Eating Disorders, Trauma, and PTSD, Part 1

What you need to know to get better

Posted Jun 24, 2018

CarolynRoss/Shutterstock
Source: CarolynRoss/Shutterstock

Eating disorders are rarely solely related to abnormal or disturbed eating habits. In fact, eating disorders are rarely even about food.  As an integrative medicine practitioner with over thirty years’ experience in treating eating disorders and addictions, knowing the root cause of eating disorders like bulimia, binge eating disorder and anorexia is critical to developing an effective treatment plan for patients.

In my practice, I’ve encountered numerous factors that have been contributing factors in the development of binge eating, anorexia and bulimia. In many cases, the root cause involved untreated and unresolved trauma. Additionally, trauma, when left unresolved, can also contribute to the development of other psychiatric disorders and even physical diseases.

The Undeniable Relationship between Eating Disorders, Trauma and PTSD

Recent studies validate the importance of assessing trauma and Post-Traumatic Stress Disorder (PTSD) in treating eating disorders. A relationship between eating disorders, particularly bulimia nervosa and binge eating disorder, and trauma has been discovered among participants in various studies (Brewerton 2007).

While child sexual abuse has long been recognized as a risk factor for eating disorders and can also manifest in other psychiatric disorders, recent studies indicate other types of trauma can also lead to eating disorders. A recent study found that “the vast majority of women and men with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) reported a history of interpersonal trauma” (Mitchell et al. 2012).  Approximately one-third of women with bulimia, 20% with binge eating disorder and 11.8% with non-bulimic/non binge eating disorders met criteria for lifetime PTSD (post-traumatic stress disorder).  Overall, the most significant finding was that rates of eating disorders were generally higher in people who experienced trauma and PTSD (Mitchell et al. 2012).

Types of Trauma that Can Lead to Eating Disorders

A study in 2007 showed that there are many types of trauma that can be associated with eating disorders including neglect, sexual assault, sexual harassment, physical abuse and assault, emotional abuse, emotional and physical neglect (including food deprivation), teasing and bullying (Brewerton 2007). Furthermore,  a study in 2001 found, “Women who reported sexual trauma were significantly more likely to exhibit abnormal eating behaviors than controls, including higher rates of both PTSD and EDs [eating disorders]” (Brewerton 2007).

The exact mechanism for why trauma contributes to the development of an eating disorder is unclear.  What is known is that trauma can cause disruption in the nervous system which may make it difficult for individuals to manage their emotions and so they turn to eating disorder behaviors or other addictions as a way to manage these uncomfortable emotions.  Sexual trauma may specifically cause body image issues, partly related to the self-critical view that can develop after sexual trauma.  Some victims may wish to be thin to reduce their attractiveness or may gain weight to accomplish the same goal (Dunkley et al. 2010; Sack et al. 2010; Yehuda 2001).

Part 2 will cover what PTSD and eating disorders have in common and what you need to know to get help.

References

Mitchell KS, Mazzeo SE, Schlesinger MR, Brewerton TD, Smith BN. Comorbidity of partial and subthreshold PTSD among men and women with eating disorders in the National Comorbidity Survey-Replication Study. The International Journal of Eating Disorders. 2012;45(3):307-315. doi:10.1002/eat.20965.

Brewerton, Timothy D. Eating disorders, trauma, and comorbidity: focus on PTSD. The Journal of Treatment & Prevention. 2007;15(4): 285-304. doi:10.1080/10640260701454311

Sack M, Boroske-Leiner K, Lahmann C.  Association of nonsexual and sexual traumatizations with body image and psychosomatic symptoms in psychosomatic outpatients.  Gen Hosp Psychiatry. 2010 May-Jun; 32(3):315-20.

Yehuda RJ.  Biology of posttraumatic stress disorder. Clinical Psychiatry. 2001; 62 Suppl 17():41-6.

Dunkley DM, Masheb RM, Grilo CM.  Childhood maltreatment, depressive symptoms, and body dissatisfaction in patients with binge eating disorder: the mediating role of self-criticism. International Journal of Eating Disorders. 2010 Apr; 43(3):274-81.