Is Trauma Driving Some Eating Disorders?

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Eating disorders can be difficult to understand and a challenge to treat. As they are extremely dangerous to a person’s health, eating disorders are associated with high mortality rates. Among all eating disorders, anorexia nervosa has the highest rate of mortality.

It is well established that trauma and eating disorders are highly correlated. A national study with a sample of 3,006 women found that of people with bulimia nervosa:

  • 26.6% had experienced “forcible rape” in their lifetimes (forcible rape is often defined as rape involving physical coercion). This number was double the rate for the general female population.
  • 26.8% reported aggravated assault.
  • 36.9% had a history of posttraumatic stress (PTSD).

Research shows most people with anorexia nervosa, bulimia nervosa, and binge eating (BED) have a history of interpersonal (relationship) trauma. This pattern holds true for both men and women. Interpersonal trauma can happen in parent-child or intimate partner relationships. Domestic violence, emotional abuse, sexual abuse, and neglect often cause long-lasting effects.

Possible reasons for the link between trauma and eating disorders

The underlying link between PTSD and eating disorders may involve difficulty in regulating uncomfortable emotions. Binging and purging may function as a way to manage emotions and give the individual a sense of control. However, more research investigating potential causal mechanisms between trauma and eating disorders is needed.

What are the implications of treatment for eating disorders?

Clinicians and programs that treat eating disorders should be alert for signs of PTSD or complex posttraumatic stress (C-PTSD). Similarly, clinicians treating people with PTSD should be alert for potential comorbid eating issues. The effects of treatment can be bidirectional. Treatment for PTSD and C-PTSD may improve outcomes for eating disorders; treatment for eating disorders may have beneficial effects on PTSD symptoms.

Treatment for trauma and eating disorders

If you have an eating disorder, it is important to seek treatment immediately. Your condition can have a serious impact on your physical health and may put your life in danger. If you have a history of trauma or if you feel that you are having difficulty managing your emotions, you may consider finding a therapist who is experienced in treating trauma as well as eating disorders. Addressing the underlying trauma may be an important part of sustainable, long-term recovery.

When you are in therapy for PTSD or C-PTSD, if you have an eating disorder, make sure that your therapist is aware of the disordered eating. If you have experienced trauma and are receiving care for an eating disorder, your therapist should know about your history of trauma.

Simultaneous therapy for trauma and eating disorders

Simultaneous treatment for eating disorders and trauma will likely increase the effectiveness of therapy. If treatment is sought for only the eating disorder, the underlying trauma will not be addressed, and the healing will not be complete.

Studies have also shown individuals with eating disorders often have a susceptibility to stress. Those with anorexia nervosa and/or bulimia nervosa are likely to experience high levels of anxiety sensitivity. In other words, they have a fear of sensations and behaviors they associate with anxiety. For example, they may fear the sensation of losing control and exaggerate inhibitions. These fears can make it difficult for them to feel safe and relaxed.

The overlap between eating disorders and PTSD is significant. If you are experiencing trauma as well as an eating disorder, you will likely benefit from an informed, integrated approach. If you have an eating disorder, your best chance of recovery lies in addressing the underlying trauma simultaneously with the eating disorder.

References:

  1. Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Archives of General Psychiatry, 68(7), 724-731. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21727255
  2. Brewerton, T. D. (2008, May 2). The links between PTSD and eating disorders. Psychiatric Times, 25(6), 1-7. Retrieved from http://www.psychiatrictimes.com/comorbidity-psychiatry/links-between-ptsd-and-eating-disorders
  3. Dansky, B. S., Brewerton, T. D., Kilpatrick, D. G., & O’Neil, P. M. (1997). The National Women’s Study: Relationship of victimization and posttraumatic stress disorder to bulimia nervosa. International Journal of Eating Disorders, 21(3), 213-228. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1002/(SICI)1098-108X(199704)21:3%3C213::AID-EAT2%3E3.0.CO;2-N
  4. Hall, K. S., Hoerster, K. D., & Yancy Jr., W. S. (2015). Post-traumatic stress disorder, physical activity, and eating behaviors. Epidemiologic Reviews, 37(1), 103-115. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25595169
  5. Mason, S. M., Frazier, P. A., Austin, S. B., Harlow, B. L., Jackson, B., Raymond, N. C., & Rich-Edwards, J. W. (2017). Posttraumatic stress disorder symptoms and problematic overeating behaviors in young men and women. Annals of Behavioral Medicine, 51(6), 822-832. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28425019
  6. Mitchell, K. S., Mazzeo, S. E., Schlesinger, M. R., Brewerton, T. D., & Smith, B. N. (2012). Comorbidity of partial and subthreshold PTSD among men and women with eating disorders in the National Comorbidity Survey–Replication study. International Journal of Eating Disorders, 45(3), 307-315. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22009722

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