by Nadia Albritton, MA
*This blog may cause triggers among survivors of eating disorders and trauma. If you or a loved one is struggling with an eating disorder please call/text the NEDA Helpline for support at: (800) 931-2237 or go on their website at: www.nationaleatingdisorders.org
Identifying the link between trauma and eating disorders
The nature and nurture of eating disorders is complex. There is still a lot that we don’t know about eating disorders. However, we do know that there is a combination of internal (biological susceptibilities) and external factors (environmental) that contribute to such predispositions. Eating disorders are a psychological illness, and as is the case with many other mental illnesses, trauma makes a significant contribution to the development of eating disorders. Read on to learn more about the root of eating disorders, their relationship to interpersonal trauma, and how to get help.
Trauma is not a choice, and neither are eating disorders
Singer Meghan Trainor once said, “I wasn’t strong enough to have an eating disorder…I tried to go anorexic for a good three hours…and I quit.” As someone who works at an inpatient clinic, the ones that are ‘strong enough’ are the people that live with an eating disorder. Indeed, the mental house of an eating disorder is insidious, confusing, and dangerous. Eating disorders are responsible for some of the the highest mortality among psychological disorders. Interpersonal trauma significantly contributes to the development of eating disorders, and it’s important to recognize that eating disorders, as with any mental illness, are never a choice.
How different types of trauma contribute to different eating disorders
It is almost irrefutable, there is comorbidity with trauma and eating disorders. In fact, a study found that “the vast majority of women and men with anorexia nervosa, bulimia nervosa, and binge eating nervosa, reported a history of interpersonal trauma” (Mitchell et al. 2012). Interestingly enough, there is a notable relationship between the type of trauma and the type of eating disorder. For instance, posttraumatic stress disorder (PTSD) is the least found in Anorexia Nervosa (AN) and most commonly seen in Binge Eating Disorder (BED) and Bulimia Nervosa (BN). A theory for this occurrence is the impulsivity exhibited in trauma responses, BED, and BN that is not usually evidenced among individuals with restrictive tendencies. One study found that individuals with childhood sexual abuse and BN are at increased risk of a lifetime of suicide attempts. On the other hand, another study reports that emotional abuse were most strongly associated with AN symptom severity. Then there is the study that concluded that even though patients reported at least one traumatic event, no difference was found between the type of eating disorder and the type of trauma experienced.
Exploring emotional regulation as a key to helping trauma and eating disorders
Nevertheless, the relationship trauma exposure and eating disorders appear to be interceded by emotional, biological and behavioral responses. The evidence suggests that emotional regulation plays a role in eating disorders. Dysregulation activity from trauma can be seen in the HPA-axis (whose main function involves how the body reacts to stress). In addition, a recent study used the Trier Social Stress Test (a lab experiment that evaluates acute stress), and showed heightened emotional reactivity, lower levels of hunger and severe post-stress body dissatisfaction among individuals with eating disorders. In addition, higher cortisol production (i.e. stress) was seen in those with BN. Exploration of emotional regulation is necessary because dysregulation result in a high prevalence of self-injurious behaviors, and are therefore used as coping mechanisms.
Effective treatment options for eating disorders and trauma
Treatment to address trauma and eating disorders takes time, but recovery is possible. I have seen it! No one treatment will work for everyone (well, maybe the FBT). Your recovery needs to be personalized and catered to your needs. You are worthy of it. Here are some effective eating disorder treatment options to consider:
Family Therapy: For many, family members can be triggering. With a family therapist, you can learn communication and conflict resolution skills to foster better familial relationships
Family Based Therapy (FBT): Also known as the Maudsley method; It is the leading treatment for children and adolescents struggling with an eating disorder.
Cognitive Behavioral Therapy (CBT): learn how to manage difficult emotions by challenging your thinking patterns
Dialectical Behavioral Therapy (DBT): “A life worth living”; what does that look like to you? This intervention will guide you on this path along with mindfulness skills, grounding techniques, distress tolerance, and interpersonal effectiveness
Cognitive Processing Therapy (CPT): A type of cognitive behavioral therapy aimed for PTSD. This intervention teaches you to observe and change the thoughts you have had since your trauma. The idea is that if you can change your thought, your feeling will follow
Prolonged Exposure (PE): A cognitive behavioral therapy that takes a gradual approach to trauma-related memories, feels and situations. Over time, the individual learns that trauma-related prompts and cues do not have to be avoided
Eye Movement Desensitization and Reprocessing (EMDR): A technique used to heal symptoms and emotional distress attached to an unsettling life experience
Accelerated Resolution Therapy (ART): An evidenced-based, rapid-eye-movement therapy for individuals who have experienced trauma
Acceptance and Commitment Therapy (ACT): Pronounced act, because once you accept the present moment, one can make a commitment and act.
O’Connor Professional Group (OPG) offers a breadth of behavioral health services to address the needs of individuals and families living with addictions, eating disorders, mood and personality disorders, autism spectrum disorders, and other behavioral health conditions. If you or a loved one is suffering from a mental health disorder or are in need of support, contact us today. Our compassionate professionals are here to help find the resources to support you and your family.
Citations:
Madowitz, J., Matheson, B.E. & Liang, J. The relationship between eating disorders and sexual trauma. Eat Weight Disord 20, 281–293 (2015). https://doi.org/10.1007/s40519-015-0195-y
Trottier, K., MacDonald, D.E. Update on Psychological Trauma, Other Severe Adverse Experiences and Eating Disorders: State of the Research and Future Research Directions. Curr Psychiatry Rep 19, 45 (2017). https://doi.org/10.1007/s11920-017-0806-6
Brewerton TD. Eating disorders, trauma, and comorbidity: focus on PTSD. Eat Disorder. 2007;15:285–304. doi:10.1080/10640260701454311.
Caslini M, Bartoli F, Crocamo C, Dakanalis A, Clerici M, Carrà G. Disentangling the association between child abuse and eating disorders: a systematic review and meta-analysis. Psychosom Med. 2016;78:79–90. doi:10.1097/PSY.0000000000000233
Alessio Maria Monteleone MD,Palmiero Monteleone MD,Ismene Serino PhD,Pasquale Scognamiglio MD,Monica Di Genio MD,Mario Maj MD, PhD Childhood trauma and cortisol awakening response in symptomatic patients with anorexia nervosa and bulimia nervosa. 23 March 2015 https://doi.org/10.1002/eat.22375
Smith, C.E., Pisetsky, E.M., Wonderlich, S.A. et al. Is childhood trauma associated with lifetime suicide attempts in women with bulimia nervosa?. Eat Weight Disord 21, 199–204 (2016). https://doi.org/10.1007/s40519-015-0226-8
Racine SE, Wildes JE (2015) Emotion dysregulation and anorexia nervosa: an exploration of the role of childhood Abuse. Int J Eat Disord 48(1):55–58. doi:10.1002/eat.22364
Rajappa K, Gallagher M, Miranda R (2012) Emotion dysregulation and vulnerability to suicidal ideation and attempts. Cognit Ther Res 36(6):833–839. doi:10.1007/s10608-011-9419-2
Klas Backholm, Rasmus Isomaa & Andreas Birgegård (2013) The prevalence and impact of trauma history in eating disorder patients, European Journal of Psychotraumatology, 4:1, DOI: 10.3402/ejpt.v4i0.22482
Alessio Maria Monteleone, Francesca Marciello, Giammarco Cascino, Monica Cimino, Valeria Ruzzi, Francesca Pellegrino, Chiara Del Giorno, Palmiero Monteleone. Early traumatic experiences impair the functioning of both components of the endogenous stress response system in adult people with eating disorders. Psychoneuroendocrinology. Volume 115, 2020, 104644, ISSN 0306-4530,https://doi.org/10.1016/j.psyneuen.2020.104644. (https://www.sciencedirect.com/science/article/pii/S0306453020300639)
Monteleone AM, Cascino G, Ruzzi V, Pellegrino F, Patriciello G, Barone E, Carfagno M, Monteleone P, Maj M. Emotional traumatic experiences significantly contribute to identify a maltreated ecophenotype sub-group in eating disorders: Experimental evidence. Eur Eat Disord Rev. 2021 Mar;29(2):269-280. doi: 10.1002/erv.2818. Epub 2020 Dec 30. PMID: 33378110.
Gordon KH, Simonich H, Wonderlich SA, Dhankikar S, Crosby RD, Cao L, et al. Emotion dysregulation and affective intensity mediate the relationship between childhood abuse and suicide-related behaviors among women with bulimia nervosa. Suicide Life Threat Behav. 2016;46:79–87. doi:10.1111/sltb.12172.
Mills P, Newman EF, Cossar J, Murray G. Emotional maltreatment and disordered eating in adolescents: testing the mediating role of emotion regulation. Child Abuse Neglect. 2015;39:156–66. doi:10.1016/j.chiabu.2014.05.011
Moulton SJ, Newman E, Power K, Swanson V, Day K. Childhood trauma and eating psychopathology: a mediating role for dissociation and emotion dysregulation? Child Abuse Neglect. 2015;39:167–74. doi:10.1016/j.chiabu.2014.07.003