Trauma and Eating Disorders: A Brief Introduction & Considerations When Finding Care
Traumatic experiences range in their identifying characteristics, severity, and impact. There are, of course, the traumatic experiences that readily come to mind when thinking about trauma: exposure to violence or a severe threat, a death or loss, an injury, and physical or sexual abuse. There is also a wide range of often “hidden”, less-talked-about or recognized traumas: constant criticism or neglect, parentification in your family of origin, chronic mental health struggles, invalidation from loved ones, bullying, an insecure attachment to caregivers, etc. No matter what the trauma is, clinicians and researchers alike recognize the profound impact of trauma on both the mind and body. Many individuals struggling with eating disorders have unresolved trauma, and these experiences greatly shape and affect the recovery process.
Trauma and the Mind/Body
Experiencing a traumatic event can be deeply painful, life-changing, and destabilizing. What further complicates and exacerbates trauma is when the experience of that trauma persists in one’s mind and body (this is certainly the case with post-traumatic stress disorder, or PTSD). It is as if the individual does not receive the message that the trauma is, in essence, “over”. This can occur for a variety of reasons: repeated exposure to traumatic events and experiences, chronic stress/anxiety/arousal, not receiving treatment for initial trauma, an internalization of harmful messages that prolong the stress response (“I’m bad” or “I’m hopeless”), etc. The autonomic nervous system diligently does its job, vacillating between a sympathetic (“fight or flight”) or parasympathetic response (typically referred to as “rest and digest”, but it can also be “shutdown and collapse”, when a particular branch of this system becomes activated).
Think about this. If someone’s body is regularly caught up in a continual, ongoing trauma response- either in a highly activated or shutdown state, the implications for eating disorder treatment are profound. For example, in a fight or flight state, the sympathetic nervous system floods the body with adrenaline and cortisol, preparing one to either confront the danger or escape it. While this response is vital for survival, it also suppresses non-essential functions, including digestion. The body prioritizes immediate survival over nourishment, leading to a decrease in hunger signals.
In a state of shutdown or collapse—often referred to as the freeze response—the parasympathetic nervous system can cause the body to shut down many functions as well. Again, the digestive system is impacted, in efforts to conserve energy. As a result, hunger cues can become muted or entirely absent.
Here’s another important element to consider. As humans, we seek regulation and stabilization. When we lack adequate resources or skills to effectively regulate and stabilize our nervous systems, we will engage in all sorts of behaviors to attempt to self-soothe (disordered eating, addictive behaviors, self-harm, etc.) So, for the individual stuck in an endless cycle of overactivation and collapse, binging or purging behaviors can represent momentary relief, comfort, or escape.
The main point here? Our bodies are NOT physiologically wired to support effective eating when we continue to experience trauma. For those suffering with eating disorders, for their loved ones, and for their providers- we must start with this understanding. Then, we must take a trauma-informed approach to re-establishing safety and regulation within the body, accessing support and resources to assist in recovery and effective nourishment, and ultimately, reconnecting individuals to a life aligned with their values and innermost needs.
Here is a brief overview of important considerations when looking for trauma-informed care:
Find a trauma-informed therapist who approaches eating disorders from a holistic perspective, helping you reconnect to your body and finding ways to regulate the nervous system.
Talk with your dietitian about specific techniques and strategies to support your relationship with food and eating.
(For example, many individuals with trauma histories benefit from certain forms of sensory input prior to meals, in order to foster an increased sense of bodily connection. This could mean holding a downward dog or child’s pose for a few minutes before sitting down to eat, or putting a weighted blanket on one’s lap. All of these activities specifically provide proprioceptive input, meaning the individual has received vital information about where the body is in relation to others and the environment. )
Talk with your team about regular, at-home practices you can utilize to regulate your nervous system (yoga, deep breathing exercises, progressive muscle relaxation, and other grounding techniques).
Remember that consistent eating routines are crucial.
(Regular eating patterns provide structure and stability, especially when hunger cues are inconsistent. Planning balanced meals and snacks at regular intervals can help maintain energy levels and support metabolic recovery.)
Especially with trauma, make sure your treatment team collaborates and everyone is on the same page!
(It can feel very nerve-wracking and vulnerable to have your treatment team discussing your treatment, especially when it’s difficult to trust others; however, your care will benefit greatly from smooth communication and effective collaboration. So, sign those releases and trust that your team wants the very best for you!)