Eating disorder treatment experts know unequivocally that trauma and PTSD are important contributing factors in the development of various eating disorders. According to a study performed by clinical psychiatrists, 23.1perent of subjects with anorexia nervosa and 25.6% with bulimia nervosa displayed signs of PTSD. The prevalence of trauma in triggering and causing eating disorders has led to trauma-informed care at eating disorder treatment centers and in the ED treatment community at large. This helps provide eating disorder treatment programs that not only allow for short-term eating disorder recovery but to provide a sustainable change in the client’s psychology and coping strategies.
A trauma-informed recovery plan must entail examining not only the symptoms of the eating disorder but also the underlying, contributing causes of the disorder in order to achieve long-lasting effects. A common roadblock to sustainable eating disorder recovery is the existence of untreated past trauma, which can trigger both the initial onset of disordered eating patterns and cause negative emotions that require coping mechanisms. These disordered coping mechanisms include eating disorder behaviors like restriction, binge eating episodes, and purging.
This blog will explore some of the ways trauma and PTSD can inform the development of eating disorders, including ARFID, bulimia nervosa, OSFED, orthorexia nervosa, binge eating disorder, and anorexia nervosa, as well as inform the care provided during eating disorder treatment.
First, What are Trauma and PTSD?
Trauma is any kind of distressing, dangerous, violent, or emotional experience that affects a person’s psychological well-being negatively. In popular culture, it is most often associated with soldiers who had been in combat or other violent circumstances. However, the psychological and psychiatric communities have come to understand that a wide range of experiences can cause trauma, which can then develop into post-traumatic stress disorder (PTSD). Some examples (aside from war or combat) which can contribute to this in both the short- and long-term include:
- A divorce or bad breakup (or seeing the same in someone close to you)
- Losing a job or financial security
- Failing out of school
- Being robbed or mugged
- Being in a car accident
- Witnessing a violent crime
- Domestic or sexual abuse
- Prolonged or severe illness or medical issues
- Long-term depression or anxiety
- Death of a loved one
Across all aspects of mental health treatment, understanding the impact that trauma has upon a person’s thoughts and behaviors has become paramount. It is no longer only considered an ailment affecting soldiers, but instead a factor that affects people of all stripes, and that greatly influences a person’s mental health. Eating disorders are no exception.
How Does PTSD Relate to Eating Disorders?
1. It’s a prime causative factor.
As we saw earlier, PTSD was present in a quarter of people with anorexia nervosa and bulimia nervosa in a clinical study. What’s more those figures were only for people actively showing signs of PTSD – it did not include people who have had past trauma but were not currently displaying those signs. This means that one of the most common contributing factors in people seeking treatment for an eating disorder is the presence f trauma in the past. It doesn’t need to be recent. In most cases, childhood trauma is something the client has been struggling with for years.Coping with the negative feelings triggered by PTSD is one of the main starting points for disordered eating patterns.
One common form of childhood trauma that specifically relates to eating disorders is “weight-shaming” at a young age. When being asked to diet or told things like, “you should lose some weight, you’re getting fat, etc” in a shameful way, can lead to lifelong body image issues. These sensitivities regarding body weight and shape are almost always associated with the onset of many although not all eating disorders.
2. Specialized eating disorder treatment almost always includes trauma-informed therapy
In decades past, eating disorder recovery didn’t always consider the effects of trauma on an individual, instead focusing more on medical treatment and behavioral therapy. Those elements of treatment are still in place, but in recent years the professionals specializing in eating disorder recovery encompass a more holistic approach to treatment. This means all aspects of a person’s physical, mental, and spiritual health come into play. A full continuum of care also includes more evidence-based therapies, which are a series of techniques that have been proven to work in scientific studies over the years.
Instead of the generalized talk therapy used for many mental health disorders, specialized techniques like Cognitive Processing Therapy (CPT)are also introduced. CPT focuses on helping the client understand what experiences have been traumatic, how these experiences can trigger coping mechanisms for the negative emotions that accompany them and attempt to replace the flawed coping mechanisms with healthier ones. CPT also helps clients understand how trauma response has contributed to the onset of the eating disorder.
Following that, through a back-and-forth with a trained therapist, the client can begin to modify their feelings and reactions to past trauma and understand how those feelings are negatively impacting their lives. CPT is normally conducted through a directed series of twelve steps, one step per session. By the end of CPT therapy, individuals are more able to understand, accept, and process their trauma and become more mindful of how it affects their decision-making.
3.Trauma treatment helps a long-term recovery by providing tools to help prevent relapse.
Left untreated, the negative thoughts and feelings that come with PTSD are potential riggers for relapses of disordered eating behaviors. As some therapists say, eating disorder recovery is like a loop-de-loop on a roller coaster; sometimes, you’re moving forward toward your goal, sometimes backward, and everywhere in between. Recovery is never a straight line, and relapses happen in most cases. After graduating from an eating disorder treatment center, clients have to put the lessons they learn into practice in the “real world,” with all the stresses that come with it.
If the symptoms of PTSD are not addressed, the difficulty of sustainable recovery is greater. As noted above, past trauma is not only one of the most common contributing factors in the development of eating disorders in the first place but is one of the most common triggers for the resumption of disordered eating behaviors. By engaging in evidence-based PTSD treatment methodologies, people in recovery can work on removing a major risk factor for relapse.
4. Trauma can also influence co-occurring disorders
Eating disorders rarely exist in a vacuum. According to NEDA, studies have shown that:
“A study of more than 2400 individuals hospitalized for an eating disorder found that 97% had one or more co-occurring conditions, including:
- 94% had co-occurring mood disorders, mostly major depression
- 56% were diagnosed with anxiety disorders
- 20% had obsessive-compulsive disorder
- 22% had post-traumatic stress disorder
- 22% had an alcohol or substance use disorder”
These figures show a clear connection between other forms of mental health disorders and eating disorders. Disordered eating behaviors can trigger feelings of guilt, shame, depression, and anxiety, and vice versa.
So what is the connection between these disorders and eating disorders like anorexia nervosa, bulimia nervosa, and binge eating disorders? Trauma can trigger each of them. Since these disorders are interrelated, trauma-informed care becomes doubly essential for complete, holistic treatment. Even disorders that are not always directly a result of trauma, such as OCD (which is similar in its compulsive behavior to the restrictive patterns shown in anorexia nervosa and the binge/purge cycle in bulimia nervosa), can be triggered or exacerbated by PTSD.
Make Trauma-Informed Care a Part of Your Recovery Journey
The prospect of entering a residential facility or even a virtual or day treatment program for eating disorder recovery can seem daunting, especially when you or a loved one is struggling with the turbulent emotions surrounding PTSD. However, there are plenty of options for eating disorder recovery available that can help you make a full recovery. It’s best to do your research to find a program that not only treats the symptoms of the eating disorder itself, but also the various underlying causes that can hamper a full recovery.