Among the general population, about 20 percent of people have experienced a serious trauma. Among eating disorder patients, that number more than doubles to roughly 50 percent. The loss of a loved one, a serious accident, and abuse of all kinds - physical, emotional and sexual - are far more prevalent in people who suffer from eating disorders. What is the connection and how does it affect treatment?
Though specific reactions to trauma are varied, they can generally be placed into one of three categories: feeling out of control, developing feelings of self-hate, and associating positive things with negative things.
Traumatic experiences, whatever they are, often leave a person feeling helpless, especially if the trauma occurred during childhood. The desire to regain control can express itself in an eating disorder. An anorexic, for example, may find reassurance in her ability to restrict her food intake. Society places a high value on body image, often equating thinness with self-control. So in the mind of someone who has experienced severe trauma, restrictive eating represents a return of the control she feels she has lost.
For others, an eating disorder is a form of self-harm. Trauma, especially physical and sexual abuse, can cause overwhelming feelings of self-loathing. Depriving the body of food, by either purging or eating nothing at all, becomes the trauma victim's way of punishing herself.
Some individuals may use an eating disorder to change their bodies. This is especially true of patients who suffered sexual abuse as a child. They become almost desperate to change the way their body looks, either because they blame themselves for the abuse or in an effort to prevent it from recurring. A woman, for example, who suffered sexual abuse as a child may use an eating disorder to make her breasts smaller and reduce the curve of her hips, trying to look less feminine and less attractive.
One of the greatest conflicts that can arise in the mind of an abuse victim is an association between good and bad things, especially in instances of sexual abuse. The victim may not have received affectionate attention at any other time than during the abuse, which creates an unhealthy connection between something good (the attention) and something horrifying (the abuse). The connection between good and bad also exists in eating disorders, especially with bulimia or binge-eating. The binge brings with it comfort and pleasure, followed either by the pain of purging or feeling sick from overeating.
Regardless of how trauma is processed or expressed in eating disorder sufferers, treatment needs to be included in the overall recovery plan. One of the greatest challenges with this type of dual treatment is that victims of abuse have a hard time trusting people and feeling accepted. This can hinder the counseling process or make the sufferer unwilling to participate in certain types of treatment. As such, progress - especially in the beginning - can be very slow.
Some therapists and psychiatrists will say that the trauma must be treated first because it's the underlying cause of the eating disorder. However, most in the medical community agree that both issues need to be treated simultaneously. An eating disorder can become life-threatening if the behavior continues, but even in a best-case scenario, mild forms of disordered eating can have devastating effects on a person's health.
It should never be assumed that an eating disorder is the result of some previous trauma. Any person who struggles with disordered eating needs to seek help immediately, regardless of the cause.
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