title: Posttraumatic stress disorder symptoms and food addiction in women by timing and type of trauma exposure.
abstract: OBJECTIVE
  Posttraumatic stress disorder (PTSD) appears to increase obesity risk but the pathways by which PTSD leads to weight gain are not known. Identification of the links between PTSD and obesogenic eating behaviors is necessary to clarify this pathway and inform development of obesity prevention strategies in PTSD-affected populations.
  
  
  OBJECTIVE
  To determine whether women with PTSD symptoms are more likely to report food addiction, a measure of perceived dependence on food, than women without PTSD symptoms. Also, to determine whether age at PTSD symptom onset and type of trauma influence the PTSD-food addiction association.
  
  
  METHODS
  Cross-sectional analysis of 49,408 participants in the Nurses' Health Study II, a cohort comprising women nurses who were aged 25 to 42 years at the 1989 recruitment from 14 US states.
  
  
  METHODS
  The Nurses' Health Study II ascertained lifetime trauma exposure and PTSD symptoms in 2008 and current food addiction in 2009. Food addiction was defined as 3 or more clinically significant symptoms on a modified version of the Yale Food Addiction Scale. Confounder-adjusted prevalence ratios and 95% CIs were estimated using modified Poisson regression.
  
  
  RESULTS
  Approximately 80% of the study sample reported some type of trauma exposure, with 66% of the trauma-exposed participants reporting at least 1 lifetime PTSD symptom. Eight percent of the cohort met the criteria for food addiction. The prevalence of food addiction increased with the number of lifetime PTSD symptoms, and women with the greatest number of PTSD symptoms (6-7 symptoms) had more than twice the prevalence of food addiction as women with neither PTSD symptoms nor trauma histories (prevalence ratio, 2.68; 95% CI, 2.41-2.97). Symptoms of PTSD were more strongly related to food addiction when symptom onset occurred at an earlier age. The PTSD-food addiction association did not differ substantially by trauma type.
  
  
  CONCLUSIONS
  Symptoms of PTSD were associated with increased food addiction prevalence in this cohort of women. Strategies to reduce obesity associated with PTSD may require psychological and behavioral interventions that address dependence on food and/or use of food to cope with distress.
authors.affiliation: Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Mason
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts3Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts4Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Flint
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Roberts
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Jessica
authors.initials: J
authors.lastname: Agnew-Blais
authors.affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
authors.forename: Karestan C
authors.initials: KC
authors.lastname: Koenen
authors.affiliation: Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts3Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Janet W
authors.initials: JW
authors.lastname: Rich-Edwards
mesh_terms: D000328:Adult; D017668:Age of Onset; D016739:Behavior, Addictive / Q000150:complications / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D005502:Food / Q000009:adverse effects*; D006306:Health Surveys; D006801:Humans; D015995:Prevalence; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D014947:Wounds and Injuries / Q000150:complications / Q000453:epidemiology*; D055815:Young Adult