Trauma and Eating Disorders

The Causes and Effects of Abuse and Developing an ED

Nov 17, 2008 Lisa Ann Schleipfer

Research into the effects of trauma, such as sexual assault or childhood abuse, are showing more and more direct links to development of eating disorders.

Eating disorders are about more than just worrying about weight, food, and body image. Eating disorders have latent social, psychological, and interpersonal factors that contribute to their manifestation. The main psychological causes, such as low self-esteem, a lack of control, loneliness, depression and anxiety, also are the main psychological results of trauma and abuse.

Correlations are high between prior traumatic experiences and EDs, especially in bulimia nervosa. Eating disorders generally have high rates of dual-diagnosis, many patients diagnosed with an ED experience co-occurring disorders such as substance abuse, anxiety, depression, and personality disorders.

Childhood Sexual Abuse and Eating Disorders

The correlations between EDs and trauma were first discovered with victims of childhood sexual abuse, or CSA. Researchers have since discovered links between EDs and other forms of trauma, such as sexual assault, sexual harassment, emotional abuse, physical abuse or assault, and neglect.

The traumatic correlations between abuse and EDs, are generally discovered in adults suffering from eating disorders, with the traumatic event occurring in their past. in the past few years, the same correlations for children who have developed eating disorders have been documented.

A 2000 study published in the Journal of the American Academy of Child and Adolescent Psychiatry, showed young females that were sexually traumatized were also predisposed to showing symptoms of eating disorders. The trauma participants had higher rates of weight dissatisfaction, were more likely to purge and diet and ate less when emotionally upset than the control group.

Bulimia and Prior Abuse

A person suffering from a traumatic event are more likely to develop bulimia nervosa than any other eating disorder. This correlation is most often associated with CSA, as studies in the late 1990s showed that childhood sexual abuse was a strong risk factor for bulimia.

Although the correlations are strong, the reason for the relationship between trauma and bulimia are unknown. One theory extends that there are biological explanations for patients with bulimia, in which bulimics release a chemical during stressful events that impacts appetite. [1] Other theories are more general, in that trauma is more likely to produce psychological disturbances that can lead to development of eating disorders.

Post Traumatic Stress Disorder and EDs

Post Traumatic Stress Disorder, partial PTSD, or clinical anxiety all have the ability to increase the probability of developing an eating disorder. [2]

PTSD is linked to eating disorders via trauma, in that a traumatic event or experience can produce similar effects to PTSD. Physical evidence of this was found in an August 2008 Brigham Young University study, which showed that after a trauma there is a reduction in the size of the hippocampus, the part of the brain that effects learning and memory, and is most often associated with PTSD.

Some professionals in the medical community believe the links between PTSD and eating disorders are almost synonymous. A 2007 study from the Medical University of South Carolina has linked PTSD and EDs to the point of suggesting that ED treatment programs should adopt a standard practice of evaluation and treatment for PTSD. [2]

Although the ties between abuse and EDs are substantial, they are not mutually exclusive. Exploring the links between trauma and eating disorders can point medical professionals in directions of better and more effective ED treatment, and by addressing the psychological implications of a traumatic event; a patient may be better able to recover from his or her disorder.

[1] Smyth, J., Heron, K., Wonderlich, S., Crosby, R., Thompson, K; (2008); The Influence of Reported Trauma and Adverse Events on Eating Disturbance in Young Adults; International Journal of Eating Disorders, 41 (3), 195-202.

[2] Brewerton, T.; (2007); Eating Disorders, Trauma, and Comorbidity: Focus on PTSD; Eating Disorders, 15, 285–304.

The copyright of the article Trauma and Eating Disorders in Eating Disorders is owned by Lisa Ann Schleipfer. Permission to republish Trauma and Eating Disorders in print or online must be granted by the author in writing.

Eating disorders are linked to past trauma.

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Nov 19, 2008 10:04 PM

Guest :

Dear Lisa,

Thank you for this comprehensive and much needed article. The people with eating disorders I work with in my psychotherapy practice are, without exception, courageous, intelligent, creative people who were severely wounded psychologically at an early age. They developed their eating disorders as a way to compensate and cope with unbearable trauma.

Eating disorders, for a while, are effective in both blocking pain and protecting psychological defenses. The complaint that eating disorders are difficult to treat, in my opinion, is based on misinformation about the illness.

Too often eating disorders are viewed as the ailments based on eating habits, body image, weight and vanity. With this perspective in mind a person with an eating disorder is not seen for who she is - a valiant and desperate person living a pseudo life because her psychological wounds have left her unable to tolerate stress or comprehend the challenges of normal life.

She is extremely vulnerable and psychologically fragile while often appearing strong, competent and talented. The difference between her external persona and her inner life is extreme, and this only adds layers of loneliness and despair to her everyday experience.

Treatment that focuses on weight, eating habits, body perception and cognitive distortions miss the emotional, deep psychological sense of fear, emptiness, abandonment, shame and desperate need to be loved – not admired or praised,
but really loved that must be addressed for healing to occur.

I believe the incorrect view of eating disorders in our culture validates an eating disordered person's harsh and critical view of herself and makes her even more unwilling to seek treatment.

Thank you again for your articulate and thorough article. If people with eating disorders appreciate that their behavior is rooted not in appearance and need to fit a desired size and shape but is actually rooted in psychological wounds that can be addressed and healed in deep psychotherapy work, more people might encourage such work. Then
Perhaps people with eating disorders would be more willing to step forward to allow themselves to receive the help that actually helps.

I'm posting a link to your article on my blog, stopeatingdisorders.com. Brava, Lisa.

Joanna Poppink, MFT
psychotherapist, Los Angeles
eating disorder recovery specialist

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