The intersection of trauma and eating disorders
Recently, I was interviewed on the “Food Freedom Podcast”, hosted by Dylan Murphy, RD, LDN. We talked all about this topic— the intersection of trauma and eating disorders.
This is a topic I’m really passionate about. As I continue to hone my vision for my career, I am realizing I will, in probably several capacities, be advocating for trauma-informed care and neuroscience-informed practices to be implemented into eating disorder treatment. There is starting to be a shift in this direction, and that excites me. But there is still so much work to be done.
I wanted to share a little bit about what Dylan and I talked about on her podcast.
First of all, in order to understand this intersection, you have to know what I mean when I use the word “trauma.” Trauma is not an event. It can be the event and it’s often used in that context. But when I use the word trauma what I’m referring to is the response. Trauma is what happens when we experience something too fast and too soon. Trauma is what happens in the body when the nervous system becomes overwhelmed.
When the body experiences trauma (the reaction), it becomes dysregulated and it seeks to return to a state of homeostasis by gaining back feelings of safety and control. Feelings of power, control, and safety are sought out not only in order for the body to return to a state of regulation but also to complete the trauma response. In other words, a person is trying to regain these things because they were missing and needed during the event that prompted the trauma response.
For people struggling with an eating disorder, certain ED behaviors serve as a means of power and control. They are attempts at self-regulation, a way of gaining back the power and control that was missing when the body became dysregulated. I do not want to be too tangential here, but what I do want to say is this— this is why eating disorders WORK. The behaviors are meeting a real and true NEED for the sufferer, which is why getting rid of the behaviors are really difficult. Therapists who treat eating disorders need to recognize just how much they’re asking when they ask a client to start to give up ED behaviors. For that client, these behaviors are truly what makes them feel powerful, controlled, and safe.
As mentioned above, eating disorder behaviors often serve as a way to achieve a sense of regulation, a sense of safety, which is what trauma ultimately robs a person of— the ability to feel safe in their body. So, ED behaviors are often manifestations of how someone is coping with their trauma.
Trauma activates our defense systems and the need for self-protection. When trauma isn’t processed, which it often isn’t, the body gets “stuck” in a certain defensive state (fight, flight, freeze, or fawn). In other words, self-protection becomes the body’s mode of operating in the world. Why? Because the person hasn’t had the opportunity to discharge the traumatic energy, typically due to a lack of coping skills.
Someone whose default MO is flight (run away/movement away from the threat) will present with anxiety, panic, obsessive thoughts, restriction, binge eating, or excessive exercise
Someone whose default MO is fight (run towards/engage) may present with purging, chewing and spitting, anger turned towards the body, and self-harm behaviors
Someone whose default mode is to freeze may feel disembodied, dissociated, and numb. They may be unable to track fullness or hunger, unable to engage in relationships, and experience depression
What typically happens is that a person struggling with an eating disorder is ebbing and flowing through these various states, multiple times a day. Just like the trauma is frozen, so is the behavior. So the ED behaviors become in many ways a way of reenacting the trauma over and over again. This happens unconsciously, in the most primitive parts of the brain. People with eating disorders don’t understand they’re doing this until it’s brought to conscious awareness.
Again, here lies the problem with eating disorders— they work! They do exactly what they’re supposed to do in that they provide feelings of safety to the sufferer and help relieve chronic feelings of anxiety, fear, and of being overwhelmed. This is why eating disorders are so hard to treat and also why people who have beat their eating disorders are some of the strongest, most badass people I know. It takes so much courage and bravery to lay down the armor.
So, I hope what you’ve learned here is that eating disorders are ineffective ways of getting very real needs met. Needs for power, love, safety, belonging, and control. Part of the healing process, then, is helping clients become conscious of this intersection (because every single human on this planet carries some amount of trauma in their body’s) and help them get their needs met in more adaptive ways.
This connection also makes a very strong case for the need to incorporate emotion-focused, experiential, and embodied therapies into eating disorder treatment. Historically, treatment has been very “top-down”. What I mean by that is therapy that targets the most mature parts of the brain, like the prefrontal cortex. Examples of this are very cognitive-type therapies, like CBT and DBT. Addressing disordered thoughts is SO important and necessary, but it also needs to be coupled with a more “bottom-up” approach. Because the parts of the brain that are needed to reappraise thoughts are fundamentally offline if a person is still reenacting their trauma and feel unsafe in their body. In other words, we need to incorporate therapies that target the lower-regions of the brain, the parts where the trauma is stored. This means working with the body, teaching client’s about their nervous systems, and using art, yoga, and movement in therapy.
With love,
Rachel