The interplay of Eating Disorders, Trauma & PTSD
We know the impact trauma has on our sense of self, the way we view relationships and the world around us.
Our attachment styles, early childhood experiences and neurodevelopment all impact on the way we view the world, ourselves and our relationships. Trauma and the impact of trauma is multifaceted and not necessarily based on one singular traumatic event. It can and often is more complex than that, which is why we called is complex trauma. Trauma impacts our nervous system and our body remembers.
Recent studies highlight the importance of assessing PTSD in treating eating disorders. A relationship between eating disorders and trauma has been discovered among various studies with rates of eating disorders higher in people who have experienced trauma and PTSD.
The link between Trauma and Eating Disorders...
The occurrence of only having an eating disorder in itself is rare. Individuals who have an eating disorder more commonly have other comorbid conditions or symptoms such as anxiety, mood, personality disorders and/or substance use disorders. Approximately over 80% of adults diagnosed with an eating disorder have at least one more comorbid disorder (Udo & Grilo, 2019) These comorbidities are highly associate with prior traumatic experiences and post-traumatic stress disorder (PTSD) (Brewerton, 2007; Vanzhula et al., 2018).
In the National Women’s Study (NWS; Dansky et al., 1997), which is the most comprehensive study completed involving the comorbidity between eating disorders and PTSD, found that the prevalence of developing PTSD was 37% in women with bulimia nervosa and 21% in women with binge-eating disorder. Specifically, a comprehensive study revealed that the prevalence of child maltreatment was significantly higher for each eating disorder (21-52%) than individuals that don’t have an eating disorder (7-13%) (Molendijk et al., 2017).
A recent study conducted by The National Comorbidity Survey Replication (NCSR) examined the links between trauma and eating disorders in both women and men. They found that in women, 100% with anorexia nervosa and bulimia nervosa reported any type of trauma and 90% with binge-eating disorder, compared to 79% of people who did not have an eating disorder (Brewerton, 2018; Mitchell et al., 2012). Findings for men indicated that 100% with anorexia nervosa and bulimia nervosa reported experiences with any type of trauma, and 98% with binge eating disorder compared to 84% of individuals who did not have an eating disorder.
Trauma & PTSD...
Trauma is the exposure to an incident or a series of events at any age that are life threatening and/or emotionally disturbing. The exposure to traumatic event(s) may cause lasting adverse effects on the individual’s daily functioning and emotional, social, mental, physical and/or spiritual wellbeing
Events / experiences that may be traumatic include...
living with a family member with mental health or substance use disorders
physical, sexual, verbal and emotional abuse
sudden, unexplained separation from a loved one
racism, discrimination and oppression
violence in the community, war or terrorism
One of the common experiences of trauma include childhood trauma. Childhood trauma occurs when a child witnesses or experiences overwhelming negative events in childhood during the ages between birth and the age of six. Young children are highly vulnerable to the impact of trauma as they are predominantly dependent on their caregivers for nurture, care, and protection. Very early childhood experiences impacts neurodevelopment and we see this in relation to emotion regulation, sense of self, their attachment and relationship with others, the way they view and experience the world around them with ongoing impacts into adulthood.
Particularly in adolescents, a recent study found 74.7% of adolescents admitted to residential treatment centres endorsed at least one type of childhood trauma, and 46.4% reported clinically significant post-traumatic stress disorder (Brewerton et al., 2021). These adolescents at residential care also reported high scores for major depression, anxiety disorders, overall quality of life and forms of childhood abuse (Brewerton et al., 2021).
We also know that individuals that have an eating disorder are also highly susceptible to experiencing medical trauma when receiving treatment as an inpatient at a hospital and in residential care settings.
Traumatic events that are emotionally distressful often results in lasting mental and physical effects. Many childhood experiences can overwhelm a child, including relationships with abuse, assault, neglect, violence, exploitation or bullying. Children may also experience traumatic events including accidents, war, civil unrest, natural disasters, loss of a parent or caregiver through death, medical procedures, separation, divorce or imprisonment.
Eating disorders are rarely about the food...
Eating disorders are complex, serious and potentially life-threatening mental illnesses. It involves maladaptive patterns in behaviours, thoughts and attitudes surrounding food, eating, body weight or shape. Eating disorders have significant detrimental effects on an individual’s life and result in serious medical, psychiatric and psychosocial consequences. Eating disorders can occur in people of any weight, size, shape, gender identity, sexuality, age, socioeconomic group or cultural background.
We take a trauma informed approach to our psychological support and intervention in the treatment of eating disorders and trauma and work with you and alongside you in your pathway to recovery.
1. Brewerton, T. D. (2007). Eating disorders, trauma, and comorbidity: Focus on PTSD. Eating disorders, 15(4), 285-304.
2. Brewerton, T. D. (2019). An overview of trauma-informed care and practice for eating disorders. Journal of Aggression, Maltreatment & Trauma, 28(4), 445-462.
3. Brewerton, T. D., Gavidia, I., Suro, G., Perlman, M. M., Genet, J., & Bunnell, D. W. (2021). Provisional posttraumatic stress disorder is associated with greater severity of eating disorder and comorbid symptoms in adolescents treated in residential care. European Eating Disorders Review, 29(6), 910-923.
4. Dansky, B. S., Brewerton, T. D., Kilpatrick, D. G., & O'Neil, P. M. (1997). The National Women's Study: Relationship of victimization and posttraumatic stress disorder to bulimia nervosa. International Journal of Eating Disorders, 21(3), 213-228.
5. Mitchell, K. S., Mazzeo, S. E., Schlesinger, M. R., Brewerton, T. D., & Smith, B. N. (2012). Comorbidity of partial and subthreshold PTSD among men and women with eating disorders in the national comorbidity survey-replication study. International Journal of Eating Disorders, 45(3), 307-315.
6. Molendijk, M. L., Hoek, H. W., Brewerton, T. D., & Elzinga, B. M. (2017). Childhood maltreatment and eating disorder pathology: a systematic review and dose-response meta-analysis. Psychological Medicine, 47(8), 1402-1416.
7. Udo, T., & Grilo, C. M. (2019). Psychiatric and medical correlates of DSM-5 eating disorders in a nationally representative sample of adults in the United States. International Journal of Eating Disorders, 52(1), 42-50.
8. Vanzhula, I. A., Calebs, B., Fewell, L., & Levinson, C. A. (2019). Illness pathways between eating disorder and post-traumatic stress disorder symptoms: Understanding comorbidity with network analysis. European Eating Disorders Review, 27(2), 147-160.