Eating disorders, trauma and shame
As both a trauma-informed and a shame-informed therapist, I see all the time in my work how eating disorders, trauma, and shame are interrelated, and how their connection can have a significant impact on a person's mental and physical health.
Trauma is a significant risk factor for the development of eating disorders. Experiencing traumatic events, such as sexual abuse, physical abuse, or neglect, can lead to feelings of powerlessness, anxiety, and depression, which can contribute to the development of disordered eating behaviours. Trauma-related distress can also lead to body image dissatisfaction, self-blame, and self-criticism, which can trigger the onset of eating disorders (1).
Shame is another significant factor in the development and maintenance of eating disorders. Shame can arise from a range of experiences, including early life experiences of neglect or abuse, social stigma, or cultural expectations around body image and weight. Shame is often internalized and can lead to negative self-evaluations, low self-esteem, and body dissatisfaction, which are common features of eating disorders (2).
Research suggests that shame and trauma often co-occurs in individuals with eating disorders. Trauma can increase feelings of shame, and shame can make it more difficult for individuals to cope with the aftermath of a traumatic event. In turn, the experience of shame can exacerbate disordered eating behaviours and reinforce negative self-beliefs, leading to a vicious cycle of shame and eating disorder symptoms (3).
Furthermore, individuals with eating disorders who have experienced trauma may struggle with the emotional regulation and coping skills necessary for recovery. They also frequently experience difficulties with trust and intimacy, which can impede their ability to form therapeutic relationships or participate fully in treatment (4).
Overall, the links between eating disorders, trauma, and shame are complex and multifaceted. Treatment that addresses both the underlying trauma and the experience of shame is often necessary for recovery. Interventions that focus on building coping skills, improving self-compassion, and strengthening social support can also be effective in promoting recovery in individuals with eating disorders who have a history of trauma and shame.
Brewerton, T. D. (2017). Eating disorders, trauma, and comorbidity: Focus on PTSD. Eating disorders, 25(4), 340-346.
Gilbert, P., & Miles, J. N. (2015). Body shame: A biopsychosocial conceptualization and overview, with treatment implications. In Body shame (pp. 3-22). Routledge.
Troop, N. A., Allan, S., Serpell, L., & Treasure, J. L. (2008). Shame in women with a history of eating disorders. European Eating Disorders Review, 16(6), 480-488.
Racine, S. E., Wildes, J. E., & Coffey, K. A. (2013). Associations between posttraumatic stress disorder and eating disorder symptoms: The roles of shame and dissociation. Journal of Trauma & Dissociation, 14(4), 418-435.