Trauma-Focused CBT in Eating Disorder Treatment

College Student Suffering From Trauma

What is the Connection?

There are many ways in which trauma can interact with eating disorder symptoms. Trauma-Focused CBT treatments are able to help treat both the trauma and the eating disorder.

As with many issues in mental health and eating disorders, there is a constant “chicken-or-the-egg” debate on which causes which.

And, as these debates often find, the ultimate understanding is that both interact to cause, continue, and possibly worsen the other.

For example, it is not uncommon for individuals that have disordered eating behaviors also to have experienced trauma. In fact, the vulnerability experienced by individuals with anorexia, bulimia or binge eating disorder may increase their risk of trauma.

Woman Struggling with eating disorder and trauma using Trauma-Focused CBT

However, as stated above, this interaction goes both ways. Individuals often engage in disordered eating behaviors as a way to cope with their past experiences of trauma.

The psychology behind this can range from neurobiological responses related to the behaviors that provide a temporary sense of euphoria or relief to more psychological aspects of self-harm or an attempt to gain feelings of control.

One research study observed that, often, disordered eating “attenuate PTSD symptoms,” and, as such, provide negative reinforcement [1].

The study goes further to say, “Dietary restriction, binge eating, purging, and other compensatory behaviors are thought to facilitate avoidance of trauma-related memories and feelings, as well as decrease arousal [1].”

Treatment Barriers

The relationship between eating disorders and trauma can also make it difficult to treat both.

Individuals struggling with both diagnoses are found to have increased distress related to their trauma when they attempt to normalize their eating behaviors [1]. Essentially, the disordered eating works as harmful, but semi-functional, skill to numb the emotions related to trauma. Remove the disordered eating behaviors, and individuals do not have the skills to cope.

Trauma experience is also a “negative prognostic indicator of ED treatment retention and outcome [1].”

Trauma-Focused CBT

Trauma-Focused Cognitive Behavioral Therapy (CBT) is an evidence-based, short-term (8-25 sessions) treatment practice that predominantly helps children and adolescents to cope with experiences of trauma.

This treatment effectively addresses many other trauma impacts, including depression, anxiety,  cognitive and behavioral problems. Trauma-Focused Cognitive Behavior Therapy also leads to improvement in the participating parent’s or caregiver’s personal distress regarding the child’s traumatic experience.  Care givers often also improve in effective parenting skills and supportive interactions with the child [2].

CBT skills, whether trauma-focused or stand-alone, focus on helping individuals to identify the distorted or unhelpful thought processes that result in negative behaviors or harmful coping skills, such as eating disorders, and teaching individuals how to change these processes.

These are helpful in individuals focusing on the thought processes behind their disordered eating as well as their reactions to trauma, some of which may even overlap.

Man consideringeating disorder and addiction treatmentMost eating disorder treatment professionals agree that trauma and eating disorders should be treated concurrently.

In fact, research indicates that this leads to more successful treatment outcomes.

As such, using the tenets of both CBT/Trauma-Focused CBT to treat co-occurring PTSD and eating disorders can help pave the road to recovery and freedom from both disordered eating and symptoms of trauma.


[1] Trottier, K. (2017). Frontline clinicians’ perspectives on utilization of trauma-focused therapy with individuals with eating disorders. Eating Disorders, 25:1, 22-36.

[2] Unknown (2019). About trauma-focused cognitive behavioral therapy (TF-CBT). Retrieved from

Image of Margot Rittenhouse.About the Author: 

Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a 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 July 18, 2019, on
Reviewed & Approved on July 18, 2019, by Jacquelyn Ekern MS, LPC

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.