Addressing Trauma in Eating Disorder Treatment

Eating disorders stem from a need to have self-control as the majority of individuals with an eating disorder lack control in most aspects of their life.  The need to manage food, weight and body shape are more about control rather than the food itself and as a result, extreme unhealthy behaviors such as self-induced vomiting, diuretic, and laxative abuse, excessive exercise, and binging are practiced in an effort to mask feelings and past experiences such as trauma and abuse. Because of this, trauma in eating disorders is a common phenomenon.

How can trauma lead to eating disorders?

The earlier these traumatic events occur in one’s life, the more intense the outcome can be. A child who witnessed an emotionally abusive parental divorce or a house fire at a very young age will most likely be burdened by this trauma later in life. Eating disorders manifest trauma at a later age, usually during a transitional period such as early teenage years or at times of stress such as going through your own divorce as an adult. Trauma of a sexual nature is most apt to result in an eating disorder. This is due to the interpersonal nature of sexual trauma and is particularly the case if the violation was at the hand of an authority figure or family member. An eating disorder allows the woman or girl to avoid the pain, shame or guilt associated with the violation. The years in between the traumatic event and the development of an eating disorder are crucial years in order to seek treatment to learn to cope with that traumatic event however many people do not show signs or symptoms until a later transition or stressful period in their lives.

Grief, another form of emotional trauma can occurs when a family member, a friend, a pet or even a relationship is lost. Grief can result in severe sadness and denial and food can easily become a tangible way in which comfort is sought. In the presence of both trauma and grief, food can commonly become a way in which one feels able to establish control, such as through means of restricting calories, or a way in which to find comfort or relief.  Being consumed with food, calories and weight can become a way to find distraction from feelings of emptiness or despair and to hide one’s emotions. While these methods might be ways to initially cope with the intense burden of grief or trauma, these behaviors can quickly escalate into an eating disorder.

Trauma informed care in eating disorder recovery

Bulimia nervosa is associated to trauma more than other eating disorder as binging and purging behaviors are seen to reduce awareness of thoughts and emotions associated with past trauma. Treatment for co-occurring trauma and eating disorders needs to be a combined effort to address all issues for a successful recovery. Individuals usually either become numb or feel incredibly overwhelmed after a traumatic event and treatment can assist with learning how to overcome these trauma response processes by learning how to think through emotional regulation and practice distress tolerance tools. Education on the trauma response processes, reactions to addressing trauma, and effective therapies and tools are needed before confronting the actual trauma. Additionally it is necessary that each individual has an established safe environment, which includes both physical and emotional safety. Individuals also need to establish a strong support system and learn what healthy relationships look like. Therapists can offer relationship-building skills at each therapy session as well as new healthy coping skills for individuals can learn to practice each new skill on a daily basis.

Confronting trauma while in eating disorder recovery is necessary in order to process all of the underlying emotions that have been avoided and masked. Talking about the past abuse and learning how to manage negative feelings and thoughts as they arise is important in order to be able to live with the trauma and in order express emotions in a healthy way outside of the eating disorder. Confronting the past can bring up painful memories, emotions and thoughts and can feel like you are taking a step backwards in your eating disorder recovery however confronting the past can allow an individual to cognitively process the events and the emotions associated with the traumatic events. The psychological and physiological responses that occur from confronting the traumatic event are typical stages of the healing process. The following are specific types of tools and therapy approaches that are used in trauma informed care when treating co-occurring eating disorders:

• Mindfulness
• Exposure therapy
• Eye movement desensitization and reprocessing (EMDR)
• Emotional regulation
• Dialectal behavioral therapy
• Cognitive behavioral therapy