Complex trauma and eating disorders

What is complex trauma?

Complex trauma refers to a person’s exposure to several traumatic events that take place over an extended period of time and usually within certain contexts or relationships. These events are severe and may include:

• Chronic neglect or abandonment
• Domestic abuse
• Discrimination or race, gender identity, sexual orientation, and more
• Sexual, physical, and emotional abuse
• Repeated sexual assault
• Incest
• Military events
• Human trafficking
• Parentification
• Genocide campaigns
• Living in war zones
• Concentration camps
• Childhood trauma

The sequence of events that can lead to complex trauma are as follows:

• It is repetitive and cumulative
• It is often interpersonal, involving abandonment, exploitation, and other forms of harm
• It frequently occurs in early childhood or adolescence (but doesn’t necessarily have to)

An example of a persistent and long-lasting trauma could be when an individual is held in emotional or physical captivity and is unable to escape the danger and harm. (1)

Symptoms of complex trauma

Complex trauma symptoms may include:

• Problems with emotional regulation
• Memory lapses
• Flashbacks
• Dissociation, such as depersonalization or derealization
• Hyperarousal or always be on high alert
• Nightmares
• Relationship problems
• Poor self-esteem
• Avoiding settings, people, and situations that trigger you
• Feeling extremely anxious
• Distorted sense of self

Additionally, individuals who have endured complex traumatic events may experience distorted perceptions of the person or situation where the abuse or harm occurred and may experience a preoccupation with the people or events involved. They may also isolate themselves from friends and family and exhibit a general distrust of others. (1)

Complex trauma and C-PTSD

Complex trauma can have long-lasting effects on a person’s mental and emotional health and often leads to the development of complex posttraumatic stress disorder (C-PTSD).

Complex PTSD is characterized by a myriad of behavioral and psychological symptoms, such as: (1)

• Interpersonal difficulties or chaotic relationships
• Rage
• Depression
• Panic attacks
• Uncontrollable crying
• Impulsivity
• Aggressiveness
• Substance misuse
• Self-destructive behaviors
• Changes in personal identity
• Somatization, or mental health symptoms manifesting as physical or medical symptoms
• Shame, guilt, and helplessness
• Suicidal ideation
• Anxiety

The connection between complex trauma and eating disorders

There is little research on the connection between complex trauma and eating disorder behaviors; however, trauma and PTSD have been linked with eating disorders like anorexia nervosa (AN) and bulimia nervosa (BN). PTSD commonly co-occurs with eating disorders and can cause eating disorder symptoms to be more severe.

One study estimated that between 9% and 24% of people with eating disorders also have comorbid PTSD, while another one estimated prevalence as high as 52%. (2,3)

A lot of research has been conducted to understand the relationship between trauma and eating disorders. One study found that several types of traumatic events can lead to eating disorders, such as:

• Bullying
• Physical and emotional neglect
• Physical or sexual abuse or assault 

Women who’d experienced sexual trauma were more likely to experience psychological issues, including increased incidence of eating disorders and PTSD. Additionally, this study linked eating disorders with trauma in many different demographics, including boys and men and children and adolescents. It also found that trauma was more common in bulimia nervosa than in other eating disorders. (4)

The exact reason why trauma can lead to the development of an eating disorder is unknown. What researchers do know is that trauma can disrupt the nervous system’s functioning, which can lead to difficulties in emotional regulation. These difficulties could cause someone to cope with disturbing memories, emotions, or other symptoms of PTSD by engaging in disordered eating behaviors. Plus, sexual assault or sexual abuse can cause body dissatisfaction and self-criticism. Many of these individuals may want to become less “attractive” or “desirable” by gaining or losing a significant amount of weight.

Much like other mental illnesses, such as depression, anxiety, and substance misuse disorders, PTSD and eating disorders may also share similar biological and genetic factors that can increase the likelihood of developing these co-morbid conditions.

Minority populations

While further study is needed, research indicates that the prevalence of eating disorders in transgender individuals is significantly higher than in the cisgender population. 

The factors responsible for eating disorders in transgender people are complex, but there is evidence that oppression-based trauma—relating to discrimination and bias—can contribute to their development.

Marginalized individuals—including trans individuals and sexual minorities—experience higher rates of violence, discrimination, alienation, and social stigma. As a result of these experiences, marginalized populations often have worsened physical and mental health. 

In some cases, transgender and other marginalized individuals develop disordered eating behaviors to manage stressors. As the threats they face are daily, these individuals may come to rely on disordered eating as a way to maintain control or symbolize strength.

Military trauma

Trauma and eating disorders are more common in veterans and military populations. A recent study found that combat exposure was not associated with eating disorders. However, military sexual trauma was associated with double the risk of developing an eating disorder.

These results highlight the need to focus on those reporting military sexual trauma when implementing eating disorder screening and treatment programs.

Treating eating disorders and co-occurring PTSD

Whenever more than one mental health disorder co-occurs, treatment can become more complicated. Those with an eating disorder and PTSD require comprehensive and integrated care that fully addresses both conditions as well as how they affect one another. Someone with PTSD may struggle with trusting their therapist or doctor or allowing them to create a treatment plan, which is why establishing therapeutic trust is so vital to care.

Eating disorder treatment and treating trauma, such as PTSD, may include various therapies, such as:

• Cognitive Processing Therapy (CPT): Patients learn how to challenge and change maladaptive beliefs related to the underlying trauma they experienced, which can help decrease the ongoing effects of trauma.
• Prolonged Exposure Therapy (PE): Teaches patients to safely and gradually approach feelings, situations, and memories related to trauma, which then teaches them that these cues and memories don’t need to be avoided.
• Cognitive Behavioral Therapy (CBT): Examines the connection between thoughts, feelings, and behaviors to rectify disordered eating symptoms.
• Eye Movement Desensitization and Reprocessing (EMDR): Aims to alleviate the distress associated with traumatic memories by asking you to think about a traumatic event while moving your eyes from side to side. Gradually, a therapist will guide you toward more positive memories. Over time this process may help desensitize a person to their traumatic memories and thoughts.
• Interpersonal psychotherapy: Helps patients understand their eating disorder within the context of relationships and can address grief, interpersonal deficits like isolation, and more.
• Family therapy: Helps the patient and their family members understand the family dynamics and how loved ones can support the patient during the treatment and recovery process.
• Acceptance and commitment therapy (ACT): Encourages patients to examine their core values, develop goals that help them fulfill those values, accept all feelings, good and bad, and commit to changing their behavior to align with their values.

Patients with co-occurring PTSD or C-PTSD and eating disorders should be sure to seek out an appropriate level of care, such as inpatient treatment or partial hospitalization treatment, if they require an intensive level of support. These programs offer a higher frequency of therapy and support than standard outpatient programs.

Within Health offers trauma-informed care and support for people with eating disorders. Reach out to our team today to learn more about the Within treatment program.