Eating Disorders And Trauma: How Adverse Experiences Can Affect Eating Behavior
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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.
How common is trauma in people with eating disorders?
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.
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.
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
Can eating disorders be caused by trauma?
Yes, eating disorders (EDs) can result from underlying trauma, especially those involving a loss of control or body-related experience. Trauma, especially childhood trauma or abuse, such as physical and emotional abuse, can significantly increase the risk of developing an eating disorder. This might be due to several factors:
- Eating disorders might serve as a defense mechanism for people who have experienced severe adverse experiences (SAD) and trauma. For some, bingeing, purging, or restrictive eating patterns might provide a temporary sense of control or relief from emotional overwhelm.
- Traumatic events, especially those involving bullying, abuse, or neglect, can lead to trauma related symptoms like low self-esteem, self-criticism, and shame, which are common underlying factors in eating disorders. Disordered eating may then become a way to deal with these negative feelings.
- Trauma, especially if it involves emotional abuse, body shaming, or bullying, can also lead to distorted body image and the desire to change to accommodate certain physical standards. This can increase the risk of an eating disorder as a person strives to reach an unrealistic body ideal.
- Posttraumatic stress disorder (PTSD) is common in the aftermath of a trauma event, such as a natural disaster, violence, or physical or sexual abuse. It is associated with several mental disorders, including eating disorders. People with PTSD might use eating disorders to “numb” their emotions and cope with painful memories.
- Trauma can alter brain function and neurochemistry, impacting areas that regulate stress, self-control, and emotional responses. Such changes might make a person more vulnerable to compulsive behaviors, including those found in eating disorders.
What is the connection between trauma and food?
Trauma can disrupt a person’s relationship with food in ways that range from disordered eating behaviors to complex emotional relationships with eating. Experts have uncovered several connections between trauma and food, most typically rooted in how food can be used to express, manage, or cope with the psychological effects of trauma.
Disordered eating can result from an attempt to use food as a coping mechanism or as an escape from psychological distress. It can result from the desire to control certain areas of one’s life. In some cases, disordered eating to gain or lose weight might act as a mechanism to avoid unwanted attention from potential perpetrators of trauma. For example, one might overeat to gain weight and feel less physically vulnerable, while others may restrict their intake to appear smaller or “disappear.”
Some trauma survivors struggle with feelings of guilt, shame, and low self-worth. Food restriction or purging behaviors may be used as a form of self-punishment. Survivors might turn to disordered eating in an attempt to reshape their bodies or meet perceived ideals if they’ve been emotionally abused, bullied, or criticized about their bodies.
The biological mechanisms behind trauma and chronic stress can affect one’s relationship with food and eating, as well. For example, studies show that trauma may dysregulate cortisol metabolism in people with severe mental health issues. Research also suggests individuals with PTSD experience lower oxytocin levels and increased vasopressin levels in the brain. Such hormonal variations might contribute to increased or decreased appetite.
Science reveals trauma can also affect the digestive system, leading to symptoms like nausea, appetite changes, or gastrointestinal issues that complicate one’s relationship with food. One study published by The Royal Australasian College of Physicians found that Australian veterans with PTSD were eight times more likely to have digestive-related symptoms or diagnoses than those without PTSD.
What kind of trauma causes binge eating?
Research suggests that binge eating disorders (BEDs) are pervasive in individuals with a trauma history, such as child sexual abuse,
but it is also nominally associated with sexual interpersonal, other interpersonal, and noninterpersonal trauma. Other research points to a more complex interplay between trauma and eating disorders. For example, a study involving women veterans found that military sexual trauma was highly associated with eating disorders such as BED, but combat exposure was not.
How do eating disorders develop?
Eating disorders can potentially develop as a result of several factors. These might include traumatic experiences like abuse, loss, or exposure to violence. The National Women’s Study published in the International Journal of Eating Disorders found that women with bulimia nervosa (BN) had experienced significantly higher rates of both sexual and aggravated assault than those without BN, indicating a strong link between “victimization” and BN. Additionally, one might develop an eating disorder as a result of physical or psychiatric illness. Some people might develop eating disorders due to severe bullying or emotional distress associated with significant life changes.
How eating disorders develop and express varies between individuals. For some, the eating disorder began in childhood, while others don't start displaying ED behaviors until later in life. Some people have more severe ED symptoms associated with lifetime trauma, while others experience symptoms associated with other severe adverse experiences. Individuals might internalize their trauma, resulting in ED symptoms like restrictive eating, purging, and other self-destructive behaviors.
What is the root cause of eating disorders?
Researchers believe EDs likely result from a combination of factors. These include:
- Genetic: Scientific research suggests that some people may be more genetically at risk for developing an eating disorder compared to others.
- Biological: Some people with eating disorders show differences in brain structure and functioning.
- Behavioral: Behaviors like restrictive eating or avoidance of certain foods, diet drug or laxative misuse, and compulsive exercise are all examples of behaviors that might drive eating disorders.
- Psychological: According to The National Eating Disorders Association, psychological factors like perfectionism, impulsivity, emotional dysregulation, cognitive inflexibility, body image and self-esteem issues, avoidance motivation, and mental health disorders might cause eating disorders.
- Social: Social risk factors for eating disorders may include societal or cultural stigmas about weight, bullying or teasing from others, societal expectations of appearance, isolation, acculturation, and traumatic experiences.
What triggers an eating disorder?
Eating disorders (EDs) aren't typically "triggered" by any one thing; however, there are factors that might contribute to behavior patterns or relapse, particularly when one is in the recovery process. For example, one might find clothing or grocery shopping induces the urge to engage in disordered eating. For others, instigators might include conversations about diets and weight loss, being surrounded by food, or weighing oneself. Some people engage in disordered eating out of loneliness, boredom, or when faced with stress.
Identifying such factors and learning to manage them throughout one's life is a part of treatment for eating disorder patients, not only in conventional outpatient therapy but also in both residential treatment and inpatient treatment facilities. A paper published in The Journal of Psychological Medicine followed a community sample of 137 adults with BED over a five-year-period. The researchers found relapse rates were higher and BED was more persistent overall than previous studies suggested—highlighting the importance of an ongoing treatment process and early intervention for managing “triggers” for ED patients.
Triggers associated with trauma can also significantly contribute to a relapse in ED behaviors. One systematic review published in Trauma, Violence & Abuse reveals that PTSD symptoms might be “associated with more severe eating disorder pathology posttreatment and a greater likelihood of treatment non-completion,” also underscoring the importance of managing potential PTSD triggers in individuals with comorbid ED, and highlighting the need for a more trauma informed approach for certain patients. Psychosomatic medicine has shown promise as an eating disorder treatment and for helping patients mitigate potential “triggers” such as anti-obesity messaging when treating trauma and severe ed symptoms.
What type of person develops an eating disorder?
Eating disorders can impact people regardless of age, sexual orientation, race, socioeconomic and cultural background, and gender identity. Here are some statistics from The National Association of Anorexia Nervosa and Associated Disorders and The National Eating Disorders Association:
- 22% of children and adolescents have unhealthy eating habits that could lead to or indicate an eating disorder
- Overall lifetime prevalence of eating disorders is estimated to be 8.60% among females and 4.07% among males
- Hispanic/Latina/o, Black/African American, and Asian Americans are more likely to engage in disordered eating behaviors than their white counterparts
- LGBT adults and adolescents experience a greater incidence of eating disorders and disordered eating behaviors than their heterosexual and cisgender counterparts
- Over 70% of people with eating disorders also have other conditions, most commonly mood and anxiety disorders
Do eating disorders rewire your brain?
Numerous studies show that eating disorders can impact brain structure and functioning. For example, studies supported by the National Institutes of Health (NIH) found that eating disorder behaviors can "alter the brain’s response process and food intake control circuitry.” Another such study found that eating disorders may also alter brain mechanisms responsible for habit formation. Such findings may shape future research directions on treating eating disorders on a neurological level.
What are eating disorders influenced by?
Eating disorders are typically influenced by a combination of factors, including, but not limited to:
- Biological factors like genetics, brain chemistry, and hormonal factors can influence EDs, as can certain traumatic medical complications, illnesses, and injuries
- Psychological factors such as poor self-image tied to body dissatisfaction, perfectionism, and controlling tendencies, and co-occurring mental conditions like depression, anxiety, PTSD, and obsessive-compulsive disorder (OCD)
- Social and cultural influences, peer influence, and media and societal pressures
- Environmental factors like trauma or stressful events, dieting and weight pressures, and family dynamics
What is the psychology of eating disorders?
A wide range of cognitive, emotional, and behavioral patterns might drive disordered eating behaviors. Some of these include:
Cognitive distortions
Cognitive distortions such as black-and-white thinking, body dysmorphia, or obsession with weight and appearance can contribute to the development of eating disorders.
Emotional regulation
For some, emotional regulation plays a significant role in disordered eating patterns. They might use certain eating behaviors to cope with distress and challenging emotions. In some cases, an individual might restrict food intake, exercise excessively, or binge to help numb or avoid facing uncomfortable emotions.
Perfectionism and control
Individuals with perfectionistic traits may be at higher risk for eating disorders, particularly when setting high standards for body image and weight. Certain eating behaviors can also give individuals a sense of control in situations where they may feel powerless. This is common in anorexia nervosa, where restrictive behaviors may provide a sense of order and control.
Low self-esteem
Eating disorders are often associated with low self-esteem and self-worth, particularly in areas of body image and appearance. Individuals with eating disorders might be highly self-critical, feeling shame or guilt around food, eating behaviors, or perceived body flaws.
Media influence and comparison
The influence of the media and social comparison are familiar drivers behind eating disorders. Living up to unrealistic standards of beauty and body types portrayed in the media, especially social media, can lead to feelings of inadequacy and influence eating behaviors.
Behavioral reinforcement
Restricting food intake, purging, binge eating, and other behaviors associated with eating disorders might create a cycle of short-term relief or a “reward” (like a sense of control), reinforcing the behavior. Over time, these behaviors can become ingrained and difficult to change as they develop into deeply rooted habits.
Interpersonal and family dynamics
High familiar expectations, critical or controlling family members, or boundary violations can contribute to eating disorder development. Additionally, some people with eating disorders isolate themselves, either due to shame or to avoid social eating situations, which can lead to loneliness and reinforce negative self-perceptions.
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