/eat.24106","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,9]],"date-time":"2024-02-09T09:32:17Z","timestamp":1707471137000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/eat.24106"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12]]},"references-count":91,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1002\/eat.24106"],"URL":"https:\/\/doi.org\/10.1002\/eat.24106","archive":["Portico"],"relation":{},"ISSN":["0276-3478","1098-108X"],"issn-type":[{"value":"0276-3478","type":"print"},{"value":"1098-108X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12]]},"assertion":[{"value":"2023-09-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-12-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}