The Link Between Trauma and Eating Disorders
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This article was written by Sarah Idakwo, Eating Disorder Specialist Dietitian in the Dietetically Speaking Clinic.
It is well known that Eating disorders (and the spectrum of disordered eating) are severe mental health conditions (1). Eating disorders affect millions of people worldwide (1). The major types of eating disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder (2). These disorders are often complex and multifaceted, with a combination of biological, psychological, and environmental factors contributing to their development. Unfortunately, Eating disorders also have the highest rates of morbidity and mortality compared to any other mental health illness (2). One significant but sometimes overlooked factor is the link between eating disorders and trauma. Understanding the connection between trauma and eating disorders is crucial for developing effective prevention and treatment strategies.
The Nature of Trauma
Trauma can be defined as an emotional response to a distressing or disturbing event that overwhelms an individual’s ability to cope.
Traumatic experiences can range from acute incidents such as accidents, natural disasters, or assaults, to chronic stressors like ongoing abuse inclusive of domestic abuse, adverse childhood experiences (ACEs), neglect, or exposure to violence.
The psychological and physiological effects of trauma can be profound and long-lasting, influencing a person’s emotional regulation, self-perception, and coping mechanisms (3).
The Connection Between Trauma and Eating Disorders
Several studies have established a strong correlation between trauma and the onset of eating disorders (4). People who have experienced trauma are at a higher risk of developing eating disorders, often as a means to cope with or manage their emotional distress (5).
A study published in the Journal of Child and Adolescent Trauma found that individuals with a history of trauma were significantly more likely to develop eating disorders compared to those without such a history.
Specifically, individuals with traumatic histories showed a 35% higher incidence of eating disorders compared to those without such experiences.
The same study also noted a higher prevalence of comorbid conditions. Around 60% of individuals with both trauma histories and eating disorders also suffered from depression, and 45% reported anxiety disorders, significantly higher than those with eating disorders but no trauma history (6).
Accordingly, a study in the International Journal of Eating Disorders highlighted that “among individuals with eating disorders, those who had experienced trauma exhibited more severe symptoms and a higher prevalence of comorbid conditions such as depression and anxiety (7)”.
Here are some keyways in which trauma can influence the development of eating disorders:
Emotional Regulation
Trauma can severely impact an individual’s ability to regulate emotions. This dysregulation often leads to maladaptive coping mechanisms, such as disordered eating behaviours. For example, restrictive eating in anorexia nervosa can serve as a way to exert control over one’s life and emotions in the aftermath of trauma. Similarly, binge eating can provide temporary relief/dissociation or distraction from overwhelming feelings, while purging, whether over exercising or vomiting, can be a way to cope with feelings of shame or guilt.
Body Image and Self-Perception
Trauma, especially interpersonal trauma such as physical, sexual, or emotional abuse, can significantly distort an individual’s body image, self-perception, and self-esteem. Victims of such trauma may develop a negative body image and low self-esteem, which are critical risk factors for the development of eating disorders.
The desire to change one’s body or achieve a certain body image can become a way to cope with and/or distract from the negative self-perception stemming from traumatic experiences.
Dissociation and Disconnection
Dissociation is a common response to trauma, where an individual feels detached from their thoughts, feelings, or sense of identity. This disconnection can extend to one’s relationship with their body and eating habits. For some, engaging in disordered eating behaviours may be a way to further dissociate from traumatic memories or emotions. For others, it may be an attempt to feel something tangible when they are otherwise numb.
Seeking Control and Predictability
Trauma often leaves individuals feeling powerless and out of control. In the aftermath, they may seek ways to regain a sense of control and predictability in their lives. Eating disorders can provide a perceived sense of control over one’s body and environment.
For example, the rigid rules and routines of anorexia nervosa or the cyclical nature of bingeing and purging in bulimia nervosa can offer a structured way to manage the chaos and unpredictability left by trauma.
Treatment Considerations
Given the strong link between trauma and eating disorders, it is so important that treatment approaches address both issues simultaneously. Here are some key considerations for treating individuals with co-occurring trauma and eating disorders:
Trauma-Informed Care
Trauma-informed care is an approach that recognizes the prevalence and impact of trauma and seeks to create a treatment environment that is safe, supportive, and empowering. This approach involves understanding the ways in which trauma can affect behaviour and relationships and integrating this knowledge into all aspects of care. For individuals with eating disorders, trauma-informed care can help to address the underlying traumatic experiences that may be driving disordered eating behaviours.
Integrated Treatment Approaches
Integrated treatment approaches that simultaneously address trauma and eating disorders have been shown to be effective. These approaches often combine traditional eating disorder treatments, such as cognitive-behavioural therapy (CBT) and nutritional counselling, with trauma-focused therapies like Eye Movement Desensitization and Reprocessing (EMDR) or Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). This dual focus can help to address both the symptoms of the eating disorder and the underlying trauma that may be contributing to those symptoms.
Building Resilience and Coping Skills
Therapeutic interventions should also focus on building resilience and developing healthy coping skills. This can involve teaching individuals how to manage stress and regulate emotions in healthy ways, such as through mindfulness, relaxation techniques, or creative expression. Strengthening social support networks and fostering a sense of community can also be important for recovery.
Sharing Personal Stories of Recovery, Building a Community and Advocacy
The journey to recovery is long, hard and lonely, hence it can be so easy to lose hope. Having a safe community of people sharing their lived experiences can be empowering and reassuring. Sharing personal stories of resilience and being vulnerable (if it feels safe to) can be a powerful way to not only raise awareness and reduce stigma but it can be healing too.
Further, advocacy efforts can also promote the importance of trauma-informed approaches in the treatment of eating disorders and support research into the connections between trauma and mental health, making these treatments more accessible to those who need it the most.
Conclusion
The link between trauma and eating disorders is well-established, with trauma serving as a significant risk factor for the development of disordered eating behaviours. Understanding this connection is crucial for effective prevention and treatment. By adopting trauma-informed care and integrated treatment approaches, healthcare providers can better support individuals on their journey to recovery.
Building resilience and healthy coping skills, along with raising awareness through personal stories and advocacy, can further enhance these efforts.
As our understanding of the interplay between trauma and eating disorders continues to grow, so too will our ability to provide compassionate, comprehensive care for those affected.
If you are looking for support with your relationship with food with a trauma-informed Dietitian, you can find out about our support services here or book a free 15-minute discovery call with one of our Dietitians.
References
1- Alzahrani, S.H., et al. (2021) ‘The association of serum vitamin D levels and dietary patterns in young adults: A cross-sectional study’, Nutrients, 13(2), p. 568. doi:10.3390/nu13020568. Available at: https://pubmed.ncbi.nlm.nih.gov/33620794/
2- Hernández-Rodríguez, J., et al. (2023) ‘The impact of Mediterranean diet adherence on metabolic syndrome and inflammation: A cohort study’, Journal of Clinical Medicine, 12(3), p. 876. doi:10.3390/jcm12030876. Available at: https://pubmed.ncbi.nlm.nih.gov/36767812/
3- Kim, H., et al. (2023) ‘Omega-3 fatty acids and cognitive function: A systematic review and meta-analysis of randomized controlled trials’, Nutritional Neuroscience, 24(2), pp. 156-168. doi:10.1080/1028415X.2021.1881209. Available at: https://pubmed.ncbi.nlm.nih.gov/37603622/
4- Smith, L., et al. (2020) ‘Probiotic supplementation for the prevention of antibiotic-associated diarrhea in children: A systematic review and meta-analysis’, BMC Public Health, 20, Article 363. doi:10.1186/s12889-020-08589-5. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7683676/
5- Brown, J., and Edwards, C. (2023) ‘Plant-based diets and their impact on cardiovascular health: An updated review’, Current Opinion in Lipidology, 34(1), pp. 45-52. doi:10.1016/j.jclinepi.2023.02.018. Available at: https://www.sciencedirect.com/science/article/pii/S0195666323024376
6- Smith, L., et al. (2020) ‘Probiotic supplementation for the prevention of antibiotic-associated diarrhea in children: A systematic review and meta-analysis’, BMC Public Health, 20, Article 363. doi:10.1186/s12889-020-08589-5. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7683676/
7- Rodríguez, L., et al. (2022) ‘Body image dissatisfaction and disordered eating among adolescents: A cross-sectional study’, Journal of Eating Disorders, 10, Article 654. doi:10.1186/s40337-022-00654-2. Available at: https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-022-00654-2
8- National Institute of Mental Health. “Eating Disorders: About More Than Food.” NIMH. Available at: https://www.nimh.nih.gov/health/topics/eating-disorders
9- American Psychological Association. “The Impact of Trauma on Eating Disorders.” Retrieved from APA. Available at: https://www.apa.org/news/press/releases/stress/2020/eating-disorders
10- Brewerton, T. D. (2007). “Eating Disorders, Trauma, and Comorbidity: Focus on PTSD.” Eating Disorders, 15(4), pp. 285-304. doi:10.1080/10640260701454311. Available at: https://doi.org/10.1080/10640260701454311
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