So many things can trigger an eating disorder. The colossal pressure to be thin, or to look the way celebrities do in magazines ( even the celebrities don't look like that in real life), to eat 'clean' ; or to look 'perfect' (and there's usually only one version of 'perfect' that's
pushed on us) ; training to be an athlete, life transitions, (such as moving to a new area or country, or getting a divorce) can all trigger an unhealthy relationship with food.
There's also a significant link between eating disorders and trauma.
Various research has discovered a relationship between eating disorders, with some emphasising a particular link between Bulimia Nervosa (BN) and Binge Eating Disorder (BED), and trauma.
A study (Scope and significance of posttraumatic symptomatology among women hospitalized for an eating disorder. Int J Eat Disord. 1998;24:147-156. (Gleaves DH, Eberenz KP, May MC.) revealed that a huge 74% of 293 women attending residential treatment had experienced a significant trauma,and studies of clinical samples also indicated a much higher than expected rate of Post Traumatic Stress Disorder (PTSD) in patients with eating disorders that had experienced a significant trauma, with 52% reporting symptoms consistent with a diagnosis of current PTSD .
What types of trauma are risk factors for eating disorders?
While child sexual abuse has long been recognised as a risk factor for eating disorders, and, of course, for other psychiatric disorders, recent studies indicate other types of trauma can also lead to eating disorders, it has been found that “a vast majority of women and men with Anorexia Nervosa (AN), BN, and BED reported a history of interpersonal trauma” (Eating disorders, trauma, and comorbidity: Focus on PTSD TD Brewerton - Eating disorders, 2007 - Taylor & Francis) . Approximately one-third of women with BN, 20% with BED and 11.8% with non-bulimic/non binge eating disorders met criteria for lifetime PTSD.
The other types of trauma that can be associated with eating disorders, along side child sexual abuse, include neglect, sexual assault, sexual harassment, physical abuse and assault, emotional abuse, emotional and physical neglect (including food deprivation), teasing and bullying.
Significantly, rates of eating disorders were generally higher in people who have experienced trauma and PTSD.
Trauma can effect type of eating disorder developed
Trauma can be categorised in many ways, including Type 1 and Type 2 trauma; It is also sometimes ( I personally think perhaps a little misleadingly) referred to as either big “T” trauma or little “t” trauma.
Type 1, or big“T” trauma results from a catastrophic event such as physical abuse or injury, sexual assault or a natural disaster.Type 2, or Little “t” trauma is less about a specific experience and more about repetitive painful situations.
Type 2 trauma would include ongoing emotional abuse by a parent, childhood neglect, or being bullied relentlessly in school.
This type of trauma involves a higher risk of PTSD developing. The type of trauma experienced by the individual often influences whether anorexia or bulimia becomes part of the equation.
Type 1 trauma is more likely to be associated with bulimia while Type 2 trauma is more often associated with anorexia.
Early Trauma
In addition, the earlier the trauma occurs, the more intense the potential outcome; This is due to the developmental stage and phase of the individual’s brain organisation and development.
Therefore, a young girl would probably suffer extreme trauma if she experienced a life-threatening car accident; yet, as is commonly the case, an eating disorder such as anorexia would not manifest until years later, most probably during a time of transition or stress.
Trauma of a sexual nature is particularly likely to result in an eating disorder. This is due to the interpersonal nature of sexual trauma and is particularly the case if the violation was at the hand of an authority figure or family member. This type of trauma is incredibly damaging on many levels, and an eating disorder allows the victim to avoid the pain, shame or guilt associated with the violation.
Treatment of Co-occurring Disorders
A person usually seeks treatment because an eating disorder has taken over her life; but no matter how skilled the support from eating disorder clinicians and professionals, if the trauma is not addressed, the treatment remains incomplete, and relapse is more likely.
So treatment needs to deal with all disorders and diseases simultaneously. Treatment and recovery teams need to utilise evidence-based recovery programmes that are effective in the treatment of eating disorders, such as that used in recovery coaching, adapted from FBT (family based treatment), and others such as MANTRA, CBT-E and 12 step programmes, alongside the skills inherent to trauma support, such as Acceptance and Commitment Therapy (ACT),and Dialectical Behaviour Therapy (DBT) . Somatic Experiencing (SE) is also an proven effective as a treatment for trauma.
Somatic Experiencing
SE is an integrative body‐focused therapy for treating people with post-traumatic stress disorder (PTSD), predicated on how animals living in the wild deal with life-threatening trauma and is concerned with survival energy. When animals are facing imminent danger, their bodies are filled with this energy, allowing them to rise to the occasion through the freeze, fight or flight response.
Once the threat is gone, animals intentionally release this pent—up energy, and then return to normal life.
Tension
It is thought that humans produce similar energy in traumatic situations, but unlike their animal counterparts in the wild, never rid themselves of this tension.
Whether an individual is traumatised once, or repeatedly, that survival energy is rarely discharged, rarely neutralised, and therefore, remains trapped inside the body. SE suggests that trauma is a physiological, not psychological condition; therefore, the body must be included in therapy.
Undoing 'Coupling'
SE also strives to undo 'coupling'. This is when an idea, notion or experience is associated with the trauma. If a young girl is repeatedly abused in a room that contains a large digital clock, she will automatically associate these types of clocks with the assault; just seeing one could trigger a state of fear and anxiety for the rest of her life.
An important goal of SE is to break this type of detrimental connection.
Process and Psycho-Educational support
Process and psycho-educational support, such as Cognitive Processing Therapy and Core Processing Psychotherapy) are essential in the treatment of trauma. So often, trauma survivors want to know “Why, why did this happen to me?” Why did the fire happen to us?Why did the rapist choose me?
The truth is that questions such as these can rarely be answered. However, what can be accomplished is moving the person out of the “why” and into the “how.” How do I regulate my stress response; how do I cope with painful thoughts and emotions. Because stress and negative emotions will show up again. It is unfortunately an inevitable part of life.
Experiential Therapies
Experiential therapies can be very valuable in the treatment of eating disorders and trauma. Art therapy can help you to access and express emotions that are too difficult and painful to verbalise ; Animal therapy, role play and guided imagery, Movement therapies such as yoga and Dance movement therapy can lead to tremendous self-discovery. The client focuses on the activities and, through the experience, begins to identify emotions associated with success, disappointment, responsibility, and self-esteem. Under the guidance of a trained therapist, the client can begin to release and explore negative feelings of anger, hurt, or shame as they relate to past experiences that may have been blocked or still linger.The client can learn to trust and respect their bodies; and aim to grow to love their bodies and want to stop harming through eating disordered behaviours.
When the impact of trauma on an individual is fully understood, it comes as no surprise that an eating disorder may be utilised as a coping strategy. Fortunately, with complete and comprehensive treatment, lifelong healing can be achieved.
References
Brewerton, T. D. (2008). The links between PTSD and eating disorders. Psychiatric Times, 25(6), 1-7.
Eating disturbance and sexual trauma in childhood and adulthood SA Wonderlich, RD Crosby, JE Mitchell
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
Somatic Experiencing for Posttraumatic Stress Disorder: A Randomized Controlled Outcome Study
Danny Brom , 2 Yaffa Stokar, Cathy Lawi, Vered Nuriel‐Porat, Yuval Ziv, Karen Lerner, and Gina Ross
Walsh, D., and Davies, D. (1999). New dimensions in psychotherapy: The Core Process approach.
Greenberg LS, Safran J, Rice L. Experiential Therapy: Its relation to cognitive therapy. Comprehensive Handbook of Cognitive Therapy. 169-187.
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.