Data Sheet 1_Biological treatments for co-occurring eating disorders and psychological trauma: a systematic review.docx

IntroductionMany people with eating disorders report having experienced childhood maltreatment or a traumatic event prior to developing an eating disorder. Although many people with eating disorders eating disorders have significant traumatic exposure or symptoms of post-traumatic stress disorder, very little research has examined the effects of combined combined treatments for this group. The purpose of this systematic review was to synthesize all existing research on biological treatments for those with eating disorders and psychological trauma, evaluate their safety, and identify future areas of research research in this area to support to support patients with eating disorders and psychological trauma.
MethodA multi-step literature search, according to an a priori protocol was performed on PubMed, Embase, APA PsycINFO, Web of Science, Scopus and Cochrane Central. Studies needed to include a biological intervention and report on at least one eating disorder or psychological trauma outcome. Given the limited research in this area, minimal exclusion criteria were applied. A quality assessment of all included studies was completed using the Risk of Bias in Non-Randomized Studies-or Interventions (ROBINS-I) tool.
ResultsAfter removing duplicates, 2623 article titles and abstracts were screened, with 43 articles selected for a full-text review. Following the full-text review, 11 articles met the inclusion criteria. The biological treatments examined included repurposed medications (n = 3), ketamine (n = 2), repetitive transcranial magnetic stimulation (rTMS; n = 2), deep brain stimulation (n =1) electroconvulsive therapy (ECT; n = 1), 3,4-methylenedioxymethamphetamine (MDMA; n = 1), and neurofeedback (n = 1). All studies reported on some improvement in either eating disorder or trauma pathology, with the strongest effect for repetitive transcranial magnetic stimulation and MDMA. While some effects were promising, missing data and selective reporting limited the interpretability of the findings. Adverse events across interventions were common.
ConclusionAlthough psychological trauma is common in those with eating disorders, very few treatments have been evaluated in this population. Future work should aim to investigate biological treatments for those with co-occurring eating disorders and psychological trauma, as these evolving treatments show potential benefits for this complex group.

引言
许多进食障碍（eating disorders）患者自述，在罹患进食障碍前曾经历过童年虐待或创伤性事件。尽管多数进食障碍患者存在显著的创伤暴露或创伤后应激障碍（Post-Traumatic Stress Disorder, PTSD）症状，但针对该群体的联合治疗效果相关研究仍极为匮乏。本系统综述旨在整合目前已发表的、针对共病进食障碍与心理创伤患者的生物学治疗相关研究，评估其安全性，并明确该领域未来的研究方向，为这类患者的临床支持提供依据。

方法
本研究依据预先制定的研究方案，在PubMed、Embase、美国心理学会心理学文摘数据库（APA PsycINFO）、Web of Science、Scopus及考克兰中央注册数据库（Cochrane Central）中开展多步骤文献检索。纳入研究需包含生物学干预措施，并报告至少一项进食障碍或心理创伤相关结局指标。鉴于该领域现有研究较为有限，本研究仅设置了极低门槛的排除标准。所有纳入研究的质量评价均采用非随机研究-干预措施偏倚风险评估工具（Risk of Bias in Non-Randomized Studies of Interventions, ROBINS-I）完成。

结果
去重后，本研究共筛选2623篇文献的标题与摘要，其中43篇进入全文审阅环节。经全文审阅后，最终有11篇文献符合纳入标准。本综述纳入的生物学治疗手段包括：老药新用药物（n=3）、氯胺酮（n=2）、重复经颅磁刺激（repetitive transcranial magnetic stimulation, rTMS，n=2）、深部脑刺激（n=1）、电抽搐治疗（electroconvulsive therapy, ECT，n=1）、3,4-亚甲二氧基甲基苯丙胺（3,4-methylenedioxymethamphetamine, MDMA，n=1）及神经反馈（n=1）。所有研究均报告了进食障碍或创伤病理状态的一定程度改善，其中重复经颅磁刺激与3,4-亚甲二氧基甲基苯丙胺的治疗效果最为显著。尽管部分治疗效果颇具前景，但数据缺失与选择性报告问题限制了研究结果的可解读性。各类干预措施的不良事件均较为常见。

结论
尽管心理创伤在进食障碍患者中十分普遍，但针对该共病群体的治疗评估研究仍极少。未来研究应聚焦于共病进食障碍与心理创伤患者的生物学治疗，因为此类新兴治疗手段对这一复杂患者群体展现出潜在的临床获益。