Is Unresolved Trauma Preventing a Full Eating Disorder Recovery?
There is a strong correlation between trauma and eating disorders. A number of studies have shown that people who struggle with eating disorders have a higher incidence of neglect and physical, emotional and sexual abuse. In particular, binge eating disorder is associated with emotional abuse while sexual abuse has been linked to eating disorders in males.
So what constitutes trauma?
Trauma comes in many forms, including childhood abuse or neglect, growing up in an alcoholic or dysfunctional home, environmental catastrophes such as Hurricane Katrina, a serious accident, loss of a loved one, and violent attacks such as rape and sexual assault. What all of these experiences have in common is that they leave the individual feeling helpless and out of control.
Trauma isn’t the same as having post-traumatic stress disorder (PTSD). PTSD is a specific diagnosis with distinct criteria, involving a serious or life-threatening experience that results in nightmares, flashbacks, attempts to avoid situations similar to those that led to the trauma and a hyperactive startle response, among other symptoms.
How Trauma Contributes to Eating Disorders
An eating disorder may develop in an attempt to cope with the trauma, suppress painful emotions or to regain a sense of control. Here are a few examples of how trauma manifests in eating disorders:
- Example 1:After the death of a parent, a child is sent to live with a grandparent who isn’t as loving and kind as her mother. She had pleasant memories around food, cooking and eating as a family, and used food to comfort herself through the sadness of losing her mom. After bingeing, she feels consumed by guilt and self-loathing and begins purging through self-induced vomiting, use of laxatives or excessive exercise.
- Example 2: A young adult woman was raped in college. Because she was powerless to prevent the attack, she began restricting her food intake to feel a sense of control over her body. Losing weight became a way to disappear or to appear childlike so she could be cared for by others or appear less attractive to men. Others who have been sexually abused or traumatized by the men in their lives may overeat, using their weight as a protective mechanism to avoid being hurt again.
Treatment for Trauma and Eating Disorders
Individuals with a history of trauma may not fully recover from an eating disorder, or may experience chronic relapse from their eating disorder, until they address the underlying trauma. As part of an integrative approach to eating disorder treatment, patients may participate in the following interventions.
Trauma is held in the body and often can’t be resolved solely with intellectual processing. Somatic experiencing is a body-awareness technique that was developed by Peter Levine, PhD. With guidance from a therapist, patients explore the sensations in the body as they work to recognize and regulate their feelings of distress.
Eye Movement Desensitization and Reprocessing
In EMDR, the patient focuses on past memories, present triggers or experiences they anticipate in the future while focusing on an external stimulus (e.g., eye movements, tones or taps). For example, the patient may be asked to focus on a particular thought or bodily sensation while simultaneously moving their eyes back and forth, following the therapist’s fingers as they move across the patient’s field of vision for about 20-30 seconds. Each session is guided by a therapist to help the patient develop new insights or associations surrounding their experience of trauma.
Individuals who have experienced trauma often struggle with self-blame or feeling responsible for what happened to them. This maladaptive thought process may follow them into adulthood. Trauma victims may recreate the trauma in some form for themselves or by perpetrating the act of their abuser on others.
Cognitive-behavioral therapy helps patients work through anger, shame, guilt and other emotions by replacing negative thought and behavior patterns with new skills and problem-solving strategies. It is backed by extensive scientific research and is widely used to treat trauma, eating disorders and a variety of other mental illnesses. In a safe, supportive therapeutic setting, patients are able to openly talk about their traumatic experiences and disordered eating behaviors.
Coping Skills Training
Eating disorders frequently develop as a way to cope with trauma. If trauma occurs at a time in life when the individual lacks the coping mechanisms to process it, they may use food to feel a sense of control.
Rather than judging the coping mechanism as good or bad, the therapist helps the patient identify the purpose the eating disorder has served and recognize that it has begun to cost more than it helps. As an adult, the patient can develop more mature coping strategies and call upon different skills than they could at the time of the traumatic event.
Dialectical-behavior therapy helps trauma sufferers build the skills of mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness to improve body image, manage painful feelings associated with trauma and guard against relapse. Learning how to trust and express anger in a healthy way are other important recovery tools.
Self-Help Support Groups
Social support is a major determinant of successful coping. A number of 12-step support groups exist for those suffering from an eating disorder, including Eating Disorders Anonymous, Overeaters Anonymous, and Anorexics and Bulimics Anonymous. Many eating disorder treatment programs invite family members to be part of the treatment team and to address their own emotional and psychological issues while their loved one is in treatment.
Beginning to address trauma can lead to an increase in eating disorder behaviors. By educating patients about nutrition and fueling the body with wholesome foods, patients can practice healthier patterns and boost their energy and mood.
When a patient is working to manage their anger, certain forms of exercise may be a tool for healthy release of anger.
Use of nutraceuticals – amino acids, nutrients and dietary supplements that improve overall health – can decrease distractions from trauma work and reduce some of the physical complaints of eating disorder recovery, such as bloating and constipation. Certain supplements and herbal remedies may also assist with symptoms of depression and co-occurring mood disorders.
A number of mind-body therapies can aid in stress management and boost mood and memory. Meditation, acupuncture, yoga, massage, energy healing, self-hypnosis and breath work are a few examples of therapies that have been helpful in treating eating disorders and trauma.
The human mind is complex. A traumatic experience in childhood can manifest as an eating disorder years later. Both trauma and eating disorders can have profound, long-term consequences that make recovery challenging. Once the issues have been identified and are being treated simultaneously by a multidisciplinary team of professionals, lasting recovery is possible.
Ross, C. (2012). Is Unresolved Trauma Preventing a Full Eating Disorder Recovery?. Psych Central. Retrieved on May 28, 2015, from http://psychcentral.com/blog/archives/2012/03/05/is-unresolved-trauma-preventing-a-full-eating-disorder-recovery/