The Intersection Between Trauma and Eating Disorders
People’s relationship with food and body can be complicated, to say the least.
Living in a dieting-obsessed culture can be a significant trigger for some people, leading them to embark on the body project that so many of us know so well-striving for body change and engaging in disordered eating behaviors.
but, many times people begin engaging in these behaviors as a way to cope with emotional overwhelm or experiences.
Research has shown that eating disorders are significantly more prevalent in people who have experienced trauma than in those who have not. In a 2018 study of college students, 52 percent of the students who engaged in disordered eating behaviors also had symptoms of PTSD. A 2007 study showed higher rates of PTSD and eating disorders in people who have experienced sexual assault, sexual harassment, physical abuse and assault, emotional abuse and neglect, and bullying. And, studies have shown that 75 percent of women who enroll in residential treatment programs for their eating disorders report having experienced some form of trauma.
while we can’t know the exact reasons for the relationship between eating disorders and trauma, what we do know is that trauma often interrupts people’s ability to manage their emotions and regulate their nervous system.
Oftentimes turning to disordered eating behaviors becomes a way to numb or to manage emotional overwhelm. Eating disorder behaviors can be a way for people to distance themselves from painful memories, thoughts, and bodily sensations. Despite the destructive nature of eating disorders, the behaviors can actually manage symptoms of PTSD, becoming a way to cope with distress.
A common response to trauma is self-harm. People who have survived trauma often experience intense feelings of shame, self-loathing, and guilt. As a result, trauma survivors often engage in destructive patterns of self-harm- including (but not limited to) food restriction, purging, and binge eating.
Here at Reclaim Therapy in Pennsylvania, we understand that your eating disorder may be an adaptive way for you to survive in the world. This could be because you’ve been eating disorders and trauma. And, to treat your eating disorder, we also need to treat your trauma that it may be rooted in.
post-traumatic stress disorder is diagnosed by the 5th version of the diagnostic statistical manual by the following criteria:
“exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
Directly experiencing the traumatic event(s).
Witnessing, in person, the event(s) as it occurred to others.
Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).
presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).
Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.)
Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:
Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia, and not to other factors such as head injury, alcohol, or drugs).
Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
Markedly diminished interest or participation in significant activities.
Feelings of detachment or estrangement from others.
Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.
Reckless or self-destructive behavior.
Hypervigilance.
Exaggerated startle response.
Problems with concentration.
Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
Duration of the disturbance (Criteria B, C, D and E) is more than 1 month.
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.”
PTSD may cause dissociative symptoms. Dissociation is defined as a disconnect in a person's thoughts, memories, feelings, actions, or sense of who he/she is. This can manifest in many different ways. Two common dissociative symptoms are:
Depersonalization: Regular or frequent experiences of feeling disconnected from your ability to process or be in your body. For example, feeling like you were living a dream, feeling like time is moving slowly, feeling a sense of disconnectedness from your body.
Derealization: Regular or frequent experiences of feeling disconnected from your surroundings, or like your surroundings aren’t real. For example, the environment around you feels like a dream, far away or distorted.
People living with an eating disorder often report dissociation. Through using anorexic, bulimic, or binge eating behaviors, they’re able to disconnect from the here and now and their past. Oftentimes these behaviors also give people a sense of being able to control something in their lives. Quickly finding that the facade of control that eating disorders offer, leads to feeling even more out of control.
letting go of the one thing that has kept you regulated and feeling safe from your past experiences and traumas (PTSD) is brave. and, for most people, it’s difficult.
Eating disorders are often a way to escape or manage the pain of trauma, disconnecting you from feeling, and at times even being, in your body. But, by continuing to use your eating disorder to disconnect you from yourself, you also become disconnected from the world, your values, your loved ones, passions, and your purpose.
we want you to know that the trauma you experienced is not your fault. you deserve connection and healing.
Often times we liken recovery from an eating disorder to the grief process. Slowly letting go of behaviors, rituals, and beliefs from your eating disorder is like grieving a part of you that served a purpose, but also caused you pain and distress.
ya’ll, this is deep work.
And as if you’re lived, emotional experiences aren’t enough to heal from, we’d be missing a part of the puzzle if we didn’t look at how living in a body (for most of you reading this, a body that identifies as a woman) in our culture is inherently traumatic. The pressures, the shoulds, the never-ending messaging that your body can and should be changed. The seeds from our culture’s fatphobia are planted early. And fatphobia is absolutely emotionally overwhelming on its own and is oftentimes exacerbated by our own personal traumas.
We may not be able to stop living in a culture that is obsessed with thinness and clean eating, but what we can do is build resilience to the messaging that trigger eating disorder and body-based behaviors.
How We Treat Eating Disorders and Trauma in Pennsylvania
Here at Reclaim Therapy in Pennsylvania, we believe in utilizing a team to help you on your path to recovery. You act as the leader of the team, sharing and setting goals for your treatment and recovery process.
nourishment is the first step in preparing to tackle your trauma.
Whether you struggle with anorexia, bulimia, binge eating disorder, or orthorexia, it’s important for your body and your brain to be nourished appropriately. Our eating disorder therapists often work closely with eating disorder dietitians to ensure people aren’t malnourished.
Being malnourished (possible at any body size with any eating disorder!) interrupts your ability to process big feelings and past experiences. This is why eating disorders are effective at what they do- again, they can disconnect us from pain. But, when your brain and body are adequately nourished you’re setting yourself up to be better able to process, deal and heal from trauma.
early stages of recovery often look like understanding and tackling behaviors, urges and learning to tolerate emotional distress and discomfort related to urges.
We focus on helping people understand, get to know, and work with their nervous systems to reduce eating disorder behaviors while finding new effective ways to cope with emotional overwhelm and distress. We commonly use CBT, DBT skills, and ACT as we get the ball rolling in early recovery. We want to help our clients feel stable and be sure that they are nourished enough to dive into trauma as they’re ready.
There are a number of interventions that the Reclaim Eating Disorder Therapists use to treat the intersection of eating disorders and trauma.
parts work
Parts work acknowledges that we, and our personalities, are all composed of multiple different parts. Some parts of us are wounded, some are protective, some are pushing us to engage in self-harming behaviors and some are grounded and keep us level-headed and connected.
Our eating disorder therapists believe that there are no bad parts- that all of our parts, including an eating disorder and body dysmorphic parts, are functioning with a purpose. Our goal is to help our clients get to know these parts as compassionately as possible so that they can understand why they’re functioning the way that they are and begin to help the part trust that other ways of functioning are possible, and possibly more effective.
Parts work empowers our clients to understand what feels like inner conflict and come back to a grounded, self-led place to care for themselves and make decisions.
emdr for Trauma
EMDR therapy is a phased treatment model that helps people reprocess traumatic events. No trauma is too big or too small for EMDR. Through the use of bilateral stimulation and imagery, EMDR allows the brain to naturally heal itself and move through the stuck, painful places that trauma creates in our minds and our bodies.
somatic work
Many times when people have experienced trauma they experience not only cognitive symptoms (thoughts, self-beliefs, etc) but also body-based symptoms (shortness of breath, tension, racing heart, GI symptoms, aches, and pains). Somatic work, or body-based therapy, helps people process events through body experiences so they can experience relief.
Healing from your eating disorders and trauma is possible.
Here at Reclaim Therapy in Pennsylvania, we specialize in treating the intersection of Eating Disorders and Trauma. We believe that you, and all people, deserve healing and recovery. And, we’d be honored to support you on your journey towards just that.
🧡,
we offer specialized therapy for people struggling with body image, disordered eating, trauma, and grief
The Reclaim Eating Disorder Therapists offer online therapy in Pennsylvania and in-person therapy in our Horsham, PA office. We also offer online group coaching for people who are struggling with binge eating and body image.