The interaction and treatment of Eating Disorders and Trauma

Until very recently, most people associated the term “trauma” with war, personal violence or natural disasters.  Post-traumatic Stress Disorder (or PTSD), is a mental health condition resulting from experiencing a distressing or terrifying event that overwhelms the individual’s ability to process or cope with what is happening in the moment. 

Trauma is very subjective, as two people can experience the same event and only one may experience it as trauma. Children are particularly vulnerable, as they have fewer coping strategies and are often powerless to help themselves during a stressful event. Consistent exposure to traumatic situations for an extended period of a child’s development can result in Complex PTSD or C-PTSD.  

Symptoms Associated with Trauma

Many of the symptoms associated with PTSD are painful and pervasive.  Emotional, physical and behavioral symptoms can result from trauma. Emotions may become dysregulated, where someone with trauma could vacillate, often quickly, between fear, anger, sadness, helplessness to feeling detached, numb, or dissociated. Relationships with loved ones are taxed by symptoms of trauma, sometimes to the point of breaking. 

Physically, trauma may manifest as headaches, profuse sweating, gastrointestinal issues, insomnia, and elevated heart rate.  Long-term untreated trauma has been associated with chronic diseases, inflammation and premature death. Behaviorally, trauma may show up as irritability or aggression, an overly sensitive startle response, self-destructive behaviors, or highly impulsive behaviors. These behaviors are an unconscious attempt to regulate the emotional turmoil individuals with trauma are experiencing internally.

Behavioral Issues Associated with Trauma

One of the behavioral issues closely associated with trauma is eating disorders.  Research has shown that 75% of women that enter a residential eating disorder treatment program experienced a traumatic event, and up to 50% can be diagnosed with PTSD or C-PTSD.  Behaviors associated with eating disorders (restriction, binge eating, purging, overexercising) help to numb or dissociate from painful symptoms.  Individuals will often become avoidant of people, places and things that remind them of their trauma.  

As eating disorders are all-consuming, the individual’s focus turns inward, fixating on weight loss, calorie counting and exercise while tuning out the external world and its inhabitants.  For others, eating out of control to the point of pain helps to distract and numb from the emotional pain within.  Similar to those who suffer from substance abuse issues, the eating disorder becomes a maladaptive means of coping with intensely painful emotions.

Recovery from both trauma and eating disorders requires a treatment plan to address both disorders simultaneously. The reason for this is that treating only one disorder at a time results in a vicious cycle, where neither problem ever really improves.  

For example, if the focus is mainly on the trauma, as painful memories and experiences emerge during treatment, the eating disorder symptoms may grow more severe to help the individual cope with the memories.  However, if the focus is mainly on the eating disorder, as eating disorder symptoms are extinguished, the coping skills the eating disorder provided are lost, and trauma symptoms of flashbacks, panic or dissociation may grow worse. Therefore, recovery is a delicate dance between treating both disorders. Understanding the symbiotic relationship between the dueling disorders is the key to helping individuals with long-term recovery.

Recovering from Trauma with Professional Help

At The Smith Counseling Group, we are experts in the fields of eating disorder treatment and trauma-focused therapies. For the treatment of eating disorders, we typically utilize a combination of cognitive behavioral therapy for eating disorders (CBT-E), Family Based Treatment (if the individual is young or living with family), Dialectical Behavioral Therapy (DBT) and nutrition management. If the individual with an eating disorder also has PTSD or C-PTSD, their treatment needs to include therapies that are also focused on healing trauma. 

Trauma therapies we practice at The Smith Counseling Group include aspects and techniques from mindfulness-based therapies, somatic therapies, Trauma-focused Cognitive Behavioral Therapy, hypnosis, and Internal Family Systems (IFS). 

Other trauma treatment modalities we do not practice, but are available to those who have experienced trauma include Eye Movement Desensatization and Reprocessing (EMDR), brain spotting, and Cognitive Processing Therapy (CPT). As trauma is subjective to the individual, treatment for the trauma needs to be equally individualized.  

Eating disorder treatment and the treatment of trauma are both highly specialized fields that require a great deal of training and experience.  If you, or someone you love is suffering from both, it is important to find a professional who is well-trained in both specialities.  

Conclusion

Healing from both trauma and eating disorders requires a nuanced and comprehensive approach. Attempting to heal only one of the disorders at a time can often lead to an increase in symptoms from the other disorder that is being neglected in treatment.  Integrating these different treatment methods promotes a balanced approach, allowing the clinician to address both the eating disorder and trauma symptoms. 

If you or someone you know is struggling with an eating disorder and has a history of trauma, consider the benefits of a combined therapeutic approach. At The Smith Counseling Group, we specialize in evidence-based treatments designed to support you on your journey to recovery. Contact us today to learn how we can help you integrate both eating disorder and trauma recovery.