The Undeniable Connection Between Eating Disorders and Trauma
Eating disorders and trauma are closely related—in general, eating disorders rarely take root in a vacuum. Often, they emerge as a response to something else, and in many cases, that’s a previous trauma. If a situation feels too overwhelming, it’s normal to do whatever you can to regain control or numb the difficult feelings. In many cases, you might not even be doing these things intentionally or consciously.
If you’re curious about whether your eating disorder is the result of a past trauma, I hope that this blog post can shed some light for you. We’ll talk about how to categorize “trauma,” how these two struggles co-occur, and how you might begin to approach recovery.
Note: I am not an eating disorder expert or health practitioner. This blog post is meant to share research and educate. If you’re looking for eating disorder help, find out how Project HEAL can help you, reach out to a crisis helpline, or consider joining a free eating disorder support group.
What is Considered a Traumatic Experience?
The word “trauma” can feel a little buzzword-y—you see it more and more in the mental health and wellness space. However, trauma is much more than a buzzword. The American Psychological Association defines it as the “response to a terrible event” both acute, like an accident, serious illness, or natural disaster, or chronic, like neglect or on-going sexual abuse.
In the aftermath of a traumatic incident, you might suffer from denial, shock, anxiety, avoidance, flashbacks, isolation from relationships, and intense or unpredictable emotions. You might also feel a lack of embodiment—as if the skin you’re living in does not even belong to you. This can result in an urge to control, punish, or detach from your own body.
How Frequently Do Eating Disorders and Trauma Co-Occur?
More than you might think, actually. On average, 25 percent of those with eating disorders also meet the criteria for post-traumatic stress disorder (PTSD). This holds true across various genders, races, body sizes, age brackets, and sexual orientations. PTSD is even more common in those with bulimia, increasing to 37 to 45 percent.
Those in marginalized communities are especially at risk for co-occurring trauma and eating disorder behaviors due to systemic discrimination. In fact, 62 percent of study volunteers had at least one traumatic event before age 18, and 83 percent had experiences with discrimination.
In therapeutic environments, eating disorder patients with a trauma history also tend to have more complex or severe symptoms and worse post-treatment outcomes. This can lead to a higher likelihood of relapse.
Why does trauma increase the risk and severity of eating disorders, and how do both mental health issues overlap? Let’s look at what trauma and eating disorders have in common with each other.
Understanding this intrinsic connection will help you cultivate a more nuanced, compassionate view of your own (or a loved one’s) illness.
Shared Symptoms Between Eating Disorders and Trauma
According to the International Journal of Eating Disorders, trauma can reinforce negative beliefs about yourself, creating the necessary conditions for an eating disorder to take root. At its core, this illness is a maladaptive coping mechanism used to numb uncomfortable emotions, soothe painful memories, or find something to control in unstable circumstances.
The motivation to cope is where trauma and eating disorders often intersect, which can lead to co-occurring behavioral patterns that easily lead to disordered eating behaviors. Here are some of the symptoms that traumatic experiences and eating disorders share, the journal continues:
Low self-esteem
Depression or anxiety
Body dissatisfaction
High impulsivity
Mood fluctuations
Perfectionism
Intrusive thoughts
Ritualistic compulsions
Isolation or avoidance
Weight or size fixation
Hyperarousal
Restriction or overeating
Emotional dysregulation
In many cases, the co-occurrence of trauma and eating disorders can also lead to other serious mental health issues like self-harm, substance abuse, or suicide attempts. This connection between trauma and the onset of an eating disorder isn’t just a mild concern—it can have potentially fatal consequences.
How Trauma Influences Eating Disorder Risk Factors
A shocking 81 percent of those with a lifetime eating disorder (early age onset) had at least one traumatic experience, and 68 percent agreed this event took place before their first eating disorder symptoms.
Emotional abuse and sexual assault are the two highest risk factors for eating disorder onset (43 and 28 percent, respectively). With that said, any form of trauma can compel you to self-medicate with eating disorder behaviors.
Once again, this circles back to the need for control. When it feels like you don’t have personal agency in one area of life, it’s common to seek a tangible locus of control somewhere else. For instance, you might not have been able to escape an abusive cycle as a child, but you could restrict calories to maintain a body that felt safer because it took up less space.
In other words, an eating disorder can shift the focus away from overwhelming emotions and place it on food, weight, exercise, or body image. When you view it through this lens, an eating disorder is used as a tool to help you manage the distress of otherwise intolerable situations. This is why trauma-informed care is so vital for eating disorder healing.
Trauma-Informed Eating Disorder Recovery
Many eating disorder patients who undergo intensive residential treatment have PTSD, but only 30 to 50 percent achieve remission (I.E. weight restoration, absence of harmful behaviors, etc.), the International Journal of Eating Disorder explains. This means, up to 70 percent could leave the therapeutic environment with their symptoms still intact.
The American Psychiatric Association recently issued the following update in its eating disorder treatment criteria: “Eating Disorders frequently co-occur with other psychiatric disorders [...] all patients should be asked about a history of trauma [...] and assessed for symptoms related to PTSD.” But with that said, some conventional treatment programs still lack a focus on holistic, trauma-informed care, which can increase both dropout and relapse rates.
This means you need both trauma therapy and support to address the eating behavior. This is where trauma-informed care comes in and it can help you heal both your trauma and the coping mechanisms you've built to manage it.
Trauma-informed care is built upon five core principles, including:
Empowerment
Trustworthiness
Collaboration
Choice
Safety
Heal Your Eating Disorders and Trauma
Project HEAL is on a mission to help more people access treatment options, and this includes options with trauma-informed approaches and practitioners. We also work to reduce the financial barriers and match you with programs that affirm your own unique identity (culture, race, gender, sexual orientation, ability, religion, etc.). This can protect you from retraumatization, too.
While there’s an undeniable connection between eating disorders and trauma—recovery is possible with the right support.
