Trauma and Eating Disorders: How Are They Linked?

Trauma and eating disorders go hand in hand for so many individuals seeking help. Literature reviews point to certain psychological impacts of trauma (like self-criticism, and emotional/behavioral struggles) that likely contribute to the development of an eating disorder as well. I have seen these links consistently in my office.

The Link Between Eating Disorders and Trauma

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Experiences of Trauma and PTSD are undeniably linked to eating disorders. Now, this doesn’t mean that trauma/PTSD alone cause eating disorders. But in my work, and validated in the research is a strong association between the two. 

As with most mental health issues, eating disorders are usually a perfect storm of genetics and environmental risk factors. Trauma is a definite risk factor. 

When I started working with individuals who had eating disorders I learned pretty quickly that I needed to become a trauma informed provider as well. I would say the large majority of clients I’ve treated have experienced some form of trauma, and in many cases these experiences have been ongoing throughout a person’s life.

Traumas that Can Induce Eating Disorders

Traumas that can induce eating disorders are widespread and include physical, sexual, emotional, childhood neglect, experiences with death and loss, as well as experiences with narcissistic abuse. 

Research has looked at adverse childhood experiences (ACE’s), and found that there are high rates of ACE’s associated with eating disorders, and that different experiences can be tied to different eating disorders. ACE’s include:

• Physical abuse

• Verbal Abuse

• Physical and emotional neglect

• Having a parent with mental illness

• Domestic violence

• Having a family member in jail

• Losses from divorce, death, or abandonment

The most studied forms of abuse in the eating disorder literature are interpersonal abuse like sexual, or physical abuse, but sexual and physical abuse isn’t all trauma, and in my work I find that many people aren’t sure how to make sense of “how traumatic” an experience has been or whether it was a “trauma.” 

I like this definition of trauma from SAMHSA:

“Trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and physical, social, emotional, or spiritual well-being.” 

When we think about trauma experiences and how they can contribute to eating disorders we can think about an eating disorder as a lifeboat. Someone experiences something that feels extremely challenging to overcome or cope with, and then an eating disorder steps in to help them survive. 

This is why we talk about eating disorder behaviors like binging, restricting, or the fixation on being fit and thin as just the tip of the iceberg. It’s not really that those things are the person’s main value, it’s that the person’s psyche found that those behaviors, fixations or even goals were far more helpful to survival than trying to survive below the water…or than dying.

Can Eating Disorders Cause Trauma?

Eating disorders aren’t known to cause trauma, but there’s an association between having an eating disorder and having experienced trauma. Eating disorder recovery can also be a long process, and it isn’t uncommon to experience challenging or even traumatic events throughout the process as parents, health care professionals, or loved ones try to get you help.

There isn’t much research discussing trauma that arises out of having an eating disorder, but if you’ve had a negative experience during the treatment of your eating disorder, please get help and don’t be afraid to seek out care where you feel more understood and safe.

I believe that the more healed from both your trauma and your eating disorder you are, the more you are able to keep yourself as safe as any of us can keep ourselves in this uncertain world. The process of trauma recovery and eating disorder recovery is about becoming more empowered and more kind towards yourself, and the more we can do this the more we generally don’t repeat patterns of unsafe behavior or get into relationships with unsafe people.

Getting Help with Trauma Informed Therapy

Trauma informed therapy is about ensuring you are currently safe and also feel safe with your therapist. Then it’s about ensuring you feel capable of taking care of yourself when you begin to revisit the harder experiences you’ve had. Trauma therapy should be a collaboration with your therapist where you are in control, consenting, and empowered.

Getting help with trauma is most effective when:

• You work with the right therapist: A practitioner you feel cares about you and wants to learn about your specific experiences. 

• You do more than just talk (eventually): It’s important to get to know your therapist first, and talking is definitely a part of that. But trauma protocols that incorporate body sensations and body awareness alongside memory recall are most in line with what we know to be most useful in healing trauma. The traumatized brain is essentially stuck evaluating your safety as if the traumatic incident(s) are still happening, and therefore taking yourself into the past and coming back into the present is key in your trauma therapy.

There are many different forms of trauma treatment and some have more evidence behind them than others. Trust yourself as you find the best treatment for yourself. Different types of trauma treatment include:

• EMDR

• Cognitive Processing Therapy

• Prolonged Exposure

• Narrative Exposure Therapy

• Brief Eclectic Psychotherapy

• Lifespan Integration

If you are deep in an eating disorder, it’s not uncommon to need to be re-nourished first so that your brain has the nutrients and fuel it needs in order to heal from trauma during trauma therapy. It’s challenging to heal if the body is malnourished or underfed, as this alone is a sign of stress and lack of safety in the body.

If you need support with coping or an eating disorder, check out my affordable online courses here. 

To find a trauma therapist, search psychology today or therapy den and filter for a practitioner with a trauma specialty or search for a trauma support group.

References:

Rienecke, R.D., Johnson, C., Le Grange, D. et al. Adverse childhood experiences among adults with eating disorders: comparison to a nationally representative sample and identification of trauma profiles. J Eat Disord 10, 72 (2022). https://doi.org/10.1186/s40337-022-00594-x

Substance Abuse and Mental Health Services Administration, Trauma and Justice Strategic Initiative. SAMHSA's working definition of trauma and guidance for trauma-informed approach. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2012.

Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Section 1, A Review of the Literature. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207192/

Tagay, S., Schlottbohm, E., Reyes-Rodriguez, M. L., Repic, N., & Senf, W. (2014). Eating disorders, trauma, PTSD, and psychosocial resources. Eating disorders, 22(1), 33–49. https://doi.org/10.1080/10640266.2014.857517

Mitchell, K. S., Mazzeo, S. E., Schlesinger, M. R., Brewerton, T. D., & Smith, B. N. (2012). Comorbidity of partial and subthreshold ptsd among men and women with eating disorders in the national comorbidity survey-replication study. The International journal of eating disorders, 45(3), 307–315. https://doi.org/10.1002/eat.20965

Trottier, K., & MacDonald, D. E. (2017). Update on Psychological Trauma, Other Severe Adverse Experiences and Eating Disorders: State of the Research and Future Research Directions. Current psychiatry reports, 19(8), 45. https://doi.org/10.1007/s11920-017-0806-6