Trauma Runs Deep: Complex PTSD and Dissociation Linked to Ultra-Processed Food Addiction

A large clinical study has found that patients struggling with ultra-processed food addiction carry a striking burden of trauma-related psychiatric illness, including rates of posttraumatic stress disorder, complex PTSD, and the dissociative subtype of PTSD that far exceed those seen in comparable patients without the addiction. The research, published in the Journal of Eating Disorders, examined 722 patients admitted to higher levels of psychiatric care and offers some of the clearest evidence yet that ultra-processed food addiction is not simply a matter of willpower or poor dietary habits, but a condition entwined with severe and often overlooked psychological trauma.

The study, led by Timothy D. Brewerton of the Medical University of South Carolina together with colleagues at SunCloud Health and the University of Illinois Chicago College of Medicine, focused on patients admitted to residential treatment, partial hospital programs, or intensive outpatient programs for eating disorders, substance use disorders, PTSD, and mood disorders. Within 72 hours of admission, each patient completed a battery of standardized self-report assessments. These included the modified Yale Food Addiction Scale 2.0, which screens for addiction-like eating patterns consistent with DSM-5 substance use criteria applied to food; the Eating Disorder Examination Questionnaire; the Life Events Checklist for DSM-5; the PTSD Checklist for DSM-5; the International Trauma Questionnaire, which captures the ICD-11 construct of complex PTSD; and the Dissociative Subtype of PTSD Scale, among other measures of depression, anxiety, substance use, and quality of life.

Of the 722 patients, 151 met criteria for ultra-processed food addiction on the modified Yale Food Addiction Scale, while 571 did not. The research team compared the two groups using multivariate analyses of variance, statistically adjusting for age, admission body mass index, sex at birth, gender, and eating disorder diagnosis. This design allowed the investigators to isolate differences in trauma exposure and trauma-related symptoms that could not be explained by these baseline characteristics alone. The results were consistent and, in several cases, dramatic.

Patients with ultra-processed food addiction reported significantly higher rates of traumatic event types across the board. Provisional DSM-5-defined PTSD was present in 72 percent of the food addiction group compared with 51 percent of those without it. Using the ICD-11 framework, 40 percent of the food addiction group met criteria for PTSD versus 25 percent of the comparison group, and 37 percent met criteria for complex PTSD compared with 20 percent. The dissociative subtype of PTSD, characterized by symptoms such as depersonalization and derealization, was identified in 53 percent of patients with ultra-processed food addiction, against 32 percent of those without. All of these differences were statistically significant at p less than 0.001.

The comorbidity picture extended well beyond trauma diagnoses. Major depression affected 86 percent of patients with ultra-processed food addiction compared with 68 percent of those without. Eating disorders were dramatically overrepresented, present in 78 percent of the food addiction group versus just 24 percent of the others. Nearly half of the food addiction group, 46 percent, had a body mass index above 30, compared with 30 percent of the non-addiction group. Taken together, the data depict ultra-processed food addiction as a marker of a substantially more complicated clinical presentation, one in which trauma, mood pathology, disordered eating, and elevated body weight converge.

Complex PTSD, formally recognized in the ICD-11, differs from standard PTSD in that it arises typically after prolonged or repeated trauma and includes what clinicians call disturbances of self-organization: difficulties with emotion regulation, a persistently negative self-concept, and problems in relationships. The dissociative subtype of PTSD, recognized in the DSM-5 system, adds a further layer in which individuals experience depersonalization, a sense of being detached from their own body or self, and derealization, a feeling that the surrounding world is unreal. Both conditions were markedly enriched in the food addiction group, and the study found considerable overlap between them.

Within the ultra-processed food addiction group, patients who met criteria for the dissociative subtype and/or complex PTSD scored significantly higher on measures of PTSD symptoms, depersonalization and derealization, loss of awareness, psychogenic amnesia, and disturbances of self-organization. They were also more likely to have a diagnosed eating disorder. Notably, 26 percent of patients with ultra-processed food addiction met criteria for both complex PTSD and the dissociative subtype of PTSD simultaneously, a level of diagnostic overlap that underscores how severe and multi-layered the trauma symptomatology can be in this population. For these patients, the trauma-related illness is not confined to intrusive memories and hyperarousal but extends into memory gaps, diminished awareness, emotional dysregulation, and destabilized self-perception.

The findings carry significant implications for how clinicians assess and treat food addiction. Screening tools used in eating disorder and addiction treatment settings rarely probe systematically for complex PTSD or dissociative symptoms, and the study suggests that this gap may leave some of the most clinically distressed patients without targeted care. The authors emphasize that thorough assessment of the full spectrum of trauma-related symptoms is essential, and that treatment for patients with ultra-processed food addiction should be integrated and individualized, directly addressing trauma sequelae rather than focusing narrowly on eating behavior alone. This is particularly urgent, they argue, for patients who meet criteria for both complex PTSD and the dissociative subtype, whose symptom profiles indicate the greatest psychiatric complexity.

The study also situates ultra-processed food addiction within a broader scientific conversation about the overlapping neurobiology of addiction and trauma. Like substance use disorders, ultra-processed food addiction involves compulsive consumption patterns that persist despite adverse consequences, and the high comorbidity observed here echoes long-standing findings that trauma and PTSD elevate risk for substance-related and behavioral addictions. Dissociative symptoms, by numbing emotional experience and fragmenting awareness, may function for some patients as a coping mechanism in which ultra-processed foods, engineered for intense palatability, provide a rapidly accessible form of affect regulation. The cross-sectional design of the study cannot establish causal direction, and the authors rely on self-report measures, with diagnoses described as provisional; nevertheless, the consistency and magnitude of the associations strengthen the case that trauma is a central clinical consideration in this population.

Published open access in the Journal of Eating Disorders, the study draws on data from patients whose anonymized information was used with written informed consent under approval from the Brany Institutional Review Board. As rates of ultra-processed food consumption continue to climb worldwide, and as health systems grapple with rising obesity and eating disorder prevalence, the research adds a vital dimension to the public understanding of food addiction: for a substantial share of affected patients, the drive toward ultra-processed food may be inseparable from unresolved trauma, dissociation, and the deep psychological wounds of complex PTSD. Recognizing and treating that reality, the authors conclude, is not optional but fundamental to effective care.

Subject of Research: The association of PTSD, complex PTSD, and the dissociative subtype of PTSD with ultra-processed food addiction in psychiatric patients

Article Title: PTSD, complex PTSD and the dissociative subtype of PTSD in patients with ultraprocessed food addiction

Article References: Brewerton, T. D., Nguyen, C., Bilenker, D., & Dennis, K. (2026). PTSD, complex PTSD and the dissociative subtype of PTSD in patients with ultraprocessed food addiction. Journal of Eating Disorders. https://doi.org/10.1186/s40337-026-01780-x

Image Credits: AI Generated

DOI: 10.1186/s40337-026-01780-x

Keywords: ultra-processed food addiction, PTSD, complex PTSD, dissociative subtype, eating disorders, trauma, depression, obesity, substance use disorder, modified Yale Food Addiction Scale, psychiatric comorbidity, ICD-11