It is well known that stress is directly related to eating disorders and their onset. But what about trauma and eating disorders? Does one cause the other? Is trauma more associated with one type of eating disorder than another? Is trauma recovery necessary to make a full eating disorder recovery, and does one have to be tackled before the other? This and more, as well as treatment options, will be discussed. But first, a better understanding of “trauma.”
Redefining Trauma: What Does it Look Like?
Trauma healing requires first recognizing a traumatic event or circumstance.
Many images come to mind when thinking about trauma: childhood neglect, domestic abuse, car accidents. The term has been recently redefined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Right now, it’s defined as: “Exposure to actual or threatened death, serious injury, or sexual violence.”
This could mean personal exposure. Or it can be exposure through witnessing or through close proximity to someone who has experienced trauma. This definition has eliminated several instances of what most would consider traumatic.
“Hidden” Trauma: Prolonged Trauma and Eating Disorders
Most studies exploring the connection between trauma and eating disorders focus on this narrow definition of trauma. However, many eating disorders stem from childhood neglect, bullying, or even events in later life, such as divorce or job loss. In fact, according to Trauma-Informed Approaches to Eating Disorders (Seubert, 2016):
“This type of trauma is often ‘hidden’ and it may include seemingly small, yet painful and cumulative, events such as grief and loss, attachment injury, and/or bullying experiences” (16).
Shari Botwin, a counselor who has been treating eating disorders for twenty years, has consistently uncovered trauma in her patients that had hindered their recovery. Situations such as tragic loss have come up again and again. Trauma, therefore, is anything that a sufferer has been exposed to that causes a fight-or-flight response, whether it’s immediately life-threatening or chronically stressful or painful.
Shari also realized around year ten that there must have been some sort of connection between these issues. Her patients, she found, were stuck in their trauma, whatever kind it may be. The connection happens inside the mind and, maybe more importantly, in the body.
The Trauma Response: Mental and Physical
What happens during and after trauma? Without getting too deep into neuroscience, when trauma is experienced, adrenaline rushes through the body. Adrenaline is the body’s fight-or-flight hormone response to danger. The memory of the trauma is imprinted in the amygdala. This part of the brain handles emotion regulation and behavior. The intensity of the emotion is also stored away and there are two huge consequences of this:
1. THE BRAIN CAN CONFUSE REGULAR SITUATIONS AS DANGEROUS.
The brain remembers the sensory things associated with a traumatic event. For example, this can include the place where something happened. Have you ever experienced anxiety or fear when returning to the scene of an accident? There’s no immediate danger, but your brain associates the place with it. So, you may panic.
So many things can be associated with a trauma, and the brain doesn’t quite know the difference. Everyday situations can cause anxiety, fear and the fight-or-flight response. This is the second problem.
2. THE FIGHT-OR-FLIGHT RESPONSE CAUSES PHYSICAL REACTIONS, AND THE NEED TO ESCAPE “DANGER.”
The fight-or-flight response is physically stressful and anxiety provoking. Heart rate increases, shaking limbs, and hyperfocus to plan an “escape” are just a few physical symptoms. Often, the need to numb feelings and sensations in the body, is so great that someone will turn to just about anything.
This includes maladaptive, or harmful, actions such as self harm, taking drugs and, yes, eating disorder behaviors.
Trauma and Eating Disorders: The Trigger
Triggers are always addressed in eating disorder treatment. A trigger is a stimulus that provokes unwanted, uncomfortable and/or anxious feelings. Once a trigger is experienced, unwanted thoughts occur. This creates an urge to use harmful behaviors to “escape.” Then one acts on the urge, or they don’t. This whole process can occur as a response to trauma.
Using behaviors provides short term relief from discomfort or panic. The brain will connect behaviors with relief. But eventually, this short term solution will do more harm than good. Feelings of shame, failure and self hatred, inevitably, cause more eating disorder urges and behavior use to cope. As long as a trauma is unaddressed, this process will most likely continue.
Eating Disorder and Trauma: Statistical Evidence
Several studies have been done to explore the co-occurrence of trauma (specifically post-traumatic stress disorder, or PTSD) and eating disorders. Because of the varied definitions and criteria for traumas, these studies have produced varied results.
One broad study includes prolonged traumas as well as acute ones. The group studied trauma and eating disorders among anorexic, bulimic, binge eating, and eating disorder not otherwise specified (EDNOS) populations.
Around 20% of eating disorders sufferers had experienced at least one traumatic event, much higher than the general population. 25% of patients in this group reported experiencing more than one. The more severe the traumatic event, the more intense eating disorder symptoms were. 33% of traumatic events happened in childhood, 29% in teenagers, and 38% in adulthood.
It is believed that sufferers of bulimia and binge eating disorder have a higher likelihood of having experienced trauma. This is probably because trauma victims usually want to numb or distract from traumatic events. They use acute behaviors, such as binge eating and/or purging, to do that.
An all-around common statistic is this: a much larger percentage of eating disorder patients have a history of trauma than the general population. Scientists and treatment specialists have concluded that they are linked. A trauma-informed treatment plan could be beneficial for patients.
Trauma and Eating Disorders: Trauma Recovery is a Necessity
Usually eating disorder behaviors have to be managed first, before tackling any other problems. That’s because eating disorders are physically damaging, potentially life threatening. It’s also difficult to process thoughts and emotions when not properly nourished.
But is eating disorder recovery possible without trauma recovery?
At ‘Ai Pono, focus is given to both eating disorder recovery and co-occurring issues, including trauma. Behavior management is tackled, along with other issues. Programming is designed with the understanding that eating disorders are not necessarily about food.
Treatment of Eating Disorders and Trauma
Several evidence-based approaches have been developed for trauma recovery. These include both ‘top-down’ and ‘bottom-up’ approaches.
‘Top-down’ therapies are cognitive, thought based exercises and practices. Words and ideas are used to process feelings, reframe thoughts and condition the mind to handle triggers.
‘Top-down’ therapies offered by ‘Ai Pono include:
- Cognitive processing groups: to allow the space to thoughtfully process emotions and memories
- Dialectical Behavioral Therapy (DBT): teaches coping skills to manage triggers and the strong emotions that come with them
- Narrative and Storytelling Based Therapy: which uses metaphors and storytelling to help describe and understand the underlying thoughts and emotions related to food/eating
‘Bottom-up’ therapies are based on the idea that our experiences affect our bodies, starting at the physical processes that occur, such as the fight-or-flight response. Bottom-up therapies involve movement-based approaches to understanding and processing.
‘Bottom-up’ therapies include:
- Emotional Freedom Technique: aims at removing energy blocks in the body, especially those that result from the constant stress and adrenaline rushes related to trauma
- Eye Movement Desensitization and Reprocessing (EMDR): aims at allowing patients to relive their traumatic experiences, while a therapist directs eye movements with a light or finger following technique, in order to distract from the painful emotions and process the experience until it becomes less emotionally impactful
With trauma healing, full eating disorder recovery is possible.
Eating disorder treatment, especially when a co-occurring problem such as trauma is present, requires a holistic treatment approach. About one in four eating disordered individuals have at least some symptoms of trauma. The trauma experience is unique, and not everyone has the same treatment needs. Individualized treatment that addresses these needs, including trauma healing, will allow for a full recovery.
If you or a loved one is suffering from an eating disorder, take the first step today and talk to someone about recovery or start by learning about the eating disorder recovery programs we offer.
