“Why doesn’t she just leave?” is often a misinformed question that is continually posed about women who stay in abusive relationships. “Why can’t she just eat?” is another misguided question, but is geared towards individuals who have an eating disorder and is often seen as a more acceptable question to ask. Although societal awareness of trauma has increased over the years, especially in the wake of the #MeToo Movement, a lack of understanding surrounding trauma and eating disorders (ED) is still prevalent in today’s culture. The number of individuals who believe that eating disorders are a choice is shocking; if the idea that if a person with an eating disorder would just eat was that easy, the problem would be solved. This perspective is highly outdated and lacks awareness that something much deeper is occurring.
Understanding what an eating disorder looks like is crucial in order to understand how it relates to trauma. In health class, most students read a brief chapter on eating disorders and their textbook has a picture of an emaciated, white girl looking in a mirror. This image severely misrepresents the individuals who can be affected by an ED, and leads to a lack of awareness and education across systems. Anorexia Nervosa (AN) and Bulimia Nervosa (BN) are the most commonly-known eating disorders, but others exist, including Avoidant/Restrictive Food Intake Disorder (ARFID), Binge Eating Disorder (BED) and Otherwise Specified Feeding or Eating Disorder (OSFED). Restricting food, compulsively exercising, purging food, eliminating food groups, clean eating and other eating disorder behaviors are ways to exert control over one’s life. People with eating disorders can be emaciated or live in a larger body. They can be any race, sexual orientation or gender. Just like domestic violence, eating disorders do not discriminate.
In a 2012 study, rates of traumatic events in persons with eating disorders ranged from 37%-100%, and a full PTSD diagnosis in eating disorder clients ranged from 4%-52%. Both PTSD and eating disorders have high rates of dissociation, and ED behaviors (including those listed above) are often an unhealthy coping skill to distract oneself from disturbing emotions and memories caused by traumatic events. For example, a woman who has experienced intimate partner violence may find temporary relief from painful memories by exercising every day for long periods of time, and severely restricting her food intake. In today’s society, fitness and healthy eating are glorified, and most people would not think twice about this woman’s behavior, but they should. An informed clinician would see that her behaviors are stemming from an eating disorder and allow her to numb out by engaging in them.
In order to effectively treat eating disorders, clinicians need to recognize the strong correlation between EDs and trauma. Eating disorders are about control, and individuals who have experienced trauma, in whatever form, use disordered behaviors to feel a sense of agency in their lives. Although not every eating disorder stems from a traumatic event, the statistics show that a high majority of them do. In a two-year study of ED clients at a hospital, the most prevalent traumas were domestic violence (5%), physical abuse (5%), sexual abuse (8%), death/loss (9%) and bullying (10%). As researchers continue to gather more evidence on this topic, the more they are finding that men and women with trauma and/or PTSD have higher rates of eating disorders than the general population. With a greater understanding of trauma and how it can manifest itself, clinicians are able to treat clients more effectively and get to the root of the issue. An eating disorder is not a food issue and it is not a choice; it is something much deeper and requires compassion, understanding and patience.
The National Eating Disorders Association (NEDA) has incredibly helpful resources and articles to learn more about the correlation between eating disorders and trauma, and how to help someone who may have an ED.
Written by Megan Baak, operations administrator for the Conference on Crimes Against Women and the Institute for Coordinated Community Response.