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October 8, 2017

The Importance of Trauma-Informed Care for Eating Disorders

Woman struggling with trauma

Stress in our life can be overwhelming. It can be both positive and negative. Stress can influence the way we cope and manage everyday events, but for some stress can become overpowering and cause distress, disease, and dysfunction [1].

When stress becomes so high that it ends in emotional and/or physical issues, it can turn into traumatic stress. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), traumatic is described as any person who experiences the ‘three Es” of Event, Experiences, and Effects [1].

How we perceive events or experiences and cope with the effects that stress has on us plays a role in whether the stressful situations become traumatic.

Those with eating disorders can be prone to what coping strategies are used, or unhealthy coping mechanisms are engaged.

How We Cope With Stress and Trauma

Avoidant coping skills are typically those that are self-punishing thoughts and beliefs which can be self-defeating, lowering self-esteem, and can result in decreased physical functioning, and diminished emotional health.

Active coping is typically described as active problem-solving and healthy coping tools which lead to a healthy mind and body.

According to a study of eating disorder patients in treatment in 2015 suggests that these individuals may be more sensitive or vulnerable to stress and its negative consequences.

In this studies those with anorexia nervosa, and bulimia nervosa were more often than not to have a primary anxiety disorder prior to the eating disorder onset. Also, those with eating disorders are more likely to perceive the threat or hostile intent from others and high levels of anxiety and fear of loss of control [1].

Post-traumatic stress disorder (PTSD) develops when a person is exposed to one or more traumatic events. Most people associate PTSD with military members or veterans of war, but often those with childhood abuse or trauma can have PTSD.

Woman laying in grass thinking of treatment

According to the American Psychiatric Association (APA), PTSD includes symptoms of reexperiencing symptoms such as flashbacks, nightmares, or intrusive images; experience irritability or angry outbursts exaggerated startle responses; avoid situations that are related to the trauma and changes in mood and thoughts associated with the trauma [1].

Two studies, the National Women’s Study, and the National Comorbidity Survey Replication have shown that those individuals who have bulimia or binge eating show higher rates of PTSD than those without an eating disorder [1].

Breaking Down Trauma-Informed Care

Trauma-Informed Care is when a treatment program’s treatment team and clinical staff are aware that a person has a history of childhood trauma which is often associated with multiple underlying issues with the eating disorder.

Many programs, like Sierra Tuscon, provide Trauma-Informed Care for their clients and staff which allows the program to recognize that childhood trauma affects how individuals experience their treatment [2].

This approach works to realize the impact of trauma on a person, recognizes the signs and symptoms of trauma, responds to the trauma with compassion and shame reduction, and seeks to resist re-traumatization [2].

This approach is implemented through securing the safety of the client, establishing trust within the clinical relationship, engage the individual in peer support, work with the person on recovery and treatment plan in a collaborative way.

The treatment team, when using this approach, will seek to empower each person, give them a voice and choice in treatment. This method also takes into consideration a person’s cultural, historical, and gender preferences.

Trauma-Informed Care is about reducing the shame that individuals feel with their past trauma experiences. This type of care is about being able to gear treatment interventions toward reducing shame while working toward recovery.

Many treatment programs which engage Trauma-Informed Care look at PTSD as a standard response to protect the mind and body from a traumatic situation.

It is being able to stay to a person in treatment that there is nothing wrong with them, and PTSD is not a disease, but a body response. Trauma-Informed Care is treating each person with dignity and respect as a person, focusing on strengths and resources.

Typically trauma-specific interventions programs will recognize the person’s need to be respected, informed, and connected to their recovery.

The clinical team will work to connect links between the trauma and eating disorder and other comorbid issues and work collaboratively with the person and support team to empower each person [3].

Remembering Some Important Points

Woman struggling with traumaWhen working with eating disorder clients and using Trauma-Informed Care is it important to be respectful and compassionate about the person’s history and perception of the events. Often when clients are struggling with trauma, it can be difficult to recall events or parts of the trauma, which is normal.

Helping them to recognize that the trauma and PTSD response is a standard response, can help the person to know that they are not ‘crazy’ or ‘out of their mind.’

Often family members or friends may not understand what is happening, and having someone who provides support, non-judgment, dignity, and respect is an essential part of the recovery journey.


Image of Libby Lyons and familyAbout 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:

[1] Trauma, Posttraumatic Stress Disorder and Eating Disorders. (n.d.). Retrieved July 31, 2017, from https://www.nationaleatingdisorders.org/trauma-posttraumatic-stress-disorder-and-eating-disorders
[2] Seymoure, J. (2016, July 15). Reducing one’s shame by using a non-pathologizing approach . Retrieved July 31, 2017, from http://www.sierratucson.com/about/blog/articles/trauma-informed-care
[3] C. (2015, August 14). Trauma-Informed Approach and Trauma-Specific Interventions. Retrieved July 31, 2017, from https://www.samhsa.gov/nctic/trauma-interventions


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 8, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on October 8, 2017.
Published on EatingDisorderHope.com

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