How PTSD and Complex Trauma Shape Disordered Eating
While trauma can affect many areas of our lives, food and eating behavior are often left out of the conversation. Trauma and eating behaviors can be strongly linked for some people. While an eating disorder is not a direct symptom of trauma (yes, you read that right), trauma and disordered eating are often closely tied. Many studies explore the connection between Trauma/PTSD and food and eating. So, where does the connection stand between PTSD, complex trauma, and disordered eating? Well, in this article, we’ll try to get to the bottom of how PTSD and complex trauma shape disordered eating and help you get the support you need to bring about change.
Understanding PTSD and Complex Trauma
Post-Traumatic Stress Disorder, or PTSD, can occur in the wake of a horrific, life-threatening event, either directly or through exposure to someone else’s horror. Examples of such traumatic events can include a car accident, physical and/or sexual assault, domestic violence, and natural disasters. People with PTSD often exhibit one or more of the following symptoms:
Recurring and intrusive memories of the event
Avoiding anything associated with the event
Diminished emotional responsiveness to other stimuli and a general sense of isolation
Exaggerated startle response and a state of constant hypervigilance
Complex trauma is the experience of multiple or prolonged traumatic events, in many cases, beginning in childhood. Examples of complex trauma include: chronic abuse and neglect, domestic violence, exposure to violence, severe bullying, repeated exposure to hazardous environments, long-term food insecurity, etc. Similar brain systems appear in stress, emotional regulation, threat detection, and also appetite, gut function, and impulse control. This overlap contributes to the common effects on eating behaviors. Both PTSD and complex trauma can impact the body’s stress response system and affect the brain regions that regulate emotional experience and other functions. Such changes can lead to increased levels of cortisol, the primary stress hormone, which is involved in the body’s metabolic response to stress and affects fat storage and breakdown in the body.
Biological Susceptibility and Trauma
It is important to say clearly that genes alone don't determine your destiny. In reality, our genetics interact with a complex interplay of environmental and social factors. Brain imaging research has identified specific changes in regions related to impulse control, fear response, and interoception in individuals with trauma-related conditions and eating disorders. While these findings help us better understand why these patterns occur, they do not negate the fact that individuals have choice and free will in their behaviors. Importantly, the brain is highly adaptable, and these changes are not irreversible — our brains have the capacity to adapt and change! While PTSD and complex trauma are frequently correlated with disordered eating, it is important to remember that people can have trauma and not have an eating disorder. There are many factors at play, and biology is just one of them.
Why Eating Behaviors Are Sensitive to Trauma
The impact of food on our physical bodies is very clear. It can be comforting to us, especially if we are feeling stressed, sad, or alone. It can give us a feeling of routine or structure in an increasingly chaotic world. And, it can be a way of gaining control in an otherwise uncontrollable environment. For someone with a history of anxiety or trauma, food can serve as one of their coping mechanisms to deal with the overwhelming body sensations that arise as a result.
Trauma can also create a body disconnection, where people lose touch with their physical bodies and experiences. Some experience numbness or detachment from the physical body. Some people experience the opposite: overwhelm of physical sensations. This complex relationship with the body and food can ultimately contribute to the development of disordered eating.
PTSD and Complex Trauma Shape Disordered Eating: Control, Safety, and Predictability
One of the most common descriptions from those who have experienced trauma is a lack of feeling in control during the traumatic event. In an attempt to regain a sense of control, restrictions around food and eating can become a way to feel that there is predictability in an unpredictable world. For example, the rigid diet and the endless monitoring of body weight and shape can feel like a way to regain a sense of predictability and control.
What makes binge eating feel necessary for one person may be different for another. For some, binge eating provides a way to cope with anxiety and/or emotional pain. Food can trigger feelings of calm and comfort in the body, a process known as safety signaling. The “high” from the food feels good, and it ditches the uncomfortable emotional state for a time. But the feeling doesn’t last. And so the binge eating continues as the body and the mind rely on the food to feel better, even though it’s only a temporary fix.
Here is some very important information to understand about any compulsive and addictive behavior. Behaviors often begin as means to survive in the new and frightening world. These types of behaviors are not weak, and they are not something you can just choose to stop doing if you just exercise more willpower or stop being so dramatic or something equally as lacking in understanding. Rather, there are very compelling reasons and neurobiological “impasses” that force the brain to “act out” in such ways, because it perceives that stopping to do so will cause greater harm than continuing in this particular manner.
Body Image, Shame, and Trauma
Shame is a common aftereffect of traumatic events. Shame is often at the root of the bodily complaints and feelings of being disconnected from the body that are seen in survivors. In the aftermath of trauma, survivors may feel shame about what happened. Interpersonal trauma, such as abuse or neglect, often evokes shame, and the body can become the locus of this shame. Many trauma survivors feel unsafe within their bodies and are frequently consumed by feelings of shame about their bodies. Shame, which is already heightened due to trauma, can further exacerbate feelings of self-loathing and self-hate and may keep survivors locked in a cycle of self-blame and hopelessness.
Body modification through disordered eating behaviors can become a coping mechanism and be further exacerbated by weight stigma. Focusing on weight, shape, and food consumption can serve as a distracting and deflating method to ward off overwhelming emotions and painful memories. However, this coping method, though created as a method of protection, introduces a new host of concerns and problems.
A Trauma-Informed Path Forward
Trauma is not the sole cause of eating disorders, but it's important to recognize its impact. Trauma-informed care practices focus on the concepts of safety and choice. It emphasizes using non-accusatory language and easing rigid structures and routines as part of its approach. In other words, recovery means learning to manage new emotions, find healthy ways to relate to the body, and build trust. That often involves therapy, nutrition, and medical care. Healing is rarely a straightforward process. Even when setbacks occur, healing that has taken place cannot be undone.
Empowerment Through Understanding
Understanding how PTSD and complex trauma shape disordered eating can reduce self-blame. In the end, disordered eating is not a moral failing — it is frequently a coping mechanism for managing overwhelming physiological stress. And just because trauma is a part of your complicated history, it does not have to be the future.
