Eating disorders have an established link to trauma. Studies have shown time and again that trauma makes us more like to develop an eating disorder like anorexia or bulimia. But binge eating disorder (often shortened to BED) is often left out of this discussion. And the truth is that the connection between trauma and binge eating disorder is strong, even compared to other eating disorders. So, what’s the reason for this link? And how can treatment help overcome both trauma and binge eating?

Understanding Trauma

“Trauma” is an umbrella term that encompasses a vast array of experiences and feelings. Broadly speaking, trauma is an experience that is disturbing to such a degree that it interferes with our ability to cope. Trauma can cause feelings of hopelessness, guilt, shame, and panic. It can even cause some individuals to dissociate as a means to self-protect.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PSTD) is a mental illness that was first identified in the 1970s and applied to soldiers returning home from the horror of combat. (It had previously been known as “shell shock,” a term that described the terror many soldiers experienced from World War I onward.) But experiences that cause PTSD aren’t limited to war. Surviving natural disasters, sexual assault and abuse, childhood abuse, car wrecks and plane crashes, intimate partner violence, death, and pregnancy-related trauma (such as stillbirth, miscarriage, or a distressing birth experience) are all types of trauma that can cause PTSD. And despite its association with soldiers, who have historically been men, women are two to three times more likely than men to develop PSTD.

Symptoms of PTSD

The symptoms of PTSD may vary from person to person. However, it all starts with at least one traumatic event where there is at least the threat of death, serious injury, or sexual violence. The traumatic event(s) can happen directly to the person, or be witnessed. In the case of close friends or family members, just hearing about the traumatic incident can trigger PTSD. Additionally, people who repeatedly hear about traumatic events, such as law enforcement, first responders, therapists, or medical personnel, are at risk.

Of course, not everyone who is exposed to trauma will develop PTSD. Here are some of the symptoms:

  • Re-experiencing a traumatic event or events through intrusive thoughts, flashbacks, or nightmares
  • Irritability, anger, and increased arousal
  • Avoidance of people, places, and elements that remind people of the trauma (“triggers”)
  • Irritable or aggressive behavior, anger, hyperarousal (body and mind kick into high gear)
  • Reckless and/or self-destructive behavior
  • Difficulty sleeping
  • Exaggerated response when startled

Symptoms of PTSD can also vary for different age groups, such as children and adolescents.

Complex Post-Traumatic Stress Disorder

While PTSD is mostly closely associated with a single traumatic event, such as combat, a car accident, or a sexual assault, prolonged exposure to trauma causes a different kind of trauma response. Complex post-traumatic stress disorder (or C-PTSD) has similar symptoms, but the traumatic event stretches for weeks, months, or even years. C-PTSD is a condition researchers are still working to fully understand, so it is not an “official” diagnosis yet, per the DSM-5. However, in addition to difficulty regulating emotions, many individuals who experience ongoing trauma have chronic pain and symptoms that do not have a physical cause doctors can pinpoint (known as “somatic” symptoms).

Binge Eating Disorder

trauma and binge eating: woman with red hair standing outside eating, licking her finger, and looking off to the sideBinge eating disorder is characterized by episodes of eating large quantities of food, often to the point of feeling pain. People with binge eating disorder usually grapple with feelings of helplessness, shame, guilt, and distress both after a binge and around the pattern of bingeing. Sometimes those with binge eating disorder are driven to behaviors like overexercising or purging to “make up” for their binges.

Binge eating is typically something that is done in secret. People with binge eating disorder may refuse to eat around others, or eat smaller portions in the presence of other people, and then binge when they are alone. In fact, people who live with binge eaters may not even be aware of it — until they find “evidence” of a binge, such as food wrappers and empty containers, refrigerators and pantries depleted of food, or huge grocery bills on a shared credit card. The secrecy of binge eating disorder, and the shame over bingeing that many people experience, can make it difficult to get a diagnosis and find help.

Binge Eating and Restriction

Something many people with binge eating disorder have in common is a cycling between restrictive dieting and bingeing. Unfortunately, many people with binge eating disorder turn to restrictive diets, attempting to “correct” their bingeing and gain control over their relationship with food… without realizing that their solution to the “problem” of their bingeing is often the cause. People with binge eating disorder often engage in multiple restrictive or fad diets, or cut out entire food groups, then bingeing in secret.

The reason for this is the way the brain and body respond to deprivation. Bodies need fuel to run. When deprived of nutrition through undereating, the brain sends out alarm signals that tell us to eat, eat, eat. And people with binge eating disorder can stay stuck in this vicious cycle of famine and feast for years. The damage it can do to the body can be extreme, with weight cycling, gastrointestinal disorders like acid reflux, heart problems, anemia, and electrolyte abnormalities being common effects of binge eating disorder.

Trauma and Binge Eating

So, while research shows that there is a definite link between trauma and binge eating, science is still working to understand why this connection exists. There are some theories about the relationship between trauma and binge eating, however.

Emotional Regulation

People who have PTSD, or a history of trauma typically have a hard time regulating their emotions. In fact, this is one of the key symptoms of PTSD. This means that in a situation where individuals without a trauma history might be distressed but able to manage the stressor, people with trauma have a harder time regulating their fight-or-flight response and getting past a difficult moment. They may feel these emotions more sharply and intensely than people who have not had traumatic experience do. Food can be used, in those moments, as a means to self-soothe and manage intense negative emotions.

trauma and binge eating: close-up of doughnuts with pastel colored frosted and sprinklesFood is much more than nutrition; it is tied to our senses, our memories, our emotions. So, naturally, eating food that is associated with positive memories and experiences can be incredibly comforting. We all experience this, to some degree, when tucking into certain dishes or foods that are linked to positive emotions and memories. The act of eating certain kinds of food can even cause the release of chemicals in our brains that make us feel happier and calmer. For people with trauma and binge eating disorder, they may turn to food for comfort to help them cope with strong negative feelings.

Self-Blame, Guilt, and Self-Harm

A common symptom of trauma-related disorders is self-harm. Survivors of trauma can be plagued with intense feelings of guilt, shame, and self-loathing. Some people may even feel that they are to blame for what happened to them. As a result, people who are coping with trauma often engage in self-destructive patterns and self-harm. Binge eating, the restrict/binge cycle, and dieting may be part of a pattern of self-punishment and self-harm.

Body Trauma

The types of traumatic events that cause PTSD and C-PTSD are usually very physical experiences: assault, abuse, car crashes, and combat. The physical response to those traumatic events is intense, and the effects last long after the event itself has ended. People with PTSD may also suffer flashbacks that force them to experience the event all over again, as if it were happening in real-time. Eating, even to the point of pain, can provide a physical distraction from the bodily experience of reliving trauma.

Body Image

Around 29% of women with binge eating disorder report that they have experienced childhood sexual abuse or sexual assault. These experiences place them as a higher risk for developing an eating disorder, and body image disturbances. Binge eating disorder can develop along with restrictive eating habits, fixation on body size and weight, and low self-esteem.

Treating Trauma and Binge Eating

Binge eating and the effects of trauma are both treatable. Because they are so closely linked, it is often helpful to treat them together. Addressing the root causes of both binge eating and the trauma behind it leads to better outcomes.

Individuals with trauma and binge eating should seek trauma-informed care. Trauma-informed care is designed to respect and respond to trauma at all levels, from administration to those providing direct care. Treatment can be a tricky time for those with trauma, as they may find themselves triggered or even re-traumatized by practitioners who are not familiar with trauma responses.

Cognitive behavioral therapy (CBT) is often used to treat both trauma and binge eating. CBT is a goal-oriented approach to treatment that takes a practical, hands-on approach to mental illnesses. Instead of mining through childhood events or picking apart the various components and causes of binge eating disorder, it focuses on the individuals thought patterns and behaviors that impact them now. For instance, someone with binge eating disorder may feel “out of control” around certain food groups, or their favorite foods. In CBT, the individual would work with their therapist to identify and acknowledge the dysfunctional assumption (“I need to control my weight and be thin; if I’m not, people won’t love me”), the automatic thought that results (“I can’t control myself around pizza”), and the feelings that result from those thoughts (feeling guilt and shame, feeling helpless and out of control). CBT aims to empower people to step outside of their thought patterns and implement new ways to respond to common thoughts and triggers, and new ways to cope.

There are other therapy modalities, such as eye movement desensitization and reprocessing (EMDR), and prolonged exposure therapy, which have been shown to be useful for treating individuals who have experienced trauma.

Intuitive Eating

Another key to treating binge eating disorder is working on healing our relationship with food, weight, and our bodies. In many cases, bingeing is brought on by attempts to diet or eat restrictively. Bingeing can also damage our bodies’ natural cues that let us know when we’re hungry, when we’re satisfied, and when we’re full. Intuitive eating is all about getting back in touch with those natural signals, and reconnecting with food as a source of nourishment, comfort, pleasure, and sheer matter of practicality. Intuitive eating allows all foods, so cutting out food groups because they are “bad” or “unhealthy” is not part of the equation anymore.

By making peace with food and stopping the restrict-binge cycle, people with trauma and binge eating disorder can work to develop healthier and more effective methods of coping.

Photo of authorLinda Gerhardt works in nonprofit technology by day, creating content, blogs, and training materials for the nonprofit sector. By night, she is a freelance writer focusing on Health at Every Size, Intuitive Eating, and fat activism. She runs a blog called Fluffy Kitten Party where she writes about health, weight discrimination, and diet culture. She lives in Northern Virginia with her husband and their adopted pets. 

 

Source

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association.