Trauma and Eating Disorders
Research shows that at least 50% of all people with eating disorders have a history of trauma. Research also shows that many more have had experiences that overwhelmed their nervous system - even if they don’t personally identify them as trauma.
What is trauma?
Trauma is recognized as an ongoing response to an experience or event that overwhelmed the nervous system’s ability to cope. This often leaves someone stuck in a state of fear, helplessness, or perceived threat, which causes the body to react to everyday stressors in a disproportionate manner. Emotional abuse, chronic criticism or bullying, being shamed, humiliated, or rejected, or growing up with an emotionally unavailable caregiver are all examples of potential traumas.
Trauma is not defined solely by the event itself, but by how the event impacted a person's nervous system, beliefs, relationships, and ability to cope.
How does Trauma differ from PTSD and CPTSD?
Post-Traumatic Stress Disorder (PTSD) is a psychiatric diagnosis that stems from direct or indirect exposure to a traumatic event. Chronic Post-Traumatic Stress Disorder (CPTSD) is similar to PTSD, but refers to chronic or long-term exposure to trauma. Examples of events that lead to PTSD are: real or imagined death, serious bodily injury, natural disaster, or sexual violence. Examples of events that can lead to CPTSD are: long-term child abuse, domestic violence, war, or frequent community violence. In order to be diagnosed with PTSD or CPTSD, a person must experience significant disruption in daily functioning that lasts at least a month past the event - although many of these symptoms persist for years. Common PTSD and CPTSD symptoms are avoidance, intrusive thoughts or images, hyper-arousal or reactivity, and negative changes in thoughts and mood. Symptoms unique to CPTSD are ongoing difficulty with emotional regulation, self-identity and esteem, relationships, and dissociation.
Important note: You do not need to meet criteria for PTSD or CPTSD to have experienced trauma or to have trauma responses. Many people experience trauma responses without a formal diagnosis, and it is these responses that we most often address in our program.
Eating disorders as a trauma survival strategy?
We know it may sound bizarre, but eating disorders often develop as a protective mechanism to manage trauma symptoms.
While not all eating disorders come from trauma, ALL eating disorders DO involve the nervous system learning patterns of protection.
When something painful, unpredictable, or out of our control happens, our brain scrambles to create meaning and establish rules in an attempt to prevent similar pain. This often means prioritizing survival over comfort. Some ways that we can “manufacture” this feeling of survival and safety are by emphasizing predictability and control, and by suppressing our own needs. This can even look like trying to become smaller or invisible. More specifically, eating disorder behaviors can create a sense of:
Control when life feels unpredictable
Numbing when emotions feel overwhelming
Distraction from painful memories or feelings
Structure and certainty during chaos
Self-protection from vulnerability
While an eating disorder initially seems to provide these representations of “safety”, we all find that eventually the temporary benefit is vastly outweighed by the longterm cost.
How we treat both trauma and eating disorders at Empowered.
A trauma-integrated approach is at the core of what we do at Empowered. Our entire program and curriculum was created to address the fact that some form of nervous system disruption is woven into the development of most adult eating disorders. We identify and begin to heal trauma through our psychoeducation and process groups, individual therapy, individual dietitian meetings, meal support groups, experiential outings, and yoga.
Community Support & Education
Understanding the relationship between trauma and eating disorders can be crucial to identifying why your eating disorder developed and what its role and function has been. It is important to understand that clients will not be asked to recall any details of traumatic events in a group setting. Our focus is on how trauma changes our body, brain, and sense of safety - and how eating disorders can develop as a survival strategy.
Weekly Individual Therapy
Our therapists are highly trained in recognizing and treating trauma in its many forms. All of our clients have the opportunity to take a deeper dive into their personal history and experiences in a safe and clinically-sophisticated environment. This deeper dive can also include modalities such as CBT (Cognitive Behavioral Therapy), DBT (Dialectical Behavior Therapy), EMDR (Eye Movement Desensitization and Reprocessing), and IFS (Internal Family Systems).
Therapeutic Meals & Experiential Outings
During programming, we incorporate daily therapeutic meals and monthly experiential outings to ensure our clients receive clinical support in real-time, and in real-world applications. Oftentimes completing a meal or going to the grocery store can be a triggering event for one’s trauma and/or eating disorder symptoms. Our ultimate goal is to help each of our clients develop coping and regulation skills in order to better navigate scenarios like these moving forward.
We understand that the idea of exploring trauma can be daunting.
Please explore some common FAQs about our program and process below.
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No, PTSD is not a requirement. Many people experience - and are severely impacted by trauma - without meeting full criteria for PTSD. Eating disorders also impact the nervous system in ways that are very similar to (and can register as) trauma. This means that the eating disorder can also be an active and ongoing trauma of its own.
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Yes, this is absolutely possible. Our approach does not identify trauma as the only possible cause of an eating disorder. However, countless data has shown that there is a high rate of co-occurrence. Regardless, our program and curriculum does not require you to identify trauma in order to benefit from our groups, individual sessions, and therapeutic community.
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Absolutely not. We will only talk about the impact of the trauma on our nervous system, thought processes, and emotions. Details of the trauma are never discussed in a group setting, but individual therapy can involve deeper trauma work if the client is willing AND it is clinically appropriate.
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Yes, we have staff that are trained in EMDR and can provide this service in an outpatient level of care. If this is important to you, please indicate this during the admissions process so that we can assign you to a therapist trained in this modality.
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Being unable to remember the details of a trauma is actually quite common. Fortunately, accounting the exact trauma in detail is not required to do trauma work.
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No. Eating disorders have no single cause. Several biological, psychological, and social/environmental factors can all contribute to the development and maintenance of an eating disorder.
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Avoidance is a common strategy used to cope with the experience of trauma. Doing trauma work can involve some dysregulation, especially as we decrease avoidance behaviors and target the roots of the trauma. This is done to gradually decrease the impact of the trauma in present day. At Empowered, we proactively help our clients develop alternative coping skills before engaging in deeper trauma work.
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During the admissions and intake process, we will talk with you about our program and what to expect. In our experience, trauma often impacts us even when we think we have it secured and tucked away. We can help you identify the impact of trauma, as well as where trauma may be affecting other areas of your life. You are not responsible for your trauma, but you are in control of your healing. If you do not feel ready to fully engage in trauma work, you can still benefit from the education in our program. We can also provide you with continued-care referrals, should you chose to engage in trauma work when you complete the program.
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Trauma-informed treatment means that the treatment team has a general understanding of trauma symptoms, and that efforts are made not to trigger trauma. Trauma-integrated means that we actively discuss how trauma shows up and contributes to an eating disorder, as well as provide deeper trauma-specific work in individual therapy.
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Our program is 12 weeks long, which is a sufficient amount of time to make progress and decrease trauma symptoms. Ideally, trauma work would continue on beyond outpatient treatment.