Trauma: An Eating Disorder’s Silent Partner
Updated: Mar 30
By: Hannah De Groot, MEd.
With the rise of interest in mental health, I see buzzwords come up a lot, not only in therapy, but also on social media TikTok and in everyday conversation. More than ever before, I hear words like gaslighting, boundaries, and narcissism come up in regular conversation. I am so glad that mental health is beginning to get the attention it deserves, and that we as a society are beginning to normalize mental health challenges. Today, I would like to educate readers on another buzzword, trauma, and explore the relationship between trauma and eating disorders.
If you’ve ever completed an intake session with a Recovered and Restored therapist, you might remember being asked, “what does trauma mean to you?”. Responses to this question vary, but most answers are something like “an event that changes the course of your life”. I completely agree with the foundation of this definition. Psychology Today defines trauma as “a person’s emotional response to a distressing experience”. Trauma can be any kind of event that causes emotional strain and a perceived threat to safety. No matter how severe, all forms of trauma are valid and deserving of compassion.
Trauma as a Spectrum
Most people think of trauma as a major, extremely distressing event, such as going to war, experiencing sexual assault or facing violence. While those experiences can be traumatic, trauma falls on a spectrum of acuity. I like to think of trauma under two main categories, Big “T” and little “t”. Big “T” events are the ones people most often associate with trauma, such as the examples listed above. These events can often be life-threatening or imply a threat to safety, even if the person is not physically harmed. Witnesses to Big “T” events might also experience symptoms of Big “T” trauma. These events are commonly associated with Post-Traumatic Stress Disorder (PTSD). On the other hand, little “t” events are not typically life-threatening, but still cause high distress. Some examples of little “t” events include bullying, divorce, and loss of relationships. While little “T” events do not usually lead to PTSD, they may still cause emotional distress and have lasting impacts. Studies show that the accumulation of multiple little “t” events over time can result in a more severe impact than a singular Big “T” event.
When left unresolved, trauma can manifest into mental health challenges, such as substance use, self-harm, and eating disorders. A 2012 study concluded 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” (Mitchell et al. 2012). It is extremely likely that high rates of transgender and nonbinary individuals with eating disorders have also experienced trauma. In fact, the National Comorbidity Survey-Replication Study found that about 80% of people who struggle with behaviors like food intake restriction, binge eating and purging have experienced exposure to trauma. It is possible that this figure could be higher due to underreporting.
Getting to the Root Cause
Working with a therapist to understand the root cause of an eating disorder is crucial for recovering. The vast majority of people with eating disorders engage in behaviors for reasons deeper than simply wanting a different body. This is especially true for individuals with eating disorders who have trauma histories. While there is no denying that eating disorders and trauma have a positive correlation, the reasoning for this relationship is unclear. On a neurological level, traumatic experiences disrupt chemicals in the nervous system, creating issues with the brain’s ability to self-regulate. This means an individual may constantly be experiencing fight-or-flight, which leads to constant stress and anxiety, as well as challenges with digestion. Furthermore, trauma greatly impacts emotional regulation.
A 2016 study examined the relationship between eating disorders and trauma to identify themes that connect the two. First, some participants turned to food to cope with challenging emotions. Some used food to deal with sadness, anger or stress, or to seek comfort. For others, difficult emotions were reflected in their eating patterns. For example, some participants restricted food intake in an effort to punish themselves for their trauma history. Lastly, some participants reported engaging with their eating disorders to avoid unwanted attention from perpetrators. Some individuals who have experienced trauma, especially those with a history of sexual assault, have reported engaging in their eating disorders to change their bodies and avoid future trauma. Some believe that looking different may help them avoid experiencing sexual assault or other forms of trauma in the future. Overall, the three themes share one commonality: the desire for a sense of control over something, whether it may be emotions, attention or the future.
Understanding Trauma as a Provider
As a provider, it is crucial that the care provided is trauma-informed. This means recognizing that a history of trauma may impact a person’s life, and influence their symptoms and responsiveness to treatment. The foundation of trauma-informed care is compassion and respect for the client. Not only does trauma-informed care help build trust between providers and clients, but it also helps providers avoid re-traumatizing the client. Trauma-informed care includes ensuring safety to the client, giving the client choices in their recovery process, collaborating with the client to make decisions, creating consistent and clear boundaries to build trust, and empowering the client to use skills and make their own decisions. Trauma-informed eating disorder treatment often involves helping the client process their trauma in a safe environment to understand how these experiences serve as barriers to their recovery. It also helps clients replace maladaptive coping strategies, such as restricting, binging or purging, with safer skills to manage challenging emotions.
The bottom line: people deserve compassion. Because of the frequency that eating disorders and trauma co-occur, it is best practice to use trauma-informed care with all clients, and treat everyone with the respect and empathy they deserve. You never truly know what someone else is going through. If you or someone you know is living with an eating disorder, symptoms of trauma, or both, we would be honored to help. https://www.recoveredandrestoredtherapy.com/contact
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Recovered and Restored is an eating disorder therapy center founded by Gabrielle Morreale. We specialize in helping teens and young women heal from eating disorders such as anorexia, bulimia, orthorexia, and binge eating disorder and treat disordered eating, anxiety, depression, and PTSD. We provide eating disorder therapy in the towns of Horsham, Upper Gwynedd, Lower Gwynedd, North Wales, Lansdale, Hatfield, Blue Bell, Doylestown, and nearby towns with eating disorder therapy. Also providing virtual eating disorder therapy in New Jersey, Delaware, and Florida. Some towns served virtually but are not limited to Pittsburg, Lancaster, Harrisburg, Center City, Cherry Hill, Haddonfield, Mount Laurel, Cape May, Avalon, Brick, Dover, New Castle, Bethany Beach, Marydel, and Oceanview