Eating Disorders are complex - this we know. How or whey they start or get triggered is also complex. What we do know is that disordered eating emerges as a way to cope and manage things like emotions, stress and the environment. We must then acknowledge that those dealing with disordered eating often have experienced some level of trauma. Leaning into this truth and incorporating an understanding of trauma is absolutely vital in treatment settings. Trauma can include the following:
Sexual harassment or assault
Physical abuse or assault
Emotional abuse
Emotional or Physical neglect
Teasing or Bullying
Death or loss of a loved one
We look to research that highlights the relationship between trauma and disordered eating to inform us. In simple terms, those who experience trauma are much more likely to develop an eating disorder later in life. Patients who have childhood trauma also often see an increase in OCD or anxiety. Let’s see what the research says:
Last year Brustenghi looked at 65 adolescents with eating disorders and found that they had statistically significant higher scores on several tests evaluating for trauma and emotional regulation (Brustenghi et al, 2019).
Brewerton, in his research, found a link between BED and BN with trauma. Women who reported sexual trauma had higher rates of PTSD and Eating Disorders (Brewerton, 2007).
Mitchell and colleagues, in 2012, found that 33.3% of women with BN, 20% of those with BED and 11.8% diagnosed with OSFED met criteria for lifetime PTSD. ED rates were higher in people with trauma and PTSD. Majority of men and women with AN, BN and BED reported a history of interpersonal trauma (Mitchell et al, 2012).
How do we become trauma informed clinicians?
First, especially for nutrition therapists, it is important to acknowledge how trauma then can affect bodily systems. The digestive tract can often bear the effects of trauma as it creates a cascade of events starting from the nervous system. Hypoarousal or “freeze” states lead to slow motility, sluggish GI tract and low energy and translates into ED symptoms like emotional overeating and bingeing. On the other end hyperarousal states like “fight” or “flight” lead to low appetite, hypermetabolism and IBS often related to restriction, purging and overexercise. For individuals with trauma to feel safe they must return to what’s known as “optimal zone” or “rest and digest”. As nutritionists, we can become facilitators guiding our clients towards the “rest and digest” zone as we support nurturance and balance.
There are eating disorder treatment programs that focus on trauma as well as full trauma programs that support those to heal and manage their experiences. These are amazing options that currently exist in our communities. Referring to a trauma specialist for therapy can also be instrumental in recovery. Cognitive- behavioral therapy (CBT) continues to be the most proven successful method in eating disorder recovery. However, modalities such as Somatic Experiencing and EMDR work best for trauma. Trauma informed yoga therapists are instrumental in supporting the team as well. It’s important to stay aware and open minded as a friend, client or clinician as to when trauma is part of an eating disorder. Here’s what you can do:
Become familiar with hyper and hypo arousal. What seems like low energy or anxiety can actually be the nervous system in either freeze, fight or flight modes.
Create a safe setting. Something as simple as lighting a candle during a nutrition session can often create a sense of peace.
Bring attention back to the body. Many times trauma manifests as a disconnect between the mind and the body. Healing this relationship can be a key to recovery. Using language like, “what do you notice” and “where does it land in your body” invites the body into the conversation.
Learn about Trauma. Attending webinars that help clinicians learn about traum can be essential for nutritionists. Our very own Executive Director, Maria Sorbara Mora will be presenting on this topic especially as it relates to nutrition professionals at the virtual Renfrew Conference in November. Her session, Body Bridges: New Pathways For Nutrition Therapists in Traditional Eating Disorder Treatment educates nutrition professionals how trauma affects the body, eating and movement. To learn more about the conference, https://renfrewcenter.com/renfrew-center-foundation/renfrew-conference.
