The Connection Between Trauma and Eating Disorders
As we started to explore in the first part of this series, Introduction to Eating Disorders, a diagnosis or presence of disordered eating is a complex issue, that is rarely about just food. To understand eating disorders involves peeling back many layers. When working with clients in therapy, I start from an understanding that disordered eating is a symptom or coping mechanism for unresolved core issues or feelings and not the whole story. While it is unclear exactly what mixture of factors predicts for the development of an eating disorder, research and clinical experience has shown a strong link between trauma and the occurrence of eating disorders, with approximately 60% incidence of eating disorders co-occurring with trauma. In this month’s blog, we will start to look at the link between trauma and eating disorders.
Trauma can be defined as an individual’s emotional response to an event(s) and the meaning they make of it. The DSM-5, used to diagnosis in the mental health field, now identifies trauma related disorders in a separate category, including Acute Stress Disorder, Post Traumatic Stress Disorder (PTSD) and Adjustment Disorders. For the sake of this specific topic, we’ll use a broad definition of trauma that is more inclusive for those who don’t meet the criteria set by the DSM-5 to show how trauma can affect the development of eating disorders.
The Amygdala, Hippocampus and Prefrontal Cortex are all regions of the brain involved in the trauma response. The Amygdala is an area of the brain associated with emotion and it connects to various sensory systems of the brain that control response. It helps to create associations in the mind with stimulus and emotion, which can then guide behavioral outcomes. Simply put, when you experience an event, the Amygdala is involved in the emotional reaction you have to that event. The Amygdala stores the details of the event, the Hippocampus processes the information, and the Prefrontal Cortex is involved with focusing, planning, managing emotions/impulses and various other higher functioning processes. This is why something can be considered traumatic to one person, but not cause a trauma response and vice versa. When there is a trauma response, studies of the brain indicate that the Amygdala has heightened activity, showing an increased fear response. For a more in-depth look at this topic, The Body Keeps the Score is an excellent resource for understanding how trauma impacts the mind and body.
When considering eating disorders or disordered eating patterns through the framework of managing or escaping emotions, it’s easy to see how a trauma response may play a role. As emotions are triggered from trauma or reliving associations from a traumatic event, an individual will seek to cope; restricting, binging, purging, or any combination of these methods offer a false sense of relief. Food can be used as one form of disassociation, a common experience with trauma survivors, sometimes described as an out of body experience. Disassociation occurs when an individual feels cut off from their thoughts, feelings, body and even the world. Initially the restricting, binging and/or purging can decrease anxiety or stress response through neurotransmitters, but the brain eventually adapts and the pathways in the brain change causing the eating disorder to function as an addictive feedback loop.
It’s important to note additional connections between shame, isolation, and feelings of loneliness are all key indicators of both trauma and eating disorders. If trauma is uncovered through the course of treatment with an eating disorder, its crucial to treat the underlying thoughts and feelings associated to facilitate change in eating disorder behaviors. In the next installment of this series, we’ll look at treatment methods associated trauma and eating disorders.