Life is full of ups and downs. But if a single, recurring, or even abstract situation becomes overwhelming or too stressful, the body can signal a trauma response. Living with trauma often means that your nervous system is more easily triggered into a state of distress. Eating disorders (such as Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder) can develop as a response to traumatic events. These mental health conditions can impact the way someone relates to food and/or their bodies. Here, we look at the ties between trauma and eating disorders in order to highlight the importance of trauma-informed care in eating disorder recovery.

Causes of Eating Disorders

As we’ll get into, there are pretty clear ties between eating disorders and traumatic events. However, trauma is only one potential predictor of developing an eating disorder. EDs are multifaceted mental health conditions with diverse causes. These roots can be tied to genetic predispositions, environmental influences, and social pressures. Though we have access to research that identifies correlations between EDs and these internal and external factors, it is challenging to pinpoint a single cause for the development of eating disorders. However, the more information we can learn about each of these potential factors, the better prepared we can be for offering more holistic treatment options. That’s why, we are taking a look at how trauma can disrupt an individual’s relationship with food and their body, leading to unhealthy coping mechanisms and behaviors associated with eating disorders. 

What is Trauma?

To understand its ties to eating disorders and other mental illnesses, let’s gain a better understanding of trauma. Trauma is a response to a deeply distressing or disturbing event. It can leave individual’s feeling helpless, diminish their sense of self, and affect their ability to feel a full range of emotions and experiences. There are three main types of trauma:

• Acute Trauma: Results from a single, isolated incident.
• Chronic Trauma: Stems from repeated and prolonged experiences, such as ongoing abuse.
• Complex Trauma: Arises from exposure to multiple, varied traumatic events, often of an invasive, interpersonal nature.

How Trauma Impacts the Nervous System

To understand how trauma impacts the nervous system, let’s start with how humans respond to stress. Our stress response occurs due to a tradeoff between the parasympathetic and sympathetic nervous systems. The parasympathetic nervous system controls the body at rest. It slows down your heart rate, relaxes the GI tract, and controls the flow of oxygen. The sympathetic nervous system does the opposite. It engages the “fight or flight” response by releasing adrenaline and increasing the heart rate, the flow of oxygen, and generally diverting energy to any function that can help you react quickly. Once the threat has passed, the parasympathetic nervous system takes back the wheel. The sympathetic nervous system is protective in the short term, but trauma can dysregulate this system. When a person experiences trauma, their bodies can become stuck with their sympathetic nervous systems “on.” Essentially, the nervous system defaults to existing in a state of fear. 

Chronic activation of the stress response can impair the brain’s ability to process and store memories correctly, leading to symptoms such as hypervigilance, anxiety, and flashbacks. Additionally, trauma can disrupt the autonomic nervous system, causing individuals to fluctuate between states of hyperarousal (fight or flight) and hypoarousal (freeze or collapse).

What is considered a Traumatic Event?

Trauma isn’t a black and white experience. Traumatic events can include various situations, each affecting individuals differently. Not everyone who lives through a stressful event will have a trauma response. Some of traumatic events may include:

• Sexual, physical, or emotional abuse
• Neglect
• Witnessing or experiencing violence
• Natural disasters
• Severe accidents or injuries
• Sudden loss of a loved one
• War or terrorism
• Bullying or harassment

Trauma and Eating Disorders

The connection between trauma and eating disorders is well-documented, with many individuals who have experienced trauma developing eating disorder symptoms as a coping mechanism. Trauma can disrupt an individual’s sense of control and self-worth, and may sometimes lead to the use of food to manage, numb, and/or avoid intense emotions. For example, restricting food intake, binge eating, or purging can serve as maladaptive strategies to cope with the overwhelming feelings stemming from traumatic experiences. 

The Pathways of Trauma to EDs

As we noted above, a traumatic event can cause profound emotional and psychological distress that becomes deeply ingrained in the body. But how can this lead to the development of an eating disorder? Here, we look at the pathways that potentially tie a traumatic event to eating disorders.

First, a traumatic experience can lead to feelings of insecurity and increased vulnerability. Trauma responses can impair emotional regulation and manifest in various ways such as changes in appetite, reduced self-esteem, isolation, sleep disruption, and co-occurring mental health disorders like anxiety and depression. These trauma reactions may lead individuals to develop disordered eating behaviors as coping mechanisms as a way to manage their emotional pain. 

Eating Disorders as Coping Mechanisms?

Wait… so are eating disorders a coping mechanism or a mental illness? As a response to trauma, they can be considered both. Eating disorders are mental illnesses and may simultaneously act as a coping mechanism in response to trauma.

A coping mechanism is a conscious or subconscious behavior that helps someone reduce or deal with emotions that are difficult to face. Coping mechanisms are necessary for an individual to navigate through life’s challenges. The spectrum of coping mechanisms is quite expansive, as it includes anything that can distract from or minimize someone’s pain. Just to give a perspective on this range, a few examples of coping mechanisms include mindfulness techniques, substance use, avoidance, or humor.

This view does not diminish an eating disorders diagnosis, but may offer a different lens of viewing potential treatments. 

Research on Trauma and Eating Disorders

With an understanding of how a traumatic experience can put someone at a higher risk of developing an eating disorder, how does this show up in clinical research? Studies indicate that traumatic experiences are highly prevalent among individuals with eating disorders, yet PTSD (post-traumatic stress disorder) is often underdiagnosed in this population. For instance, research on patients with Anorexia Nervosa found that over 50% of participants met the criteria for PTSD, though few had received an official diagnosis.

Some predictors of eating disorders may include emotional abuse, physical neglect, and sexual abuse. A comprehensive review of the comorbidities of eating disorders and trauma revealed several trends. It highlighted that childhood sexual trauma is a significant nonspecific risk factor for eating disorders. Additionally, it showed that the link between trauma and eating disorders spans across all demographics, affecting children, adolescents, and adults of all genders. Though trauma can put someone at a higher risk for developing any type of ED, it is more frequently associated with a diagnosis of bulimia nervosa.

Treatment Options

Effective treatment for eating disorders requires a comprehensive approach that addresses both the physical and psychological aspects of the condition. Trauma-informed care is essential for both medical and psychological treatment, ensuring that the individual’s trauma history is acknowledged and integrated into their care plan. This approach can help create a safe and supportive environment, fostering recovery from both the eating disorder and the underlying trauma.

Medical and Nutritional Intervention

Eating disorders have one of the highest mortality rates of any psychiatric disorder. Because of this, treatment often necessitates medical monitoring and nutritional intervention. Working with a registered dietitian who specializes in eating disorders can be an important aspect for nutritional rehabilitation.

Psychotherapy

While medical and nutritional interventions are necessary for addressing the physical aspects of eating disorders, it is imperative to address the underlying psychology of these mental illnesses. Here are some therapeutic modalities commonly used in eating disorder treatments that can be utilized in both outpatient and inpatient settings:

• Cognitive Behavioral Therapy (CBT): CBT helps individuals identify and change distorted thinking patterns and behaviors related to food, body image, and self-esteem, and develop healthier coping strategies.
• Dialectical Behavior Therapy (DBT): DBT combines cognitive-behavioral techniques with mindfulness practices, teaching skills for distress management, improving relationships, and regulating emotions.
• Family-Based Therapy (FBT): Also known as the Maudsley Method, FBT involves the family in the treatment process, empowering parents to support their child’s recovery and improve communication within the family.
• Eye Movement Desensitization and Reprocessing (EMDR): EMDR can help individuals process traumatic memories and reduce their emotional impact, and may alleviate some of the symptoms associated with eating disorders.

Find Trauma-Informed Eating Disorder Treatment with The Alliance

Recovery from an eating disorder can be challenging. Treatment often necessitates a holistic approach to mental and physical healthcare along with the support of loved ones. Those living with eating disorders who have also experienced trauma can benefit from providers trained in trauma-informed care to help process their experience with an eating disorder, as well as the experiences from their past.

The National Alliance for Eating Disorders is an organization that supports individuals and their loved ones navigating eating disorders. Our helpline therapists can connect you with treatment options, support groups, and other personalized resources. If you’re seeking help or support for yourself or a loved one, please call our helpline at (866) 662-1235.