The Connection Between Trauma and Eating Disorders
Written by ‘Ai Pono Hawaii Staff Writer
Eating disorders are complex conditions that could affect people of all ages, genders, and backgrounds, with trauma being considered as one of its leading contributing factors.
Studies have shown that individuals with a history of physical and/or psychological trauma are more susceptible to developing disordered eating behaviors in their life as compared to individuals with no traumatic experience. Researchers, though, still have to exactly pinpoint how or why trauma contributes to the development of an eating disorder.
Not all individuals that have eating disorders have a traumatic history, however it’s vital for those that are dealing with trauma and eating disorders at the same time to find a treatment that caters to both. Fortunately, there are specialized treatment plans are able to successfuly and holistically address co-occurring trauma and eating disorders.
Causes and Symptoms of Trauma
According to the Trauma Informed Care model, trauma is the “exposure to an incident or series of events that are emotionally disturbing or life-threatening with lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, and/or spiritual well-being.”
These emotionally disturbing or life-threatening events could include, but not be limited to physical, sexual, and emotional abuse, neglect, assault, bullying, illnesses, loss of a loved one, poverty, racism, discrimination, disasters, and wars. An estimate of 60-75% people in North America have experienced a traumatic event at some point in their lives.
Trauma is highly personal. Not everyone who experiences or witnesses a disturbing and harmful event will develop trauma, and not all individuals who have similar traumatic experiences will react in the same way.
A traumatized person can have a range of physical, emotional, and psychological responses – both immediately after the traumatic event and in the long term.
Physical responses to trauma can manifest as headaches, nausea, fatigue, racing heart, sweating, and digestive symptoms, among other symptoms. Meanwhile, emotional reactions may include feeling anger, fear, shame, or guilt. Traumatized individuals may also develop mental health issues such as anxiety and depression.
Other trauma responses could include:
Experiencing flashbacks, or an individual reliving the traumatic event in their mind
Having nightmares about the event
Insomnia
Worsening of existing medical conditions
Feeling unsafe within an environment, which can lead to withdrawal and/or isolation
Adjusting emotions according to other people’s mood to avoid conflict
Having intense fear that a similar traumatic event will happen again
Continued avoidance of related matters to the traumatic event
Fearing abandonment
Although trauma can happen at any age, children exposed to potentially traumatic situations do have a greater risk of experiencing debilitating long-term effects on their health. Research indicates that children are more vulnerable to trauma because their brain's organizational systems are still developing.
During stressful or traumatic events, children experience heightened states of stress that lead to their bodies releasing hormones related to stress and fear. As a result, childhood trauma, especially ongoing if it’s ongoing or complex, can disrupt normal brain development that could manifest in a child’s physical health, mental capacity, and daily behavior.
An individual's response to trauma can also vary depending on the type of trauma they are subjected to. According to Medical News Today, the different types of traumas include:
Acute trauma- where an individual was exposed to one dangerous situation.
Chronic trauma – where an individual is repeatedly exposed to a stressful situation for a prolonged period of time.
Complex trauma – where an individual suffered multiple traumatic events.
Vicarious or secondary trauma – where an individual developed a trauma after being in close contact with someone who went through a traumatic event; or they witnessed harm happening to someone else.
Whether it be an isolated, repeated, or ongoing traumatic event, Healthline noted that it usually takes four to six weeks for an individual to move past their initial shock. However, traumatized individuals can exhibit various responses even after several weeks past the dangerous situation.
Defining PTSD
If symptoms of trauma persist in the following weeks after the traumatic event, an individual could be experiencing a condition known as post-traumatic stress disorder or PTSD.
According to the American Psychiatric Association, PTSD is a “psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event, series of events or set of circumstances.”
The Anxiety and Depression Association of America (ADAA) also noted that PTSD is a “longer-term condition where one continues to have flashbacks and re-experiencing the traumatic event.” Said individual should also have a “high level of ongoing distress and life impairment.”
Not every individual who experienced a traumatic event will develop PTSD. Persons who lived through a traumatic experience that didn’t develop PTSD were usually individuals who had a strong support system, identified themselves as a survivor instead of being a victim, reframed their perception of trauma, and also helped others in their healing process.
Not all individuals who exhibit some behaviors or symptoms of PTSD would also be diagnosed with the disorder.
The Diagnostic and Statistical Manual of Mental Disorders has established a criteria that indicates if an individual’s trauma experience warrants a PTSD diagnosis. The following criteria is specific to individuals aged six years old and above, and all specifications should be met for an individual to be diagnosed with PTSD:
Criterion: Stressor
A person should be exposed to trauma in the following ways: 1) direct exposure, 2) witnessing it in person, 3) learning that a family member or close friend was exposed to a trauma, and 4) repeated and/or indirect extreme exposure to aversive details of the trauma.
Criterion B: Intrusion symptoms
Following the traumatic event, an individual exhibited one or more of intrusion symptoms such as 1) recurrent and involuntary distressing memories of the trauma, 2) nightmares, 3) dissociative reactions such as flashbacks, 4) physical reactivity at exposure to traumatic reminders, and 5) intense emotional distress to cues that resemble the trauma.
Criterion C: Avoidance
A person avoids or limits themselves in engaging with trauma-related stimuli – may it be internal (memories, thoughts, or feelings) and/or external (people, places, objects, activities, and situations) that remind them of the event.
Criterion D: Negative alterations in cognitions and mood
An individual developed or worsened their negative thoughts and feelings in the following ways; 1) inability to recall key aspects of the trauma; 2) overly negative thoughts and expectations on oneself and/or the world; 3) persistent blaming of self or others for causing the trauma; 4) increased negative emotions such as fear, horror, guilt, and shame; 5) decreased interest in activities; 6) feeling of detachment and isolation from others; and 7) inability to experience positive emotions such as happiness and satisfaction.
Criterion E: Alterations in arousal and reactivity
After the traumatic event, an individual began experiencing hyper-arousal and reactivity such as 1) irritability or aggression (whether verbal or physical); 2) reckless or destructive behavior; 3) hypervigilance; 4) heightened startle response; 5) difficulty concentrating; and 6) difficulty sleeping.
Symptoms should also last for more than a month, are not attributed to medication, substance abuse, or other illnesses, and should cause significant distress or impairment in an individual’s social and/or occupational functioning.
An individual could also meet all the criteria for PTSD and still also experience high levels of the following two symptoms in reaction to trauma-related stressors:
Depersonalization – wherein an individual has persistent or recurrent experience of feeling detached or being an outside observer from oneself.
Derealization – wherein an individual has persistent or recurrent experience of unreality of surroundings.
According to statistics from the National Center for PTSD, about 5 out of every 100 adults or 5% in the United States has PTSD in any given year. Women are more likely to develop PTSD than men, with about 8% of women and 4% of men will have PTSD at some point in their lives.
The Link Between Trauma and Eating Disorders
Traumas are known to affect an individual’s nervous system in a way that it could disrupt one’s ability to regulate their emotions. Individuals with trauma are more likely to not be able to manage their stressors as compared to individuals without trauma history.
As a result, people who are dealing with trauma often develop coping mechanisms that help them manage these uncomfortable emotions, with some involving themselves in maladaptive behaviors such as disordered eating or addiction.
While researchers still must identify how trauma and eating disorders are linked, studies have shown that both conditions are “related to problems with stress hormones and mood-boosting brain chemicals.”
They added that in most cases, individuals are often first exposed to a traumatic experience before they start developing eating disorders, leading them to hypothesize that traumatized individuals engaged in eating behaviors as a means of coping with the emotions or associations related to the traumatic event.
According to the statistics by National Eating Disorders Association:
Approximately one in four people with an eating disorder has the symptoms of PTSD.
A study of more than 2,400 individuals hospitalized for an eating disorder also found that 97% had one or more co-occurring conditions.
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 substance use disorder
Two major national representatives have shown that individuals with bulimia nervosa, binge eating disorder, or any binge eating have significantly higher rates of PTSD than individuals without an eating disorder.
Binge eating and/or purging appear to be behaviors that facilitate; 1) reducing the hyperarousal or anxiety associated with trauma; and 2) the numbing, avoidance, and forgetting of traumatic experiences.
A study found that women who were victims of assault were more likely to develop bulimia than those who had not been assaulted.
A study showed that the majority of individuals with anorexia nervosa, bulimia, and binge eating disorders have a reported history of interpersonal trauma.
Overall, the National Eating Disorders Association reported that among these several studies that associate trauma to developing eating disorders, the most significant finding is that eating disorders were generally higher on individuals who experienced trauma and PTSD.
Studies also noted that traumatic experiences, such as emotional abuse and physical neglect including food deprivation, are associated with developing eating disorders.
As noted above, the most common eating disorders that are linked with trauma are bulimia, anorexia, and binge-eating. A more in-depth discussion about the types of eating disorders can be found here, but to recall:
Anorexia is wherein patients severely restrict their food intake and may also perform excessive and other purging behaviors. Most people with anorexia also have a distorted body image. Common signs and symptoms include profound fear of weight gain, rapid weight loss, consistently being underweight, and refusal to accept that their excessively low body weight can be dangerous.
Bulimia is wherein patients persistently eat large amounts of food and resort to behaviors that counteract the impact of this binge-ing. Usually, their means of purging include inducing vomiting, excessive exercising, and consumption of laxatives and/or diet pills. The repeated binge-and-purge cycle can harm the digestive system of individuals with bulimia, cause chemical imbalance, damage various internal organs, and cause weight fluctuations and lowered immune system.
Binge eating disorder (BED) is wherein patients consume large quantities of food. Unlike bulimia, individuals with BED do not do purging activities.
It’s important to note that experts have yet to validate how the connection between trauma and eating disorders was made possible, but studies have shown that there's a higher incidence of trauma among people with eating disorders, meaning those who have suffered a traumatic experience are more likely to develop an eating disorder than those who don’t have trauma.
Experts have theorized that individuals with trauma, especially from sexual and emotional abuse, can develop eating disorders due to body image issues. Victims might believe that they need to look a certain way to be considered more or less attractive and desirable, which can cause them to turn to food as a way to control or manipulate their bodies.
Body image issues remain to be an integral aspect of any eating disorder, and if there’s trauma related to how an individual views their body, it could trigger unhealthy habits geared towards modifying their bodies to avoid the repeating feelings of pain and shame. This could result in individuals resorting to unhealthy eating behaviors in an effort to protect themselves from another perceived harm.
Feeling of being out of control are common symptoms for individuals with trauma. Relating this to eating disorders, experts theorize that patients might have developed it as a way to re-establish or regain a semblance of control in their lives. Restricting, binge eating, and purging can be seen as an act of safety if individuals with trauma have internalized the belief that they’ll be harmed based on how they look.
Individuals with a history of trauma or those who struggle with PTSD are also known to have experienced difficulty in managing their emotional reactions. Researchers theorize that people dealing with trauma have developed eating disorders in their attempt to deal with their emotions. This could be because they’d like to distance themselves from disturbing and discomforting thoughts and memories associated with their traumatic experience, or cope with the overwhelming feelings from the event.
While both are often linked causally with trauma being the cause of eating disorders, there’s also the possibility of eating disorders causing an individual to be more vulnerable to traumatic events. For example, individuals with severe eating disorders can warrant serious health complications that could elicit a trauma response afterward.
Treating Trauma and Eating Disorders
Dealing with an eating disorder is already a sensitive matter to begin with, but healing from trauma also adds a layer of complexity. Hence, it is important to seek treatment that targets both.
As trauma is often the root of an eating disorder, it is vital to learn about its underlying and contributing factors in the said eating disorder. Working on the recovery with an increased understanding of their trauma, its causes, and how it affects their eating behavior would give them a better insight on how to deal with both conditions.
As described in our article about the types of eating disorders and their treatments, individuals dealing with trauma could go for major therapies such as cognitive behavior therapy (CBT) and dialectical behavioral therapy (DBT), among other options.
CBT focuses on eliminating negative patterns of thinking and irrational beliefs that foster such thought patterns, while DBT combines cognitive and behavioral methods to help patients manage distressing emotions, which are particularly helpful for patients who react to stressful situations by displaying extreme behaviors.
Engaging in a treatment program wherein specialists who are equipped to deal with trauma are beneficial as these experts help individuals uncover reactions associated with their trauma, and make victims understand how to accept and process these emotions.
Once those underlying causes of trauma are addressed, true, long-term recovery from the eating disorder becomes possible. On the other hand, if an individual is not provided with the opportunity to engage in trauma informed care, this trauma could serve as a continuous trigger for their eating disorder which could lead to relapse or impede full recovery.
Begin Your Healing from Trauma and Eating Disorders
Effectively treating trauma and eating disorders requires specialized guidance from a highly experienced team of specialists.
With over 35 years of knowledge and experience, ‘Ai Pono Hawaii, an eating disorder recovery center located near the coast in Maui, has cemented itself as an institution that offers holistic and effective treatments to patients with all kinds of eating disorders.
At our residential eating disorder and trauma treatment center, we provide a safe space for individuals to endeavor upon trauma work in a fully supported and safe space. We utilize a genuinely holistic approach to treating trauma and eating disorders that allows patients to identify the connections between their eating behaviors and their trauma.