Trauma’s Role in Triggering Eating Disorders

This article explains the relationship between traumatic experiences and eating disorders, including binge eating, anorexia, and bulimia.

Social media body image pressures can exacerbate eating disorders, and the process by which this takes place is described, alongside ways to tackle these issues for anyone suffering from difficult eating behaviors and body image issues.

What is an eating disorder?

In its Dictionary of Psychology, the American Psychological Association defines an eating disorder as:

‘Any disorder characterized primarily by a pathological disturbance of attitudes and behaviors related to food, including anorexia nervosa, bulimia nervosa, and binge-eating disorder.’

Reading this, you might be surprised to learn eating disorders are about so much more than food. Eating disorders and body image issues can be thought of as trauma made visible. In other words, much deeper issues are at play – often relating to traumatic experiences – that result in disordered eating behaviors.

Eating disorders tend to be an umbrella term for several diagnosable conditions. What follows is an explanation of each type of eating disorder – what it’s called, how it presents and its unique characteristics.

1. Anorexia Nervosa

Anorexia Nervosa, commonly known as anorexia, is a severe mental disorder characterized by an obsessive preoccupation with weight, food, and calorie consumption. Individuals grappling with anorexia experience an overwhelming fear of gaining weight, which leads them to restrict their food intake severely.

Those affected by anorexia often struggle to perceive their current body weight accurately. It’s important to note that Anorexia Nervosa without a significantly low body weight is categorized as Atypical Anorexia (refer to the OSFED section below).

Anorexia Nervosa can be classified into two subtypes:

• Restrictor Subtype: This subtype involves strict limitations on food intake.
• Binge/Purge Subtype: In this subtype, individuals consume large quantities of food, followed by purging behaviors, and typically have a history of food restriction.

2. Bulimia Nervosa

Bulimia Nervosa, commonly referred to as bulimia, is characterized by the recurring occurrence of binge eating episodes paired with compensatory actions.

Individuals battling bulimia repeatedly attempt to offset their eating episodes through practices such as fasting, self-induced vomiting, excessive exercise, or the use of laxatives, diuretics, or other medications. Similarly, they often exhibit heightened concerns regarding their weight and body shape.

3. Binge Eating Disorder (BED)

Binge Eating Disorder (BED) is characterized by recurring episodes of excessive food consumption. People with binge eating disorder may consume food at an unusually rapid pace, eat until they experience discomfort due to fullness, consume substantial quantities of food even when not hungry, and often feel emotions like guilt, disgust, or depression following these episodes of eating.

4. Body Dysmorphic Disorder (BDD)

Body Dysmorphic Disorder (BDD) manifests as an intense fixation on an imagined flaw in one’s physical appearance or an excessive preoccupation with a minor physical imperfection, which may go unnoticed by others. Those with body dysmorphic disorder often hold distorted perceptions of their body, focusing on particular body features like hair, skin, or the nose.

5. Avoidant/Restrictive Food Intake Disorder (ARFID)

Avoidant/Restrictive Food Intake Disorder (ARFID) is a condition that prevents individuals from eating certain foods. Those with ARFID may encounter substantial weight loss, nutritional deficits, reliance on dietary supplements, or disruptions to their psychosocial well-being.

6. Pica

Pica is characterized by the consumption of non-nutritive substances persisting for a minimum of one month. Individuals with pica may ingest ice, clay, soil, or paper items.

7. Rumination Disorder

Rumination Disorder is defined by the repetitive expulsion of food, which continues for at least one month. This behavior encompasses actions like re-chewing, re-swallowing, or spitting out food.

8. Other Specified Feeding or Eating Disorder (OSFED)

Other Specified Feeding or Eating Disorders (OSFED) arise when an individual exhibits some, though not all, of the criteria for a specific eating disorder.

OSFED encompasses several categories, including:

• Atypical Anorexia Nervosa manifests when someone displays anorexia symptoms with a body weight within or above the normal range.
• Binge Eating Disorder with episodes that are less frequent or do not persist long enough to warrant a formal diagnosis.
• Bulimia Nervosa with less frequent occurrences or insufficient duration to meet the full diagnostic criteria.
• Purging Disorder, where an individual engages in purging behaviors without experiencing binge eating.
• Night Eating Syndrome occurs when people consume at least 25% of their daily intake after the evening meal.

What are the signs and symptoms of an eating disorder?

Identifying an eating disorder can be a complex and delicate matter. One key indicator is observing a significant shift in people’s attitudes toward food and their bodies.

While there are more specific signs depending on the diagnosis, it’s crucial to recognize not everyone neatly fits into these categories, and all concerns related to eating and body image issues warrant immediate attention.

Emotional/Behavioral Indicators:

• Increased emphasis on weight loss, dieting, and controlling food intake
• Engagement in food rituals
• Withdrawal from social interactions
• Frequent instances of dieting and body-checking
• Pronounced mood swings

Physical Indicators:

• Noticeable fluctuations in body weight
• Gastrointestinal discomfort
• Feeling dizzy upon standing
• Difficulty concentrating and sleeping
• Challenges related to dental, skin, hair, and nail health

How many people have an eating disorder?

9% of the U.S. population, or 28.8 million Americans, will have an eating disorder in their lifetime^[1].

What are the dangers of eating disorders?

Eating disorders are one of the most deadly of all mental health conditions.

According to statistics from the National Association of Anorexia Nervosa and Associated Disorders (ANAD), the mortality rate for eating disorders in the United States equates to one death every 52 minutes or 10,200 deaths each year^[2]. About 26% of people with eating disorders attempt suicide^[3].

For those who do not die as a result of their eating disorder, they are still at high risk of other life-limiting symptoms. Many of the symptoms and effects of eating disorders cast a long shadow over sufferers’ lives.

Some of the key dangers associated with eating disorders include:

• Malnutrition: Most eating disorders involve restrictive eating patterns, which can lead to severe malnutrition. This can result in a host of health issues, including weakness, fatigue, and organ dysfunction.
• Physical health complications: Eating disorders can lead to a range of physical health problems, including electrolyte imbalances, heart problems, gastrointestinal issues, and bone density loss (osteoporosis). Severe cases can result in cardiac arrest, kidney failure, and other life-threatening conditions.
• Psychological distress: Eating disorders often co-occur with mood disorders like depression and anxiety. The constant preoccupation with food, weight, and body image can cause significant emotional distress and impaired quality of life.
• Social isolation: People with eating disorders may withdraw from social activities and relationships due to shame, guilt, or fear of judgment. This isolation can exacerbate feelings of loneliness and depression.
• Impact on relationships: Eating disorders can strain relationships with family and friends as the individual becomes increasingly focused on food and weight, leading to misunderstandings and conflicts.
• Reduced cognitive function: Malnutrition can impair cognitive function, affecting memory, concentration, and decision-making abilities.
• Developmental delays: In adolescents, eating disorders can interfere with normal growth and development, leading to delayed puberty and stunted growth.
• Dental problems: Frequent vomiting, often associated with bulimia, can lead to dental issues such as erosion of tooth enamel and cavities.
• Fertility issues: Eating disorders can disrupt hormonal balance, leading to irregular menstrual cycles in females and, in severe cases, infertility.
• Self-harm: Eating disorders are associated with an increased risk of self-harm, particularly in individuals who feel trapped by their disorder and are unable to break free from its grip.

How are eating disorders related to trauma?

Eating disorders and trauma are intricately linked in various ways. Studies estimate 30% of people dealing with eating disorders have experienced sexual abuse^[4], for example, and that other forms of abuse and neglect can also be considered risk factors for the development of eating disorders^[5].

Research has also shown trauma is more prevalent in individuals with bulimic eating disorders compared to those with non-bulimic eating disorders^[6], shedding light on the differential effects of trauma within the eating disorder spectrum.

Experiencing multiple episodes or forms of trauma can heighten the risk of developing eating disorders, suggesting a cumulative effect of trauma on these conditions. While trauma itself may not necessarily correlate with greater eating disorder severity, it is strongly linked to increased comorbidity, often mediated by post-traumatic stress disorder (PTSD), among individuals with eating disorders.

In other words, the complex interplay between eating disorders and trauma underscores the importance of recognizing and addressing the traumatic experiences that can contribute to the onset and course of these disorders, with a focus on comprehensive care and trauma-informed approaches in treatment.

What is the role of social media in the development of eating disorders?

The evolution of eating disorders is a multifaceted process influenced by a diverse array of biological, psychological, and sociocultural factors. An individual’s vulnerability to developing an eating disorder results from the intricate interplay among these elements, with specific risk factors differing from one person to another.

Having said this, research tells us body image issues are closely related to eating disorders, and this relationship can be exacerbated by social media pressures.

Body image is defined as a person’s thoughts, feelings, and perception of the aesthetics or sexual attractiveness of their own body^[7], and poor body image is a risk factor for the development of disordered eating and eating disorders.

Social media has been found to affect body image negatively. Over-engagement with social networking platforms and images leads to unattainable ideas of beauty standards, which ultimately results in low self-esteem and body image issues^[8].

Eating disorders are particularly complicated because they are centered on the body. In a culture that values thinness, youth, physical ability, and attractiveness, many people who experience difficulties in their lives of any kind may struggle to accept their bodies, particularly when so many external messages tell us that our bodies are wrong.

There are also intersections between eating disorders and other mental health conditions (such as anxiety and depression^[9] or post-traumatic stress disorder^[10]) and physical health conditions (particularly digestive issues^[11]).

Finally, there is a relationship between individuals with marginalized identities being at higher risk of developing eating disorders.

For example, Black teenagers are 50% more likely than white teenagers to exhibit bulimic behavior, such as binge-eating and purging, and yet Black, Indigenous, and People of Color are significantly less likely than white people to have been asked by a doctor about eating disorder symptoms^[12].

Neurotype is another key intersection to consider when looking at eating disorder development. Research tells us 20-30% of adults with eating disorders also have autism, 3-10% of children and young people with eating disorders also have autism, and 20% of women with anorexia have high levels of autistic traits. There is some evidence these women benefit the least from current eating disorder treatment models^[13].

What are the protective factors against developing negative body image and eating disorders?

There are a range of protective factors that can act as a shield against the development of eating disorders.

High self-esteem and a positive body image form a foundation of self-regard that offers some protection. This is bolstered by critical media processing, often called media literacy, which empowers individuals to navigate and question societal beauty standards.

Emotional well-being and academic achievement also provide vital reinforcement, while qualities such as self-direction, assertiveness, and adept social skills enable individuals to excel in various social roles. Individuals equipped with effective problem-solving and coping skills are better prepared to navigate life’s challenges.

Belonging to a family that prioritizes holistic well-being over an undue focus on weight and physical attractiveness can also be protective, as can the practice of eating regular meals together as a family, fostering a healthy relationship with food, and promoting a supportive environment.

These interconnected factors weave a tapestry of resilience, helping individuals fortify themselves against the influence of eating disorders.

Treatment for trauma and eating disorders

At The Center • A Place of HOPE in scenic Washington State, we offer compassionate and comprehensive treatment options for individuals grappling with the complex challenges of trauma and eating disorders.

Our specialized programs are designed to provide a nurturing and healing environment where clients can embark on their journey toward recovery. Our experienced team of clinicians and therapists tailor treatment plans to address the unique needs of each individual, focusing on evidence-based therapies to promote lasting healing and transformation.

Whether you’re seeking support for trauma-related issues or looking to overcome the debilitating effects of an eating disorder – or both – we are committed to guiding you on a path to recovery.

Get Help Now. Call 1-888-771-5166 (8am-5pm PT), schedule a call or complete our treatment form.

1. & 2. Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020. Available at: https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/.
3. Arcelus, Jon et al. “Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies.” Archives of general psychiatry 68,7 (2011): 724-31. https://doi.org/10.1001/archgenpsychiatry.2011.74
4. Behar, R, Arancibia, M, Sepulveda, E, Muga, A. (2016). Child Sexual Abuse as a Risk Factor in Eating Disorders. Eating Disorders: Prevalence, Risk Factors and Treatment Options. Nova Science Publishers. 149-172. Retrieved April 4, 2023 from https://www.researchgate.net/publication/311899862_Child_sexual_abuse_as_a_risk_factor_in_eating_disorders
5. Brewerton, T. D. 2005. Psychological trauma and eating disorders. Review of Eating Disorders, 1: 137–154.
6. Lilenfeld, L. 2004. “Psychiatric comorbidity associated with anorexia nervosa, bulimia nervosa and binge eating disorders”. In Clinical handbook of eating disorders: An integrated approach, Edited by: Brewerton, T. D. 183–207. New York: Marcel Dekker, Inc.
7. Grogan, S (2016). Body image: Understanding body dissatisfaction in men, women and children. Taylor & Francis.
8. “The beauty myth puts big users of social media at risk of low self-esteem”. University of South Australia. Retrieved November 1, 2017.
9. Ballenger , J. C. , Davidson , J. R. , Lecrubier , Y. , Nutt , D. J. , Foa , E. B. Kessler , R. C. 2000 . Consensus statement on posttraumatic stress disorder from the International Consensus Group on Depression and Anxiety . Journal of Clinical Psychiatry , 61S : 60 – 66 .
10. Brady , K. T. , Killeen , T. K. , Brewerton , T. D. and Lucerini , S. 2000 . Comorbidity of psychiatric disorders and posttraumatic stress disorder . Journal of Clinical Psychiatry , 61S : 22 – 32 .
11. Staller, K., Abber, S.R. and Burton Murray, H. (2023) ‘The intersection between eating disorders and gastrointestinal disorders: A narrative review and practical guide’, The Lancet Gastroenterology & Hepatology, 8(6), pp. 565–578. doi:10.1016/s2468-1253(22)00351-x.
12. Becker, A. E., Franko, D. L., Speck, A., & Herzog, D. B. (2003). Ethnicity and differential access to care for eating disorder symptoms. International Journal of Eating Disorders, 33(2), 205-212. doi:10.1002/eat.10129
13. Solmi, F., Bentivegna, F., Bould, H., Mandy, W., Kothari, R., Rai, D., . . . Lewis, G. (2020). Trajectories of autistic social traits in childhood and adolescence and Disordered eating behaviours at age 14 years: A UK general population cohort study. The Journal of Child Psychology and Psychiatry, 62(1), 75-85. https://doi.org/10.1111/jcpp.13255