Prior abuse can trigger eating disorder behaviors due to trauma and feelings of shame, guilt, and a need for self-punishment. Eating disorder behaviors are often a way to self-manage the memories and emotions through starvation, binging, purging, and self-harming.
People who battle with an eating disorder are approximately at a 30% increase for having past trauma .
Bulimia is connected to trauma more than other eating disorders as 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.
Challenges in Confronting the Trauma in Eating Disorder Recovery
Trauma can be extremely difficult to confront. Many unhealthy behaviors are used to avoid the memories, emotions, and thoughts surrounding past experiences. Often eating disorder behaviors are a way to numb and disassociate from the present moment.
Being able to work through trauma and an eating disorder is best done within a supervised setting, preferably a treatment center that offers intensive outpatient programming, partial hospitalization, and residential care .
Confronting trauma means that the events of the past are brought into the present moment. It is talking about the abuse, learning how to manage feelings and thoughts that arise, and gaining a way to express trauma in a healthy way outside of the eating disorder.
Trauma can affect symptom presentation, stress reactions, engagement in therapy, as well as the progress of recovery .
At first, it can be overwhelming to start the process as emotions will feel more intense and thoughts may be more present than when in the eating disorder. It is essential to keep on track with treatment goals throughout the recovery process.
When an individual experiences trauma, immediate reactions occur. Coping styles vary from person to person.
When trauma is combined with an eating disorder, the psychological health changes.
It is due to the unhealthy behaviors around avoiding and numbing the traumatic event(s).
Trauma affects a person’s beliefs about the future, hope or loss of hope, limited expectations around life, fear that their life may end and that their life will not return to ‘normal’ as it was before abuse.
Many individuals experience exhaustion, confusion, sadness, anxiety, agitation, numbness or disassociation, physical arousal, and blunted affect immediately after trauma .
Continued distress with trauma, whether one time or over a period of time, can include periods without rest, severe dissociation, and flashbacks with fear of safety.
Delayed responses can also occur that include persistent fatigue, sleep disorder development, nightmares, fear of recurrence, and extreme anxiety around flashbacks.
Other issues such as depression, and avoidance of emotions, sensations, or activities that are associated with the trauma even if a vague association can also occur.
Trauma responses are typically either that a person feels overwhelmed with emotions or numbed out to the feelings. Treatment can assist individuals with learning how to think through emotional regulation and distress tolerance tools.
It is often being able to manage emotions through healthy coping skills, without the use of eating disorder behaviors. Mindfulness, cognitive restructuring, desensitization therapies such as Exposure Therapy and Eye Movement Desensitization and Reprocessing (EMDR) can be extremely helpful .
Education on the trauma response process, reactions to addressing trauma, and effective therapies and tools is needed before confronting trauma.
Being able to process trauma is typically recommended regardless of the length of time trauma was experienced (one time or for a duration of time), or how long ago the trauma occurred.
Educating the client on understanding when trauma is addressed, that there will be psychological, physical, and physiological responses that occur. These are typical stages of the healing process.
Emotional regulation is another vital tool to Confronting Past Trauma in Eating Disorder Recovery. Individuals who have this co-occurring issues often have difficulty with regulating anger, anxiety, sadness, and shame, particularly if the trauma occurred at a young age. Engaging in eating disorder behavior is a way to suppress the trauma and deny emotions.
Feeling comfortable with the treatment team is also key. Establishing a therapeutic relationship can help an individual learn how to confront trauma healthily while also addressing eating disorder symptoms.
Often a person will need a trauma and an eating disorder therapist to be able to address both concurrently.
Trauma in Eating Disorder Recovery and Working Together
Individuals with eating disorders typically have a higher predisposition to stress due to the constant negative thoughts and emotions around poor body-image and self-worth.
Individuals may use eating disorder behaviors to cope with trauma, which can be impulsive and increase the rate of co-occurring disorders such as anxiety and depression .
Treatment plans are individually focused and work on reducing stress and anxiety around the trauma and triggers. It is working on taking care of a person as a whole and learning self-soothing strategies in recovery and support systems.
Using therapies such as Dialectical Behavioral Therapy (DBT), Cognitive Behavioral Therapy (CBT) and desensitization therapies can assist a person in being able to recover from both disorders.
Trauma and eating disorder work includes individual and group therapy, nutritional support, psychiatric appointments, and peer support networks to help a person recover.
There are some significant elements to assisting a person with an eating disorder and trauma recovery . Being able to establish a safe environment is essential. This includes both physical and emotional safety.
Building up healthy coping tools with your client is also important. Being able to offer skills and tools at each session can help a person not feel like they are losing control, which can trigger unhealthy coping mechanisms.
Support healthy relationships with your client. Educating the person on what healthy relationships look like, building a sense of trust and safety through trauma-informed care, empowering the clients to be able to take back their personal power.
Treatment focuses needs to be on the person’s strengths and that they are a part of the team and recovery. Listening to your client on their treatment goals, and knowing that their decisions and opinions are heard too and worked into the treatment plan is imperative.
About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.
Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.
References: N. (2012). Trauma and Eating Disorders. Retrieved September 26, 2017, from https://www.nationaleatingdisorders.org/
 What to Expect From Trauma Therapy During Treatment. (2017, July 11). Retrieved September 26, 2017, from https://willowplaceforwomen.com/expect-trauma-therapy/
 Center for Substance Abuse Treatment (US). (1970, January 01). Understanding the Impact of Trauma. Retrieved September 26, 2017, from https://www.ncbi.nlm.nih.gov/books/NBK207191/
 Gleissner, G. (2017, April 28). Trauma and PTSD: Linkage to Eating Disorders. Retrieved September 29, 2017, from http://eatingdisorderspecialists.com/trauma-ptsd-linkage-eating-disorders/
 Trauma & Eating Disorders – The Unique Role of Residential Treatment Settings. (n.d.). Retrieved September 29, 2017, from https://www.waldeneatingdisorders.com/trauma-eating-disorders-the-unique-role-of-residential-treatment-settings/
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published on October 11, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on October 11, 2017.
Published on EatingDisorderHope.comConfronting Your Trauma in Eating Disorder Recovery