What Is the Relation Between Eating Disorders and Trauma?

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A recent study, in press in Appetite, examines the association between eating disorders and different types of trauma.¹

Eating disorders are characterized by abnormal eating and eating-related behaviors. Three common eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder. I briefly describe these disorders below.

People who meet the criteria for anorexia nervosa have a severe fear of becoming fat; they also experience body image distortions (e.g., perceiving themselves to be overweight even when, objectively speaking, they are underweight). People with anorexia restrict their food intake to the point that their weight falls below what is considered minimal normal weight (as determined by the their age, height, etc).

Another common disorder, bulimia nervosa, is characterized by a type of cyclical behavior, of eating binges followed by self-induced vomiting (and/or misuse of laxatives and other extreme measures to avoid gaining weight).

Binge-eating disorder is somewhat similar to bulimia, except that in this disorder the eating binges are not usually followed by extreme compensatory behaviors.

Previous studies have linked eating disorders to a number of issues at different stages in development. Some of these factors include gastrointestinal problems, picky eating, physical neglect, and sexual abuse (during childhood); self-esteem issues (in early adolescence); and perception of not receiving enough social support from one’s family (in late adolescence).²

The most potent risk factors for the development of eating disorders are likely constant weight concerns, and to a lesser extent, having a history of physical neglect and/or sexual abuse.

Though sexual abuse can result in trauma, so can physical trauma. Indeed, a 2016 review found that physical abuse was associated with all eating disorders examined.³

Some researchers, including the present study’s authors, have suggested the need to study additional potentially traumatizing events (e.g., exposure to loss/death, bullying, war, etc) because these events may not only play a role in the development of eating disorders but also in the disorders’ symptom severity and prognosis.¹

For instance, previous research has shown that the experience of traumatic events is positively associated with severity of eating disorder symptoms, negative self-image, psychosocial impairment, and presence of other psychiatric conditions like anxiety and depression.⁴

The present study

The current investigation attempted to determine the prevalence of common types of traumas in a clinical sample of adolescents.¹

The sample included data for 182 patients who had been seen in an outpatient setting at a large hospital between 2012 and 2014. The patients were aged 12-22 (average age 15), were 92% female, and all had received a diagnosis of an eating disorder.

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Data analysis showed that more than a third of the sample had experienced at least one traumatic event.

While none had been exposed to a national disaster, terrorism, or war, up to 2% had experienced traumatic neighborhood violence, motor vehicle accidents, and traumatic medical procedures.

The most prevalent traumas, however, were domestic violence (5%), physical abuse (5%), sexual abuse (8%), death/loss (9%), and bullying (10%).

The results also revealed that people who had experienced more traumas were more likely to have a diagnosis of bulimia (as opposed to other eating disorders) and have a higher body mass index (a commonly used measure of a person’s weight in relation to her height).

In addition, the authors discovered a significant relation between post-traumatic stress disorder (PTSD), expected body weight, and bullying (and in another analysis, domestic violence).

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But researchers were unable to determine whether bullying victimization was preceded by weight gain, or whether the opposite was the case. Of course, both possibilities are conceivable. That is, obese children and adolescents are more likely to be bullied, and those who are bullied (or have experienced other forms of abuse) may overeat as a way to cope with the trauma.

Hicks White and colleagues conclude their article by warning clinicians that in the case of patients who have experienced trauma, the use of usual treatments can have a harmful effect; therefore, providers should instead incorporate “interventions that promote safety and stabilization and specifically address trauma.”

Potential takeaways:

If you have an eating disorder and have experienced trauma, let your health provider know. Remember, trauma does not mean war-related trauma or other extreme type of violence. Bullying, for instance, can also be traumatizing.

So note any potential traumatizing incidents you can recall, to your provider so that you can, with her help, determine if or how these events might have influenced your eating difficulties.