Trauma: How Does This Put an Individual at Risk for Co-occurring Disorders?

Contributor: Leigh Bell, BA, writer for Eating Disorder Hope

eye-278148_640Eating disorders are an effective, yet dangerous and frighteningly common, way to cope with the effects of trauma. This is especially true with bulimic disorders. The binge-purge process seems to numb and offset the wrenching, unsettling, and uncomfortable emotions a traumatic event may cause.

While not everyone with an eating disorder experiences trauma, those who do are at greater risk for post-traumatic stress disorder, substance abuse, alcoholism, anxiety, and depression. To understand why, we must realize how trauma affects someone.

The “Shattering of Innocence”

The fundamental psychological effect of trauma is a “shattering of innocence,” writes Lynn Margolies, a psychologist and former Harvard Medical School faculty and fellow.1 “Trauma creates a loss of faith that there is any safety, predictability, or meaning in the world, or any safe place in which to retreat. It involves utter disillusionment.

“Because traumatic events are often unable to be processed by the mind and body as other experiences are, due to their overwhelming and shocking nature, they are not integrated or digested. The trauma then takes on a life of its own and, through its continued effects, haunts the survivor and prevents normal life from continuing until the person gets help.”

Numbing the Trauma with an Eating Disorder

DeathtoStock_Wired9Until this help is sought, people crippled by trauma may numb emotions with an eating disorder, especially bingeing and purging. More than half (54%) of U.S. women with bulimia have been victims of a major crime, like rape, molestation, and/or aggravated assault.2 Almost 40% of women with bulimia have lifetime histories of PTSD.

In one report, 74 percent of 293 women in residential treatment for an eating disorder said they had experienced a significant trauma, and more than half reported symptoms consistent with a PTSD diagnosis.3 Meanwhile, rates of PTSD in anorexic women, who don’t binge-purge, are about the same as the general population, 10 percent.4

The Binge-Purge Cycle

The binge-purge cycle anesthetizes and/or suppress emotions rooted in traumatic experiences. Alcohol and drugs have a similar effect, so it’s not surprising people with bulimia also have a greater propensity for substance abuse.

A five-year study of 2,436 women in treatment for eating disorders shows 34 percent of those with bulimia also had a substance abuse problem, compared to only 5 percent of women with restrictive anorexia (Blinder, et. al.).

These Destructive Behaviors Keep Trauma “At Arm’s Length”

The binge-purge cycle, drugs, alcohol, and other destructive behaviors — what psychologists call “experiential avoidance behaviors” — temporarily keep at arm’s length emotions and memories related to traumatic experiences.

Yet, not everyone who has an eating disorder experiences trauma, and vice versa. Research, over the last decade, acknowledges a strong, yet not fully understood, genetic link to eating disorders, hinting that people are predisposed to develop an eating disorder. Whether one does or doesn’t is decided, in part, by environmental factors. A traumatic event can be one of these factors.

Additional Psychological Issues Are Common

Using laptopPast trauma, however, doesn’t determine the severity of an eating disorder, but again, someone with an eating disorder and a history of trauma is more likely to have other psychological issues, including and often mediated by PTSD.5 The trauma and its symptoms must be effectively addressed to achieve full recovery from an eating disorder and all associated co-occurring disorders.

This is challenging. An eating disorder can put someone into a “psychic coma,” where one’s mind is completely immersed in the coping behavior leaving little time to process feelings related to a traumatic event.6 The eating disorder is all-encompassing and effectively protects someone from dealing with truly difficult feelings. But these emotions should be tackled at some point.

Digesting the Memories and Feelings of PTSD

“Successful treatment of PTSD allows the traumatic feelings and memories to become conscious and integrated – or digested – so that the symptoms are no longer needed and eventually go away,” writes Margolies.

“This process of integration allows the trauma to become a part of normal memory rather than something to be perpetually feared and avoided, interfering with normal life, and frozen in time. Recovery involves feeling empowered, reestablishing a connection to oneself, feelings, and other people, and finding meaning in life again.”

Community Discussion – Share your thoughts here!

What tools in your eating disorder recovery have helped you overcome trauma?


  1. Margolies, L. (2010). Understanding the Effects of Trauma: Post-traumatic Stress Disorder (PTSD). Psych Central. Retrieved on March 10, 2015.
  2. Dansky B., Brewerton T., Kilpatrick D., O’Neil P, (1997) The national women’s study: Relationship of victimization and post-traumatic stress disorder to bulimia nervosa. International Journal of Eating Disorders. 21(3), 213-28
  3. Brewerton, T. (2008). The links between ptsd and eating disorders. Psychiatric Times.
  4. Blinder B.J., Cumella E.J., Sanathara V.A. (2006). Psychiatric comorbidities of female inpatients with eating disorders. Psychosomatic Medicine. 68, 454-462.
  5. Brewerton, T. (2007). Eating disorders, trauma, and comorbidity: Focus on PTSD. Eating Disorders, 15(44), 285-304.
  6. Scheel, J., (2013, March 6). PTSD and Eating Disorders: How symptomatology recreates the roles of abuser & abused. Retrieved March 17, 2015 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.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on April 10th, 2015
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