TREATING EATING DISORDERS & TRAUMA: AN EXPERIENTIAL APPROACH
Full recovery from an eating disorder requires healing co-occurring symptoms like trauma.
While no single factor is responsible for the development of an eating disorder, there are a number of issues, including trauma, that can increase a person’s susceptibility.
What is Trauma?
Trauma occurs when one’s boundaries are breached- physically, emotionally, or otherwise. It can be experienced as a one-time event, a prolonged event, or a series of events.
Traumatic injuries shock our cognitive, emotional, physical, spiritual, and even social systems and live in the body’s deep reservoir of memory. (“Our issues live in our tissues.”) We cannot address or heal them without looking at the whole person.
An eating disorder can be a symptom of trauma- a means to express boundaries and control. For some, eating disorders serve as a language to express things they lack the skills or security to communicate in any other way.
Types of Trauma
Some types of trauma are listed below as examples; however, it is important to know that there are other types of trauma as well, and that all types of trauma are valid. We do clients a disservice by not reminding them of this, because while some people in recovery can describe obvious experiences of trauma, others may feel as though they are “not sick enough” because their traumatic experiences are less obvious or don’t have a name yet. Trauma isn’t pie; one person doesn’t have less of it simply because another person appears to have more.
- Sexual abuse and assault
- Natural disasters
- Domestic violence
- Medical events such as severe illness or injury
- Loss of a loved one
- Long-term codependent relationships
- Abandonment, neglect or attachment injuries
- Generational trauma
- Racial trauma
- Emotional abuse
- Forced displacement or relocation
- Witnessing violence
The Connection Between Eating Disorders & Trauma
Perhaps not all but definitely the majority of our eating disorder clients have experienced trauma that somehow contributes to their disordered eating behavior.
For people living with severe trauma that has not been acknowledged or processed, it is not uncommon to develop maladaptive coping mechanisms, such as disordered-eating behaviors, to self-soothe.
For these people, and that is to say MOST people, disordered eating is not “the problem.” Rather, eating disorders are often the client’s maladaptive solution to their problem. In the short term, eating disorders may actually provide some sort of harm mitigation and a way to survive– until they do the opposite.
If trauma is the loss of boundaries, autonomy, and control, then disordered eating is seen as a way to reclaim a sense of control-whether consciously or subconsciously- with the added appeal of numbing what is too painful to acknowledge. But while an eating disorder may enable someone to survive, it will never allow someone to thrive. Therefore, in order for eating disorder treatment to be effective, we know we must address the impact of trauma simultaneously.
Treating Trauma & Eating Disorders
People with trauma are not broken. If that were the case, most of us would be in pieces because most of us have had our boundaries violated. Look at it more scientifically:
When someone experiences trauma, it is stored unconsciously as implicit memory. These memories are fragmented, disconnected, and difficult to pin down but are always present and can be easily activated or triggered. When that happens, the client’s own senses can be weaponized against them, forcing them to re-remember or even re-experience the traumatic event.
Our goal as therapists is to create integration of what is fragmented to help the client move toward health and wellness. We explore both implicit and explicit content. We do this in a variety of ways that, when tied together, help clients heal all of their pieces. This puts the client into a position where they can see trauma as something outside of themselves rather than something lurking in their subconscious. It gives them their power back and creates a boundary. (“This is where I begin and my trauma ends.”)
Some methods we use at Alsana include:
- Sand tray therapy: This is a form of expressive therapy that allows clients to illustrate their trauma, one session and one step at a time, with their therapist present. We actively aid in facilitating this expression, teasing out the details at a pace that is ultimately set by the client.
- Movement: Creating positive associations with the body is vital for feeling safe and grounded. Whatever trauma someone has experienced, it happened while they were living in their body. Naturally, this can lead to dissociation or even contempt for the body. If we want to help someone return to their life, we have to help them return to their body and it is difficult to do this without movement.
- Mindfulness: This is the practice of keeping the mind where the body is– in the present moment. Again, if we hope to welcome someone back to their life, we must help them find a way back to the present–that place and time where their life is happening. Breath work, meditation, and other mindfulness practices promote a state of calm and clarity.
- Body awareness: We help clients learn to identify and follow what is happening in their own bodies. This helps us to understand what sensations are associated with the client’s triggers, emotions, moods, etc.
- Self-compassion: This is the ability to treat one’s self with the same loving kindness, forgiveness, and patience that we extend to our loved ones. Healing from trauma involves recognizing one’s own humanity and it can’t be done without practicing self-compassion.
We want to understand each client’s trauma responses, triggers, and make sure to do so at a pace that allows the client to be grounded and present. As we do this, we build resilience and widen the client’s window of tolerance to everyday stressors and stimuli.
Four Big Things to Remember About Treating Trauma
- Pacing is key: We don’t push clients into the deep end of their trauma and tell them to swim. PACING IS IMPORTANT, as too much too quickly will flood the client’s senses and they will become overwhelmed, likely reverting to maladaptive ways of coping.
- Don’t be avoidant: While we do take it slowly, we don’t avoid trauma triggers because we don’t want to validate them. We have clients observe their physical and emotional thresholds and help them take the next steps to uncouple their trauma and triggers.
- Widen your perspective of WHAT trauma is and WHO experiences it: As we mentioned before, we don’t want clients to feel they are unworthy of treatment simply because their experience of trauma doesn’t look like the most familiar and gruesome examples of trauma. All trauma is valid and cumulative and, like eating disorders, it impacts all genders, sexual orientations, ethnicities, and ages.
- We don’t escape trauma, we manage it: Trauma is part of being a human being. As we help clients move their implicit memories to verbalization and explicit memory, we also empower them by helping to build a mastery of coping skills that can be called upon if needed instead of reverting back to eating disorders or other maladaptive coping behavior.
Another Important Note About Trauma & Eating Disorders
Eating disorders are rarely linked to one factor alone. It’s not neat, tidy, and convenient like that. But as we have seen, there is a strong correlation between eating disorders and trauma- maybe more than most people realize.
Much in the same way that trauma can be a triggering event for disordered eating, having an eating disorder or any mental illness makes a person much more susceptible to violence and certain kinds of traumatic situations. In fact, people with severe mental illnesses are more than 10 times more likely to be victims of violent crime than the general population.
Once clients are stuck in this vicious loop, fueled by their eating disorder and isolation, their ability to trust may be severely diminished, making it difficult to receive help. Recovery happens in community, and when our community knows better, we do better for those we serve. That’s why we feel so strongly about educating ourselves and one another about trauma and why we hope that the general population will join us in trying to better understand this issue.
Meet the Authors
Rebecca Baker, M.Ed., LPC, SEP, CEDS
Regional Executive Director
“I feel personally fulfilled when I am able to connect with clients who are in distress and serve as a supportive figure for them. I work to assist clients in processing difficult experiences and it is rewarding to see clients move through them with greater confidence and trust in themselves. It is especially fulfilling when I see clients conquering the world, starting families, getting their master’s degree, facing their perpetrators in court, or just generally being able to finally engage with life in a healthy way.”
Rebecca Wolfslau, MA, PLPC, NCC
Director of Clinical Services
“Seeing all of the little successes- even the unconscious ones- is the most fulfilling part of the work I do. Each time I meet with a client, even if there is struggle, I can see they are building new skills and neural pathways and that’s really important to me. I love it when I can see clients widening their level of tolerance and facing their fears.”