Eating Disorders And Trauma: How Adverse Experiences Can Affect Eating Behavior

Medically reviewed by Corey Pitts, MA, LCMHC, LCAS, CCS
Updated November 5, 2024by BetterHelp Editorial Team
Please be advised, the below article might mention trauma-related topics that include suicide, substance use, or abuse which could be triggering to the reader.
Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

Eating disorders are mental health conditions that appear to result from a complex mix of overlapping factors, so there is no one way to know if someone may develop symptoms. However, undergoing a traumatic experience may leave some people at a higher risk. Strongly adverse events can incite eating disorder behaviors, and the specific forms of trauma involved may influence the resulting pathology. 

Reports of childhood trauma are common in people with eating disorders, and many people with these conditions also experience symptoms of post-traumatic stress disorder (PTSD). The exact relationship between these conditions is not fully understood, but some studies suggest that traumatic experiences early in life may be linked with a younger onset of eating disorder symptoms and greater challenges in recovery. Specialized care approaches may be helpful for people affected by both eating disorders and trauma. 

A woman ists hunched over on a couch while sitting next to her female therapist who is writting on a clipboard.
Getty
Address trauma and disordered eating with evidence-based therapy

How common is trauma in people with eating disorders?

Traumatic events are extremely frightening, shocking, life-threatening, dangerous, or damaging experiences that lead to severe negative emotions and can be a risk factor for a wide variety of mental illnesses. While experiencing trauma often leads to post-traumatic stress disorder (PTSD), traumatic events have also been found to increase the risk of a wide variety of other psychological disorders, including eating disorders, conditions involving unhealthy attitudes and behavior related to food consumption and body weight.

A study from 2021 found that about 67% of participants with an eating disorder reported experiencing at least one traumatic incident in their lifetimes. Research strongly suggests that childhood trauma is a significant risk factor for eating disorders in adolescence. Although not everyone who undergoes trauma develops PTSD, the higher prevalence of trauma exposure among people with eating disorders means they’re at greater risk of PTSD, too. Some estimates suggest that approximately 27% of this population meets the criteria for PTSD. 

Effects of trauma on eating disorder symptoms

Not everyone with eating disorders can trace their symptoms back to a traumatic experience, but evidence indicates that cases involving trauma may be more severe than others. Researchers have found that people with eating disorders and a history of trauma report more challenging pathologies, including:

  • More severe eating disorder symptoms
  • Higher levels of anxiety and depression
  • Lower mindfulness
  • A greater tendency to avoid new and challenging experiences

A 2017 meta-analysis of multiple studies also found evidence that people who experienced childhood maltreatment developed eating disorders at an earlier age than average. These individuals were also more likely to have multiple co-occurring mental illnesses and suicidal ideation. 

Can trauma affect eating disorder treatment outcomes?

People with co-occurring symptoms of trauma may experience more difficulty in eating disorder recovery. A 2024 paper analyzing 16 past studies reported that those impacted by PTSD had less success in treatment and a more significant occurrence of lingering symptoms afterward. 

Other findings suggest that people with PTSD symptoms may be more prone to dropping out of eating disorder treatment programs early. This finding may be related to difficulties with trust resulting from adverse experiences with past caregivers or authority figures. For example, clients who struggle to perceive themselves as secure with their doctors or therapists could be more likely to exit treatment.

How different types of trauma can affect eating disorder risk

The term “trauma” can refer to a wide range of threatening or harmful experiences, from experiencing violent combat to being neglected by caregivers as a child, among others. Some evidence suggests that these differing forms may have distinct effects on eating disorder symptoms. For example, anorexia might be more frequently linked to sexual trauma. 

Sexual trauma may be uniquely linked to anorexia

Experiencing sexual abuse or violence may have impacts on psychological health that aren’t shared with other forms of trauma. For example, studies suggest that sexual trauma may be disproportionately likely to produce feelings of shame. This result could partly explain why a 2022 study found that sexual forms of trauma — such as rape, sexual assault, and childhood sexual abuse — were linked with a higher risk of anorexia nervosa, while other trauma types were not. 

Anorexia involves severe restrictions on food intake, usually related to strong body dissatisfaction and a preoccupation with thinness and weight. Survivors of sexual abuse may be more prone to negative feelings about their bodies due to internalized feelings of shame. 

A woman in a green shirt lays on a therapist couch while talking to her male therapist.
Getty/fotomaniya

Multiple forms of trauma may lead to binge eating disorder

The study referenced above also found that while sexual trauma was specifically linked to anorexia, all forms of trauma were associated with a higher risk of binge eating disorder. Binge eating refers to episodes of compulsive overeating, often emphasizing unhealthy but flavorful foods. This behavior might emerge as an attempt to cope with the negative emotions resulting from trauma.

Violent trauma events may increase the risk of bulimia and purging disorder

Bulimia nervosa is an eating disorder marked by a pattern of binge eating followed by purging, which involves deliberately expelling food through methods like induced vomiting or laxative misuse. A 2019 review reported that children exposed to violence in childhood were more likely to develop bulimia in adolescence. Other studies have found links between trauma exposure at any age and higher incidences of purging behavior

What is the connection between trauma and eating disorders?

The exact way that traumatic experiences lead to eating disorder behaviors may not be the same for every individual, and researchers are continuing to investigate the possible links. However, the existing research on these illnesses has identified a variety of potential mechanisms by which trauma might increase the risk of disordered eating. For example, negative self-image, emotional regulation challenges, and impaired interpersonal functioning may play a role. 

Trauma and negative self-image

Evidence suggests that traumatic experiences can lead to a distorted self-identity, often involving intense self-criticism or self-blame. Low self-esteem is also a known risk factor for eating disorders. Individuals who experienced trauma might be more likely to adopt harmful beliefs about their own body weight, appearance, and personal worth due to their adverse childhood experiences. 

Lack of emotional regulation

Another possible connection between trauma and eating disorders, identified by a 2017 study, is difficulty with self-regulation of emotions. Survivors of trauma often experience heightened negative emotions that are difficult to control or mitigate. Some may turn to disordered eating behaviors as an attempt to soothe these feelings or regain a sense of control over their lives and bodies.

Stress-related neurological damage

Experiences of severe stress, including those that relate to psychological trauma, can cause overactivation of certain brain systems, which may cause neurological damage. Researchers have found evidence that the regions impacted by this neurotoxic effect include those involved in regulating stress and eating behavior, among other functions. This finding suggests that people who experience severe trauma may be more susceptible to compulsive food-related behaviors. The effect could be more pronounced for people whose trauma occurs in childhood when brain development is at an earlier and more vulnerable stage. 

Impaired interpersonal functioning

Some forms of trauma, such as mistreatment from parents or other caregivers, can disrupt a person’s ability to trust others or be secure in their interpersonal relationships. This impact could be an additional pathway linking childhood trauma to eating disorders, which often involve a higher-than-normal tendency to believe one is judged, rejected, or isolated. Affected individuals may turn to disordered eating behaviors in part because they’re afraid they’ll be unloved or abandoned if they gain weight.

Addressing trauma in mental health care for eating disorders

As evidence suggests trauma may influence eating disorder onset and recovery, many mental health professionals are incorporating trauma-informed care techniques into their treatments for these illnesses. Research is still early, but results suggest this approach may improve outcomes. Below are a few examples of treatment styles that could benefit people with trauma-related eating disorder symptoms. 

Integrated eating disorder treatment based on cognitive processing therapy for mental health 

Cognitive processing therapy (CPT) is a type of psychotherapy intended to help clients recognize and re-evaluate negative beliefs that they’ve developed as a result of their traumatic experiences. This form of therapy is strongly recommended for PTSD treatment by the American Psychological Association (APA). A 2022 study found that integrating CPT with other standard approaches, such as cognitive-behavioral therapy, was an effective way to treat eating disorders with comorbid PTSD. 

Dialectical behavior therapy for eating disorders

First developed for use in patients with personality disorders and suicidal behavior, dialectical behavior therapy (DBT) is a multi-stage process in which clients practice:

  • Self-acceptance and mindfulness 
  • Emotion regulation strategies
  • Interpersonal skills
  • Tolerating distress

This approach has been found helpful in PTSD, and emerging research indicates DBT may also work well for eating disorders. There’s no clear evidence that this intervention works better than other first-line treatments, but DBT may be effective for clients with trauma-related difficulties in managing emotional distress. 

A woman in a doctors coat sits at a wooden table and talk to her laptop screen with a smile during a telehealth call.
Getty/RealPeopleGroup
Address trauma and disordered eating with evidence-based therapy

Alternative mental health treatment options for eating disorders 

Some with eating disorders may benefit from receiving mental health care over the internet rather than in person. Online therapy through a platform like BetterHelp can offer a sense of distance and control that may ease trauma-related discomfort with authority figures. This distance could help clients experience a stronger connection with their therapists, improving treatment outcomes. In addition, clients can have more control over how they receive support, being able to choose between phone, video, or live chat sessions. 

Multiple recent studies have reported evidence that Internet-based treatment can work well for eating disorder recovery. A 2023 review of controlled trials found that the existing research supports the effectiveness of online care, though more studies may be needed to draw definitive conclusions. Online therapy has also been cited as increasingly more cost-effective than other options. 

Takeaway

Traumatic experiences can increase the risk of developing eating disorders and worsen symptoms. Decreased self-esteem, impaired emotional regulation, and neurological damage from traumatic stress may influence this connection. Including trauma-informed therapies in eating disorder treatment may improve its effectiveness for many patients. Consider contacting a trauma-informed therapist online or in your area for tailored support.
Healing from eating disorders is possible
The information on this page is not intended to be a substitution for diagnosis, treatment, or informed professional advice. You should not take any action or avoid taking any action without consulting with a qualified mental health professional. For more information, please read our terms of use.
Get the support you need from one of our therapistsGet started