Trauma and Depression: What is the Connection with Eating Disorders?

Contributor: Rachel Collins, LPC, guest contributor for Eating Disorder Hope

Childhood trauma is commonly associated with the development of depression and the severity of the symptoms of the depression once developed (Huh, Kim, Yu, & Chae, 2014). Depression is a common symptom in response to trauma. Post-traumatic stress disorder (PTSD) and depression is a common dual diagnosis.

It has been found that depression in those also diagnosed with PTSD is three to five times more likely than in those not diagnosed with PTSD (National Center for PTSD, 2014). Repeated exposure to trauma is associated with greater level of psychopathlogy including anxiety, depression, and substance abuse.

Cognitive and experiential avoidance of dealing with the traumatic event can be seen as a focus on the repetitive focus on the past which can contribute to and maintain symptoms of depression (Woo & Brown, 2013).

Traumas Associated with Eating Disorders

Traumas commonly associated with eating disorders include:

Sexual assault

Harassment

Physical abuse and assault

Emotional abuse

Neglect

Teasing and bullying (Brewerton, 2007)

Eating disorders, trauma and depression are terms that are often synonymous with each other. Significant amounts of those presenting with an eating disturbance have a history of trauma exposure (Briere & Scott, 2007). A risk factor for the development of an eating disorders is a history of childhood sexual abuse.

The Connection Between Trauma and Bulimia

Trauma is noted to be a more common occurrence in those that have been diagnosed with bulimia. The trauma itself not only lends to the development of eating disorders but also other co-morbid conditions such as anxiety and depression (Brewerton, 2007).

Trauma appears to be more common in those with binge/purge types of eating disorders rather than restricting types. Food becomes a method of coping and creates more positive feelings that allows the individual to avoid negative thoughts associated possibly with traumatic events (Backholm, Isomaa & Birgegard, 2013).

Trauma-Focused Cognitive Behavioral Therapy

Cognitive behavioral therapy is the most common form of therapy for many mental health conditions, including eating disorders, depression and trauma. Individuals who have experienced trauma and present with symptoms related to trauma, such as symptoms of PTSD can be treated using the Trauma Focused Cognitive Behavioral Therapy (TF-CBT) which also addresses depression associated with trauma (Cohen & Mannarino, 2008).

The model consists of eight components including:

• Psychoeducation
• Relaxation
• Affect modulation
• Cognitive coping
• Trauma narrative
• In vivo exposure
• Conjoint sessions
• Enhancing safety

TF-CBT for children and adolescents with symptoms of PTSD has research support for its effectiveness (Smith, Yule, Perrin, Tranah, Dalgleish, & Clark, 2007). This model was developed focuses like behavioral therapy on relaxation and exposure to fears (Sharf, 2008).

The Benefits of TF-CBT

The cognitive component of TF-CBT is an off shoot of the cognitive theoretical orientation that looks at dysfunctional thought patterns and how those in turn affects an individual’s feelings and actions (Sharf, 2008).

Feather and Ronan (2009) found that TF-CBT had clinically beneficial effects and positive outcomes for their research participants which can have a positive effect on the reduction of depressive symptoms. Strengths and limitations of any theoretical approach have to be considered. David-Ferdon and Kaslow (2008) conducted a meta-analysis of the research available on the use of cognitive behavioral therapy with depressed children and adolescents.

Through the analysis it was found that groups for children with a parent component to the group improved treatment outcomes when based in a cognitive behavioral theoretical orientation. It was also noted that for adolescents that group and individual therapy with a cognitive behavioral theoretical orientation was beneficial in improving presenting symptomalogy (David-Ferdon & Kaslow, 2008).

The Complex Process of Treating Trauma-Associated Eating Disorders

Treatment of eating disorders that are associated with trauma is a complex process. The trauma needs to be addressed to help lower other presenting symptoms such as depression. Dealing with trauma can help boost self-esteem and body image disturbances that are associated with the eating disorder.

One facet of the individual’s presenting symptoms cannot be dealt with without dealing with the others to help the individual have the best chance at successful recovery.

Community Discussion – Share your thoughts here!

What is your experience with successful treatment for trauma and eating disorders? What advice do you have to share?

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.

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References:

1. Backholm, K., Isomaa, R., & Birgegard, A. (2013). The prevalence and impact of trauma history in eating disorder patients. European Journal of Psychotraumatology, 4, 1-8.
2. Brewerton, T.D. (2007). Eating disorders, trauma and comorbidity: Focus on PTSD. Eating Disorders, 15, 285-304.
3. Cohen, J.A., & Mannarino, A.P. (2008). Trauma-focused cognitive behavioral therapy for
   children and parents. Child and Adolescent Mental Health, 13(4), 158-162.
4. David-Ferdon, C., & Kaslow, N.J. (2008). Evidence-based psychosocial treatments for child and
   adolescent depression. Journal of Clinical Child and Adolescent Psychology, 37(1), 62-104.
5. Huh, H., Kim, S.Y., Yu, J., & Chae, J.H. (2014). Childhood trauma and adult interpersonal relationship problems in patients with depression and anxiety disorders. Annuals of General Psychiatry, 13(26).
6. National Center for PTSD. (2014). Depression, trauma and PTSD. Retrieved on April 2, 2015 from http://www.ptsd.va.gov/public/problems/depression-and-trauma.asp
7. Sharf, R.S. (2012). Theories of psychotherapy and counseling: Concepts and cases (5th ed.). Belmont, CA: Brooks/Cole.
8. Smith, P., Yule, W., Perrin, S., Tranah, T., Dalgleish, T., & Clark, D.M. (2007). Cognitive- behavioral therapy for PTSD in children and adolescents: A preliminary randomized controlled trial. Journal of American Child and Adolescent Psychiatry, 46(8), 1051-1061.
9. Woo, C.R.., & Brown, E.J. (2013). Role of meaning in the prediction of depressive symptoms among trauma-exposed and nontrauma-exposed emerging adults. Journal of Clinical Psychology, 9(12), 1269-1283.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on April 18th, 2015
Published on EatingDisorderHope.com