Providing trauma-informed therapies such as EMDR, brainspotting, somatic therapies, and more.
Learn more about our program from our Director of Eating Disorder Programming, Dr. Anita Johnston, PhD, CEDS.
Eating disorders present us with a paradox: they are about food, and they also aren’t about food. Because trauma and eating disorders often go hand-in-hand, treating trauma and eating disorders in the same intensive treatment program can be incredibly helpful and in many cases can assist in expediting the recovery process.
Recent studies have found that “the vast majority of women and men with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) reported a history of interpersonal trauma” and that the rates of eating disorders were generally higher in people who experienced trauma and PTSD [1].
When considering finding the right eating disorder and trauma treatment center, many important factors must be considered including:
Setting of the eating disorder and trauma treatment center
Staff experience and qualifications and staff to patient ratio
Treatment modalities offered by the eating disorder and trauma treatment center
Finding eating disorder and trauma treatment centers can be a challenge for many reasons. In some cases, it may be difficult for the individual to determine what the primary presenting issue is - trauma symptoms or eating disorder symptoms. Sometimes an individual may have experienced a recent acute trauma and benefit more from attending a primary trauma treatment program first, even though they have also recently developed eating disorder symptoms.
However, in many other cases, if an individual has been experiencing symptoms of an eating disorder for months or years while also identifying as having experienced past trauma, a primary eating disorder treatment program that is also able to address trauma is appropriate. Anyone who is experiencing both trauma and eating disorder symptoms would be advised to discuss their symptoms with their outpatient providers or to complete a pre-admissions assessment in order to determine the most appropriate clinical setting.
It can be a challenge to find eating disorder and trauma treatment centers that are substantially equipped to deal with both trauma and eating disorders. A reputable eating disorder and trauma treatment center needs to implement a trauma-informed approach throughout all aspects of its programming.
Trauma-informed means that treatment is focused on the impacts of trauma, recognizing these impacts, integrating knowledge about the fundamentals of trauma into the treatment center’s philosophies, policies, and therapies, and to avoid any re-traumatization during the course of treatment. A trauma-informed eating disorder and trauma treatment center is inherently person-centered and empathetic in their approach.
“Eating disorders are like a weed. If you just cut it off at the top, given the right circumstances, it can come back. But if you dig deep and eradicate the roots, you can eliminate it altogether.”
The above quote by ‘Ai Pono’s Founding Clinical Director, Dr. Anita Johnston reminds us of the importance of addressing core issues on the path towards eating disorder recovery. We know that eating disorders typically develop and sustain themselves in order to serve an adaptive function (i.e. protection, defense, coping, or something else). While engaging in treatment in an eating disorder and trauma treatment center, one can clearly identify the intended function of the eating disorder in order to develop new and more appropriate means of coping.
Because trauma is often at the root of an eating disorder, working to resolve the life impeding symptoms of trauma is a valuable part of sustainable eating disorder recovery. Effective eating disorder and trauma treatment programs allow patients to see, experience, and understand the connection between past events in their lives, current trauma symptoms, and their eating disorder within a safe and supportive environment.
The symptoms of both trauma and eating disorders are best treated using a holistic approach which integrates both “top-down” and “bottom-up” therapies. “Top-down” refers to psychoeducation and other cognitive treatment approaches such as individual and group psychotherapy, cognitive reframing, certain elements of Dialectical Behavioral Therapy, or Cognitive Behavioral Therapy. “Bottom-up” therapies include more body-based modalities such as EMDR, brainspotting, somatic therapy, or even restorative yoga, meditation, and breathing.
By combining cognitive and body-based therapies under the roof of one eating disorder and trauma treatment center, patients are able to get the most benefit out of their treatment and develop a wider range of tools and coping skills to use in promoting long-term eating disorder and trauma recovery.
There are biological, psychological, and social origins and impacts of eating disorders and trauma, therefore, utilizing a range of evidence-based therapeutic approaches in the treatment of eating disorders and co-occurring trauma renders the best therapeutic outcomes.
At our eating disorder and trauma treatment center, we utilize a genuinely holistic approach to treating trauma and eating disorders that allows patients to see and understand that their behaviors regarding food and eating are symptoms of deeper, unmet needs. Once these needs are identified, we can then work through learning and practicing alternative and sustainable coping skills and methods in order to end the eating disorder and work towards post-traumatic growth.
At ‘Ai Pono, we also specialize in treating co-occurring trauma or PTSD. Because the origins of eating disorders are often attributed to some form of trauma, addressing trauma or PTSD symptoms within a safe therapeutic environment is vital to the eating disorder treatment and recovery process.
Treating both trauma and eating disorders simultaneously allows patients to make in the moment observations and reflections regarding the relationship between their traumas and their behaviors in regards to food and eating. Patients can then further process these connections and insights in intensive individual or group therapy in order to dig down deeper and move beyond insight into action and real change.
Trauma and eating disorders present with both psychological and physical symptoms and there is overlap between many of the symptoms. Within a residential eating disorder and trauma treatment center, these symptoms can be monitored by 24/7 nursing staff, doctors, and psychiatrists.
At ‘Ai Pono Hawaii’s eating disorder and trauma treatment center, we provide an intimate, homelike setting with a high staff to patient ratio. This means that those struggling with particular foods or meals can receive the individual support needed leading up to, during, and following mealtimes.
The natural beauty of our location in Maui is an intrinsic part of our treatment program and patients are provided with frequent fresh air breaks, daily mindful walks to the nearby beach, opportunities to engage in nature-based therapies, and weekend excursions to relax and unwind from the week. Maintaining this balance and connection to our natural surroundings helps to provide patients with a sense of groundedness which can counteract the effects of trauma such as overstimulation, nervous system activation (fight/flight/freeze), or feeling a lack of connection with one’s environment.
Those struggling with trauma and eating disorders could find themselves feeling lost or unsettled in larger, novel environments. At our eating disorder and trauma treatment center, we provide our patients the chance to get away from the stressors of their everyday life and focus exclusively on their healing.
Narrative Therapy/Storytelling
Mindfulness Groups
Outdoor Excursions to Nearby Beaches or Parks
Visits to Local Cultural Sites
Nature-based Therapy
Art Therapy
Movement Therapy including Ecstatic Dance
Full Moon Letting Go/Intention Setting Gatherings
Offerings such as these provide our patients with a genuinely holistic immersion and new and interesting ways to reexamine their eating behaviors without preexisting judgment or expectations.
When one enters a Residential Treatment Center for eating disorder and trauma treatment, we always recommend a smooth transition to a lower level of care after the residential treatment episode is complete. So that patients remain supported and can continue to make therapeutic progress, we recommend all patients pursue either Partial-Hospitalization (PHP) or Intensive Outpatient (IOP) care following their residential treatment.
Moving through the appropriate levels of care is particularly helpful in the treatment of eating disorders and co-occurring trauma because the treatment process for trauma can be involved. As one gains more stability with their eating disorder, deeper trauma work may become possible and therefore deeper levels of healing and resolution can be achieved.
For patients who complete the residential level of care at our eating disorder and trauma treatment center, ‘Ai Pono always recommends transitioning to a Partial Hospitalization or Intensive Outpatient Program. If a patient is residing in or staying in Hawaii, they are eligible to attend our Intensive Outpatient Program. For those who are leaving the Island, our clinical team will work with each individual to provide referrals and shape their aftercare plan so that all patients who transition out of our care feel safe and supported as they move forward in their recovery journey.
It’s very important that anyone seeking an eating disorder and trauma treatment center do adequate research to ensure that the environment they choose is one that can provide them with the setting and resources that they need to address both trauma and their eating disorder. We encourage you to reach out to us today if you feel you or someone you know is experiencing both trauma and eating disorder symptoms and may not know what their next best step is. We can help to provide recommendations, treatment, or even referrals.
