PTSD and Bulimia

Woman concerned about eating disorder Relapse Support

Bulimia and post-traumatic stress disorder (PTSD) have an undeniably close relationship in which the binge-purge cycle is the lesser of two evils and cloaks the emotional pain of traumatic memories. Shame. Powerlessness. Fear. Anxiety. Panic.

Bingeing and purging anesthetizes these feelings but the feelings return, so one binges and purges again, and the bulimic cycle begins. Rates of PTSD in women with restrictive anorexia (10%) are almost equal to the general population, but about 25% of women with binge-purge behaviors have PTSD1.

In a study of 293 women in residential treatment for eating disorders, 74% said they had experienced a significant trauma, and more than half reported symptoms consistent with PTSD2.

The Persistent Distress of Post-traumatic Stress Disorder

PTSD is a formal diagnosis in which one experiences persistent mental and emotional stress after a traumatic event where life was felt to be in danger. People with this disorder typically have recurring and graphic memories of the trauma, as well as trouble sleeping and dulled responses to people and his/her environment.

Women with bulimia have significantly higher rates of sexual and aggravated assault than women without the illness, and the victimization could very well cause or help maintain the bulimia3 A study of 3,006 women showed almost 26% of women with bulimia had experienced forcible rape compared to 13% of women without bulimia. Aggravated assault was also significantly more prevalent in women with bulimia (27%), as was post-traumatic stress disorder (37%).

Bulimia and PTSD Aren’t Always Paired

Depressed woman talking with her therapistIt’s important to remember PTSD and bulimia are not a package deal. Everyone with bulimia, thankfully, has not experienced a traumatic event; and not all with PTSD will develop bulimia. However, as experts further unravel the relationship between bulimia and PTSD, they’re finding the bond goes far beyond numbing pain.

“The nature of bulimia makes it a psychological and behavioral abusive fit” for PTSD, said Cathy Reto4. Bulimia, in a sense, assumes symptoms similar to, but not as terrifying, PTSD.

How Bulimia Replaces the Intrusive Thoughts of PTSD

Bulimia replaces intrusive thoughts and memories with feelings and obsessions about food, weight, bingeing, and purging with the same quality and intensity as PTSD, Reto said. Bulimia narrows one’s world to these food-related feelings and obsessions, which are far more controllable and understandable than those surrounding the past trauma.

The binge-purge cycle also allows someone with a traumatic past to re-experience the unpredictability and confusion tied to the trauma but do so in a controlled environment, Reto said.

Bulimia protects, albeit harmfully, people with PTSD, and seeing the eating disorder in this light could help better treat those struggling with this co-morbid condition.

Leigh BellAbout the Author: Leigh Bell holds a Bachelor of Arts in English with minors in Creative Writing and French from Loyola Marymount University in Los Angeles. She is a published author, journalist with 15 years of experience, and a recipient of the Rosalynn Carter Fellowship for Mental Health Journalism.

Leigh is recovered from a near-fatal, decade-long battle with anorexia and the mother of three young, rambunctious children.


  • Blinder B.J., Cumella E.J., Sanathara V.A. (2006). Psychiatric comorbidities of female inpatients with eating disorders. Psychosomatic Medicine. 68, 454-462.
  • Brewerton, T. (2008). The links between ptsd and eating disorders. Psychiatric Times. Accessed May 1, 2015.
  • Dansky, B National Women’s Study: Relationship of victimization and post-traumatic stress disorder to bulimia nervosa.
  • Reto, C. The Relationship between Eating Disorders and Trauma: A reconceptualization of PTSD. [PowerPoint slides]. Retrieved from

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 May 15, 2015.
Reviewed By: Jacquelyn Ekern, MS, LPC on May 15, 2015.
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About Baxter Ekern

Baxter is the Vice President of Ekern Enterprises, Inc. He is responsible for the operations of Eating Disorder Hope and ensuring that the website is functioning smoothly.