PTSD as a Co-Occurring Issue with Eating Disorders

Woman on beach The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders used by mental health professionals. The diagnostic criteria for PTSD is the result of one or more of the following scenarios:

  • A traumatic event
  • Witness of a traumatic event
  • The traumatic event occurred to a relative or friend (the event being violent or accidental)
  • Repeated exposure to the details of a traumatic event.

PTSD will affect 25% of individuals who experience trauma. The trauma can occur to someone who has been harmed, threatened, seeing a loved one or another person being harmed or witnessing a disturbing event. People with PTSD feel stressed or afraid even when that danger is not present.

The Effects of PTSD on an Individual’s Life

The effects of PTSD cause distress in the individual’s life, concentration and capacity to interact. The individual will experience recurrent dreams of the traumatic event, spontaneous memories that will affect his life or even the inability to remember what happened exactly during the event.

In the same time, he might experience diminished interests in activities, estrangement from others, self destructive behavior, sleep disturbances or related issues.

The Origins and Symptoms of PTSD

PTSD was first brought to national attention in relation to war veterans. It can also occur from many types of abuse, accidents and natural disasters. The patient with PTSD may have:

  • Flashbacks of reliving the trauma
  • Bad dreams
  • Difficulty sleeping
  • Angry outbursts


The person may experience dissociation, isolation from oneself and feeling that they are unworthy, unlovable and different from other people. They may feel emotionally numb, guilty, worried, depressed, and “on edge”. They are on high arousal and may easily be startled.

Many patients experience shame and guilt. They may see themselves as a victim today controlled by the flashbacks, compensatory behaviors including the eating disorder, substance abuse, engaging in high risk-taking behaviors, and by social withdrawal. They hold the belief that the world is unsafe, unpredictable and that people are untrustworthy.

The Co-Occurrence with Eating Disorders

Posttraumatic Stress Disorder (PTSD) often co-occurs with eating disorders. New data confirm the link between PTSD symptoms and eating disordered behaviors. According to Brewerton, PTSD is associated with higher rates of substance use disorders, other comorbid psychiatric disorders and a variety of destructive and impulsive behaviors, including suicide.

One of the primary purposes of the eating disorder behavior and thoughts are to cope with uncomfortable feelings or painful past thoughts about traumas (flashbacks). Patients with bulimia nervosa or binge eating disorder are more commonly associated with past trauma and PTSD.

How to Deal with the Effects of Trauma

It is important to know the appropriate time to deal with trauma. Treatment cannot be as effective with the obstacles of the constant battle of suppressing the trauma that may have preceded the eating disorder or substance abuse.

Treatment of the trauma allows the patient to quit the struggle and focus on the eating disorder recovery.

The Role of CBT and EMDR

Two of the most important interventions in treating a patient with eating disorders and PTSD are Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR).

Cognitive Behavioral Therapy

CBT is the treatment of choice for eating disorders and is usually started early in treatment. Spiritual interventions have been effectively incorporated into a variety of evidence-based cognitive-behavioral treatment (CBT). Spangler (2010) blended spirituality and CBT for patients with eating disorders.


He supplemented Fairburn’s (2008) cognitive behavioral treatment of eating disorders with spiritually-based interventions such as mindful eating, meditation, mindfulness, and forgiveness activities. He found using these techniques in addition to challenging clients’ thoughts and beliefs had better results than cognitive behavioral techniques alone.

Eye Movement Desensitization and Reprocessing

There are procedures to assess if a patient is ready to proceed with EMDR. The primary therapists need to determine when it is appropriate to deal with past traumas.

It can be helpful to have an EMDR therapist consulting with the primary therapist and the patient to create a treatment plan to include various modalities of trauma resolution. This consultation will empower the patient to proceed at his or her own pace.

Contributed By:  Rebecca Cooper, LMFT, LPCC, CEDS, Founder, Rebecca’s House Eating Disorder Treatment Programs, Author, Diets Don’t Work®

Rebecca Cooper, Professional Educator & Founder, is the gifted author of the Diets Don’t Work® structured program. Her creative, unique, and intuitive approach to the life threatening problem of disordered eating has profoundly changed the way this devastating illness is treated. Her extensive experience has enabled her to develop this highly successful program which internalizes new eating behaviors. It is being used by several recovery homes, therapists, eating disorder treatment programs and their clients and is 12-Step compatible. Rebecca was also the first IAEDP Chair President – Orange County and is currently an IAEDP approved Certified Eating Disorder Specialist supervisor (CEDS-S) and international speaker.


  1. Spangler, D.L. (2010). Heavenly bodies: Religious issues in cognitive behavioral treatment of eating disorders. Cognitive and Behavioral Practice, 17, 358-370.
  2. Fairburn, C.G. (2008). Cognitive behavior therapy and eating disorders. New York: Guilford Press.
  3. Brewerton TD. (2007) Eating disorders, trauma and comorbidity: Focus on PTSD. Eating Disorders, 15,285–304.

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.

Reviewed By: Jacquelyn Ekern, MS, LPC on March 13th, 2015
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