You eating disorder treatment plan may warrant extra care if you have experienced trauma.
If you’ve experienced trauma and have an eating disorder, you’re far from alone. It’s not uncommon for people with eating disorders, especially binge eating disorder, to have a history of trauma. Because lingering effects of trauma can affect your recovery from an eating disorder, understanding and addressing any trauma in your life and getting the support you need can be a critical part of your treatment.
What kinds of trauma affect eating disorders?
Trauma is our emotional response to a terrible event. Researchers broadly categorize trauma as interpersonal (assault or abuse by another person) or noninterpersonal (adverse events not involving another person, such as accidents, disasters, or serious illness). A recent study of U.S. adults took a look at both types of trauma and their relationship to anorexia nervosa, bulimia nervosa, and binge eating disorder.
In the results, anorexia nervosa and binge eating disorder were significantly associated with sexual interpersonal trauma. This means that if you have anorexia nervosa or binge eating disorder, you’re more likely to have experienced sexual trauma than someone without these eating disorders.
Additionally, among people who experienced multiple types of trauma, binge eating disorder was significantly associated with nonsexual interpersonal trauma and noninterpersonal trauma.
If you’ve suffered from trauma and have an eating disorder, reach out for help.
“In the unconscious mind, food equals love because food is our deepest and earliest connection with our caretaker.”
Why is binge eating so strongly correlated with trauma?
We don’t know all of the factors involved, but for some, binge eating disorder is a way to exert control over negative emotions, which can be intense for someone who has experienced trauma. After binge eating, there is shame about eating a large amount of food. This intense shame serves as a distraction from dealing with underlying negative emotions, looking at what led to them, and assessing how to cope in a healthy way. This shame can also lead to avoiding people, which can prevent those who have an eating disorder from reaching out for help as well as from developing trusting relationships.
How does a history of trauma affect treatment for an eating disorder?
In the initial assessment for an eating disorder, a clinician should assess you for trauma. If you have a history of trauma, the treatment plan should address both the trauma and the eating disorder.
Focusing on treating the eating disorder and regulating food first may help you better tolerate dealing with the trauma. Food helps our whole system—brain, body, emotions, and hormones—regulate. If you’re bingeing and purging, overexercising, or depriving yourself of food, you’re bound to be mentally and emotionally dysregulated. For example, when you have an eating disorder, it’s possible to appear very concerned about food and health externally, but in reality internally discount the importance of nutrition as integral to wellness. A therapist can help you break through this key component of denial that is part of the eating disorder lens.
Therapy may also address dissociation, which is a central symptom of a trauma response. It’s your mind’s attempt to separate from traumatic events and memories by disconnecting from your body. If you have a history of trauma and an eating disorder, you may experience the body as a holder of the trauma instead of as a part of a whole, integrated self. This can lead you to make a split between the mind and body.
Identifying dissociative episodes as they are happening and gaining some awareness of them are important recovery steps. Because trauma disrupts a sense of safety, an important step in the therapeutic work focuses on accessing a sense of safety in the present moment through the use of grounding strategies, self-talk, or reaching out to another person.
“If you want to improve the world, start by making people feel safer.”
What types of treatment are used for trauma if you have an eating disorder?
While every treatment plan is highly individualized, dialectical behavior therapy (DBT) and cognitive processing therapy (CPT) are two options to consider.
DBT is a specialized, skills-based form of therapy that focuses on helping you experience life as worth living. DBT skills center on tolerating distress, regulating and managing difficult or intense emotions, and improving the interpersonal skills needed for positive relationships. As you develop greater ease with these practiced skills, you feel more competent overall. Thus, you’re less likely to attempt to use eating disorder behaviors to numb memories or disconnect from the body.
CPT is based on confronting the “just-world” myth—that good people may struggle but, in the end, good things always happen to the good people because the world is just. In fact, the reality is that sometimes bad things happen to good people. If you’ve been raised to believe in a just world and then you experience trauma, you’re likely to react by deciding you’re not good (because bad things happen to bad people) or that the world actually isn’t fair or safe and people cannot be trusted. CPT confronts these all-or-nothing perspectives by helping you develop a new set of beliefs—rooted in a more accurate, compassionate human experience. The goal of CPT therapy is to reestablish trust in self and others, exert positive control over goals, employ reasonable safety practices, engage in self-care, and enjoy close relationships.
If DBT and CPT don’t resonate with you, there are other science-backed options you can consider. Somatic-based trauma therapies have shown great benefits and rely less on changing emotion regulation or cognitive processes. Somatic therapies focus on releasing trauma that is stored in the body with body-based techniques such as somatic experiencing (applying body awareness and specific physiological techniques), EMDR (dislodging and reprocessing traumatic and disturbing memories), polyvagal theory (neuropsychological understanding of the vagus nerve’s role in fear, digestion, and building connection), tapping (calming the sensations in the body and dealing with negative thoughts and distressing emotions), and more.
“You are not a mistake. You are not a problem to be solved. But you won’t discover this until you are willing to stop banging your head against the wall of shaming and caging and fearing yourself.”
Bottom line, there are many paths to healing.
If you’ve experienced trauma and have an eating disorder, it’s important to understand that it’s not your fault.
Seek out help by reaching out to a mental health provider who specializes in both trauma and eating disorders. Discuss how to get started and be sure you understand and agree with the rationale. Some clinicians may want to tackle both together, while others may recommend starting with the one that is primary. Of course, if you have any medical problems due to an eating disorder, you will have to include some medical and nutritional components even if you begin with a focus on healing from trauma.
You may also find relief by following the eight-week program in my book, The Binge Eating Prevention Workbook.
American Psychological Association. (Undated.) Trauma. https://www.apa.org/topics/trauma
Brom, D., Stokar, Y., Lawi, C., Nuriel-Porat, V., Ziv, Y., Lerner, K., Ross, G. (2017). Somatic Experiencing for Posttraumatic Stress Disorder: A Randomized Controlled Outcome Study. J Trauma Stress, 30(3), 30–312. https://doi.org/10.1002/jts.22189
Convertino, A.D., Morland, L.A., & Blashill, A.J. (2022). Trauma exposure and eating disorders: Results from a United States nationally representative sample. International Journal of Eating Disorders, 55(8), 1079–1089. https://doi.org/10.1002/eat.23757
Kuhfuss, M., Maldei, T., Hetmanek, A., Baumann, N. (2021). Somatic experiencing – effectiveness and key factors of a body-oriented trauma therapy: A scoping literature review. European Journal of Psychotraumatology, 12(1). https://doi.org/10.1080/20008198.2021.1929023
Porges, S. W. (2022). Polyvagal theory: A science of safety. Frontiers in Integrative Neuroscience, 16. https://doi.org/10.3389/fnint.2022.871227All Blogs