The Intersection of Eating Disorders and Trauma: A Therapeutic Approach

the relationship between eating disorder and trauma

Eating disorders are complex mental health conditions that can have devastating effects on individuals’ lives. They often intersect with trauma, creating a unique and challenging set of circumstances. Understanding this intersection and adopting a therapeutic approach that addresses both the eating disorder and the underlying trauma is crucial for effective treatment and recovery.

Today, I want to explore the relationship between eating disorders and trauma, examine how trauma can contribute to the development of eating disorders, and discuss therapeutic strategies for addressing both issues simultaneously.

Understanding Eating Disorders and Trauma

Eating disorders encompass a range of presentations, including anorexia nervosa, bulimia nervosa, and binge eating disorder. These disorders involve disturbances in eating behaviors, body image, and weight regulation, and they often co-occur with other mental health issues such as depression, anxiety, and substance abuse.

Trauma, on the other hand, refers to experiences that are deeply distressing or disturbing and overwhelm an individual’s ability to cope. Trauma can take many forms, including physical, sexual, or emotional abuse, neglect, accidents, natural disasters, or witnessing violence. These experiences have profound and long-lasting effects on a person’s mental, emotional, and physical well-being.

The Relationship Between Eating Disorders and Trauma

Research has shown a strong correlation between eating disorders and trauma. Many individuals with eating disorders have a history of trauma, with studies suggesting that up to 80% of patients with eating disorders report a significant trauma history. Trauma can precede the onset of the eating disorder or occur concurrently, exacerbating symptoms and complicating recovery.

Several factors contribute to the relationship between eating disorders and trauma. For some individuals, disordered eating behaviors may develop as a coping mechanism to numb or escape from painful emotions and memories associated with trauma. Restricting food intake, binge eating, or purging can provide a temporary sense of control or relief from overwhelming feelings of fear, shame, or worthlessness.

Additionally, trauma can distort an individual’s body image and self-perception, leading to dissatisfaction with their appearance and a preoccupation with weight and shape. This distorted body image can fuel the development of eating disorders and perpetuate harmful behaviors aimed at achieving an unattainable ideal.

Furthermore, the experience of trauma can disrupt the regulation of stress hormones and neurotransmitters in the brain, affecting appetite, mood, and impulse control. Dysregulation in these systems may contribute to the development and maintenance of disordered eating patterns.

Therapeutic Approaches to Addressing Eating Disorders and Trauma

Effective treatment for individuals with co-occurring eating disorders and trauma requires a comprehensive and integrated approach that addresses both the symptoms of the eating disorder and the underlying trauma. Therapists must create a safe and supportive environment where clients feel comfortable exploring their experiences and emotions.

Trauma-Informed Care

Central to treating individuals with co-occurring eating disorders and trauma is the adoption of a trauma-informed approach to care. Trauma-informed care recognizes the prevalence and impact of trauma on individuals’ lives and emphasizes safety, trustworthiness, choice, collaboration, and empowerment in the therapeutic relationship.

Therapists working with this population should be knowledgeable about the effects of trauma on mental and physical health and be sensitive to the potential triggers and re-traumatization that may occur during treatment. Creating a sense of safety and predictability is essential for building trust and facilitating healing.


Psychoeducation plays a crucial role in helping clients understand the connections between their eating disorder and trauma and empowering them to make informed choices about their recovery. Providing information about the physiological and psychological effects of trauma and how they relate to disordered eating behaviors can help clients develop insight into their experiences.

Additionally, psychoeducation can help clients learn coping skills and strategies for managing distressing symptoms and triggers. Teaching mindfulness techniques, grounding exercises, and emotion regulation skills can provide clients with tools to navigate complex emotions and sensations without resorting to maladaptive behaviors.

Cognitive-Behavioral Therapy (CBT)

Cognitive-behavioral therapy (CBT) is one of the most widely used and empirically supported treatments for eating disorders. CBT focuses on identifying and challenging dysfunctional thoughts and beliefs related to food, weight, and body image and developing healthier coping strategies and behaviors.

In the context of trauma and eating disorders, CBT can help clients recognize and challenge the negative beliefs and coping mechanisms that have developed in response to their traumatic experiences. By identifying and reframing maladaptive thoughts and behaviors, clients can develop more adaptive ways of coping with distress and managing their eating disorder symptoms.

Emotion Focused Family Therapy (EFFT)

EFFT, a well-researched family-based model, offers caregivers and significant others a significant role in supporting their loved ones recover from an eating disorder and PTSD. Therapists empower caregivers by offering targeted behaviors and emotional support, facilitating therapeutic apologies, and working through obstacles and fears in the process of caring for their loved one.

Internal Family Systems (IFS)

IFS approaches eating disorders and PTSD symptoms as “parts” that are protective in an individual’s internal system. According to the IFS Institute, IFS conceives of every human being as a system of protective and wounded inner parts led by a core Self. From an IFS perspective, the mind is naturally multiple and that is a good thing. Just like members of a family, inner parts play extreme roles within each of us. The core Self is in everyone. It can’t be damaged. It knows how to heal.

Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy (DBT) is another evidence-based treatment that can be effective for individuals with co-occurring eating disorders and trauma. DBT combines elements of cognitive-behavioral therapy with mindfulness-based practices and emphasizes acceptance and change.

In the context of trauma, DBT skills such as distress tolerance, emotion regulation, and interpersonal effectiveness can help clients build resilience and coping skills to manage the intense emotions and triggers associated with their traumatic experiences. By learning to tolerate distress without resorting to self-destructive behaviors, clients can develop healthier ways of responding to their emotions and experiences.

Eye Movement Desensitization and Reprocessing (EMDR)

Eye movement desensitization and reprocessing (EMDR) is a specialized form of therapy that has been shown to be effective in treating trauma-related symptoms. EMDR involves accessing and reprocessing traumatic memories while simultaneously engaging in bilateral stimulation, such as eye movements or tactile stimulation.

In the context of eating disorders and trauma, EMDR can help clients process and integrate traumatic memories and experiences that may be contributing to their disordered eating behaviors. By reprocessing these memories, clients can reduce the intensity of associated emotions and beliefs and develop a greater sense of control and self-efficacy.

Family Therapy

When family is involved in the treatment of PTSD and eating disorders, the prognosis is better. Family therapy can help improve communication, strengthen relationships, and address patterns that may inadvertently contribute to the maintenance of the eating disorder and trauma symptoms.

We heal in community. Involving family members and other important relationships in treatment provides invaluable support and resources for clients as they work toward recovery. Family therapy helps families understand the impact of trauma on their loved one and learn concrete emotion and behavior coaching skills to provide support and encouragement throughout the healing process.


I have been treating PTSD and eating disorders for over 20 years. I’ve witnessed the mental and physical illness and loss of life that results in being trapped in these deeply entrenched struggles. As a pragmatist committed to employing effective and efficient treatment, I have developed a deep reverence for the power of psychedelics as a possible tool to enhance the therapeutic process. The therapeutic use of psychedelics targets and transforms these emotion processing difficulties even when people have been trapped in patterns for decades! Off-label interventions are commonly used for PTSD, particularly complex, chronic, and refractory PTSD. Ketamine is a psychedelic medicine that has been used off-label to treat major depressions has been found to have a rapid and robust antidepressant effect, and has shown to have rapid and robust antidepressant effects for major depression, and shows potential for the treatment of PTSD.

Our Therapeutic Approach

Our approach to treating eating disorders and trauma is both individualized and anchored in evidence-based treatments. We adhere to the principles of Intuitive Eating and Health at Every Size, emphasizing a holistic view of health and wellness. We integrate mindfulness, Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Emotion Focused Family Therapy (EFFT), and Internal Family Systems (IFS) into our therapeutic framework, tailoring our approach to meet the unique needs of each individual.

Living with an eating disorder and a history of trauma can feel isolating and overwhelming, often disconnecting individuals from their true selves and deepest values. Through therapy, we delve into the complex relationship between food and body, reclaiming safety within the self and offering new coping strategies to navigate emotions and reconnect with bodily signals. Beneath the surface of the eating disorder and the trauma lie unexplored parts of the self, waiting to be acknowledged, heard, and understood.