**This is just a short narrative about eating disorders and its relation to trauma**
Eating disorders fall into several categories: restriction of food, known as anorexia nervosa with subtypes, avoidant/restrictive food intake (sensory-based), binge eating disorder (also with subtypes), pica which is eating non-food substances, rumination disorder which is repeated regurgitation of food. Eating disorders are often misunderstood by the person who suffers from the disorders and by those around them. A person who does not have an eating disorder may not understand that an eating disorder is not about food or body image. While the categories of eating disorders may have different signs, symptoms, and presentations, there is a general agreement that each type shares one thing in common: the underlying cause and an attempt at self-regulation and control. (This excludes pica and avoidant/restrictive disorders.)
The American Psychological Association has shown that among the underlying triggers that contribute to eating disorders are poor parental relationships, bullying, low self-esteem, and past history of abuse or trauma. We cannot ignore familial, media, and societal influences around body image and food consumption. There is always the latest fad diet. Additionally, well-meaning doctors will tell patients they need to lose weight. As an example: one doctor told a patient “You have such a pretty face. Why wouldn’t you lose weight?”
Eating disorders are less about the actual food and more about having direct control over that specific aspect of life when control over practically every other part of life feels taken away. For example, when a person experiences a traumatic event, such as physical or sexual abuse, they may feel like they have lost control of their own bodies and their lives. As a result, they may feel powerless (and may in fact be powerless) so they will try to gain control where they can, which is often related to what they eat or whether they will eat at all or eat volumes of food.
Post-Traumatic Stress Disorder, a separate disorder, related to experiencing a particularly distressing event or a prolonged trauma, such as sexual abuse, has been studied in correlation with the diagnosis of an eating disorder. It has been found that 75% of women who have enrolled in residential treatment for an eating disorder had reported experiencing some form of trauma, and about half of the respondents had a history of PTSD.
The combination of trauma and an eating disorder leads to a vicious cycle of feeling like they are gaining control over an aspect of their lives, followed by self-blame, guilt, and anxiety. The anxiety is followed by using their eating disorder behaviors, to provide them with temporary relief, only to be quickly replaced once again by guilt, shame, depression, and anxiety. Eating disorders are used by a person as a survival skill when they see no better options. It gives them the illusion of self-regulation.
This cycle continues until their whole life becomes consumed by food, body image, and eating. A person’s health may become so compromised that they may finally seek help or family members may insist on this. Unfortunately, for some people, the only escape from this dreadful cycle is suicide attempts and other forms of self-harm. The eating disorder often spins out of control, while the person using the behaviors, fools themself into believing “it’s not that bad”.
Body image issues are more complicated than one might guess and go beyond wanting to look appealing. For folks that have experienced body-related trauma, medical or otherwise, the body becomes the receptacle of disgust, shame, and intense scrutiny. This body for them is the reason all is bad. If only the body can achieve “perfection”, be it an ideal weight, ideal muscle mass, the “right inches”, etc. then all is falsely believed to be well.
As we mentioned, eating disorders, which include distorted body images, are rarely about the food itself. Hence, the path to recovery from an eating disorder is not through the person’s restrictive or bingeing habits but rather to find and work through the underlying triggers or traumas that caused the disorder. While medications may be used to ease the symptoms of co-occurring disorders such as depression or anxiety, the initial treatment for an eating disorder is some form of therapy to get to the heart of the triggers and the source of the underlying trauma. A team approach, including a registered dietician, a psychiatrist, a medical practitioner (familiar with eating disorders), and a psychotherapist, is the gold standard of care for a person presenting with an eating disorder. Always carefully screen if there is an underlying hidden trauma that needs attention.
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