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Trauma and Eating Disorders

by Jenny Beck, LPCC-S, Director of Outpatient Services

What we know about the onset and development of eating disorders has taken several big steps forward in the last decade, thanks to advances in technology that have helped us see what is happening in the brain while an eating disorder is taking over someone’s life. With the knowledge that eating disorders are brain-based illnesses has come the introduction of new, effective treatments that can provide relief from these deadly diseases.

As with eating disorders, our understanding about the impact of trauma is growing, too. Trauma affects our brains in ways that make it extremely difficult to function as we otherwise might. Whether the trauma in question is a physical injury or attack, sexual assault, childhood abuse, surviving a natural disaster, or witnessing the death of someone else, traumatic events can turn a life upside down. Though not everyone who experiences a traumatic event will develop Post-Traumatic Stress Disorder (PTSD), we know that living through a trauma increases one’s risk for developing a host of psychiatric illnesses, including eating disorders.

While our society has come a long way from the time when silence and secrecy were the standard with both eating disorders and trauma, there is still more work to be done. Eating disorders and PTSD both involve using unhealthy methods to cope with emotional pain. For someone facing both, the result can feel overwhelming. And having one is often a barrier to full recovery from the other.

Take, for example, the findings of a large national study on people with eating disorders from 2012. Nearly every participant reported experiencing at least one significantly traumatic event (Mitchell et al.). Another study found that participants with eating disorders experienced an average of nearly four traumas during their lives (Tagay et al., 2015).

And consider that 25-40% of those with bulimia nervosa also meet full diagnostic criteria for PTSD (Mitchell et al., 2012; Tagay et al., 2015), as do 25% of those with binge eating disorder and 16-23% of those with anorexia nervosa (Mitchell et al., 2012; Tagay et al., 2015). For those whose mission it is to offer expert treatment for eating disorders, these numbers provide evidence of what we’ve heard in our offices for years. We have learned from the stories of our brave clients that their eating disorders are not the only war being waged inside them. While not surprising, these data demonstrate how vital it is to ensure people with eating disorders don’t have to choose between physical health through eating disorder recovery, and emotional health through recovery from past trauma. People who have both an eating disorder and trauma deserve to have expert care for both.

This is universally true, yet not all communities are met with the same level of support and awareness. In fact, some communities are especially vulnerable to the intersection of trauma and eating disorders; unsurprisingly, they are the ones that have been historically underserved and underrepresented in mental health treatment. For example, in the Mitchell et al. study from 2012, a staggering 99% of men who had an eating disorder had also experienced a traumatic life event. And as the result of a recent study of male veterans, we learned that non-combat related traumas experienced during military service nearly quadruple the risk of developing an eating disorder (Arditte-Hall, 2017). When looking specifically at the impact of sexual assault during military service, one study found that this type of trauma doubles the risk of developing an eating disorder, an effect twice as strong for male service members (Blais et al., 2016). And finally, we cannot overlook what is happening in communities of color, where there is an especially strong correlation between eating disorders and childhood trauma (Gentile et al., 2007).

With statistics like these, it is clear that those with eating disorders and a history of trauma face a doubly difficult journey in recovery. This is reinforced by many studies that demonstrate that experiencing multiple traumas and their associated psychological distress are linked with more severe and more acutely dangerous eating disorder symptoms (Arditte-Hall, 2017; Mitchell et al., 2012; and Isomaa et al., 2015). In other words, eating disorders pose a markedly greater risk to the lives of those who have experienced more than one trauma. Given that anorexia nervosa in particular has the highest risk of mortality among all psychiatric illnesses, what we should learn from this is that treating the trauma is critical if we want people with both eating disorders and PTSD to experience long-term recovery.

So what is the takeaway here? We believe it is time to extend evidence-based treatment and meaningful support into every corner of our culture, both for eating disorders and for trauma. And as much as we want to, we know we cannot do that overnight, nor can we reach everyone today.

We can, however, start with you.

If you are waging war with your eating disorder, we want to help you - no matter who you are, where you are, or from where you’ve come. We want to help you build a life of meaning and purpose.

And if you are one of the thousands of people with an eating disorder who has a past (or present) that includes something traumatic, we want to help you with that, too - no matter who you are, where you are, or from where you’ve come.

You don’t have to live in the shadow of your trauma. You don’t have to live in the darkness of your disorder.

We invite you, right where you are, to take a step toward acceptance and healing. Treatment is scary, and treatment works - and it can work even for you, no matter what you’ve been told or what you’ve believed.

Treatment works.

We can help.

Recovery is real.