The link between medical trauma and eating disorders

What is medical trauma?

Medical trauma occurs when an individual experiences frightening treatment experiences in a healthcare setting. It involves a patient’s psychological and physiological responses to frightening or distressing medical treatment, illnesses, injuries, procedures, or pain. Much like other types of trauma, medical trauma can be a one-time event or ongoing.¹

Medical events that may cause medical trauma include:^2,3

• Shock related to a medical diagnosis (e.g., learning about a life-threatening illness)
• Emergency or unexpected medical procedures or interventions
• Hallucinations or paranoia brought on by delirium, such as the belief that the healthcare professionals are hurting them
• Conditions of the medical setting, such as terrifying sounds or sleep disturbances
• The nature of the injury or condition (e.g., life-threatening)
• Perceived or actual poor treatment by healthcare providers
• Prolonged time spent in a hospital for an acute or chronic illness
• Multiple genital or OB/GYN exams
• Invalidating or dismissive care, such as from medical professionals who are transphobic, homophobic, fatphobic, or racist

Medical trauma can cause many harmful consequences, including PTSD and eating disorders like anorexia nervosa, bulimia nervosa, or binge eating disorder. 

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Causes of medical trauma

If you have mental health issues like anxiety disorder or PTSD, you may have an increased risk of experiencing medical trauma. Otherwise, certain procedures, illnesses, and events (including psychological trauma) may lead to medical trauma and subsequent PTSD, such as:

• Life-threatening medical event: Surviving a potentially fatal medical event can increase a person’s risk of experiencing medical trauma and subsequent complications.
• Being in the intensive care unit (ICU): People who require care in the ICU, whether due to an accident, injury, or sudden injury, may feel helpless and out of control, especially if they experience a life-threatening event, which can be distressing and lead to PTSD.
• Heart attacks: People who survive heart attacks, especially those who had to be resuscitated, may develop medical trauma afterward.
• Racism: Racism, especially anti-Blackness, is prevalent in the medical community, causing staff to dismiss patient concerns or symptoms, spend less time with the patient, fail to provide culturally responsive care that considers the patient’s culture, beliefs, and traditions, and beyond—all of which can be traumatic and lead to PTSD.
• Weight stigma: Many medical professionals discriminate against people living in larger bodies, providing poor quality of care, invalidating or dismissing patient complaints, making inappropriate weight-related comments, and prescribing weight loss as an intervention. This can be traumatic for many individuals living in higher-weight bodies.
• Giving birth: This includes forced procedures against the gestational parents’ will, discriminated care, emergency c-sections, having an infant in the newborn intensive care unit (NICU), and more. 
• Cancer: For many people, receiving a cancer diagnosis and then going through prolonged or repeated treatments in the hospital can be a traumatic experience.

Not everyone who experiences the above events will develop medical trauma or PTSD; many different intersecting biological, psychological, and sociological factors influence a person’s response to terrifying or distressing events or emergencies.

​Symptoms of medical trauma

While many people may experience medical trauma symptoms right after a distressing medical treatment or event, not everyone develops PTSD due to medical trauma. For some people, the symptoms may lessen or dissipate over time, while others will progress to PTSD.

Children may exhibit different signs of stress related to medical trauma. Children under six years of age may experience the following symptoms:⁵

• Excessive clinginess
• Re-enacting the medical trauma during playtime
• Forgetting how to talk or even being unable to
• Wetting the bed despite having been potty trained

The connection between medical trauma and eating disorders

Between 20% and 30% of adults who experience medical trauma develop PTSD or experience post-traumatic stress symptoms.² About 80% of children and teens experience traumatic stress symptoms after a medical trauma, while up to 30% experience persistent traumatic stress or PTSD.²

The connection between medical trauma and eating disorders is likely due to the risk of developing PTSD, which is a known risk factor for eating disorder development and can also exacerbate existing disordered eating symptoms.

One study has found that up to 52% of individuals with eating disorders like anorexia, bulimia, and binge eating disorder, also have co-occurring PTSD. In contrast, another study found the prevalence between 9% and 24%.^6,7

Emotional regulation

While the co-occurrence of PTSD and eating disorders has been well-established, the precise reason why trauma can cause eating disorders is still not entirely understood. However, it is known that traumatic events, such as medical trauma, can disrupt a person’s nervous system functioning, resulting in poor emotional regulation. 

Eating disorder researchers and professionals posit that people experiencing the distressing effects of trauma may cope with intrusive thoughts, emotions, or scary memories by engaging in disordered eating.

These behaviors, such as fasting, excessive exercise, calorie counting, self-induced vomiting, and using laxatives and diuretics, can help distract someone from their upsetting emotions or help them avoid dealing with them.

Additionally, people who have experienced medical trauma might avoid seeking medical care for their eating disorders due to their terrifying or traumatic experience with the medical system. As a result, their eating disorder will worsen without treatment, increasing the risk of medical and psychological complications. 

Receiving comfortable and integrated care for PTSD and eating disorders

When medical trauma exists, patients may be suspicious of treatment providers or medical settings, or may avoid treatment because of their experience. This can make it difficult for individuals with eating disorders to get the help they need to recover and heal their relationship with food and movement, transforming medical trauma.

Because of this, it’s essential to find an eating disorder treatment program that understands the far-reaching consequences of medical trauma and how it can influence a patient’s perspective and compliance with treatment. 

Online eating disorder treatment

A virtual eating disorder treatment program, such as Within Health, may be a beneficial option for someone who has experienced medical trauma since they can recover from their eating disorder in a comfortable environment, such as their home, while receiving high-quality, trauma-informed care from a dedicated team of mental health professionals and other specialists.

At Within Health, we offer individualized treatment planning for every patient, and they can access all of their interventions through our easy-to-use app. For example, for someone with medical trauma and an eating disorder, their treatment plan may include various therapies that are used for persistent traumatic stress reactions, such as:

• Prolonged exposure therapy: Patients learn to gradually and safely face memories, situations, and emotions related to their medical trauma, which shows them that they don’t need to avoid these trauma-related cues.
• Cognitive behavioral therapy: Patients learn to understand the connection between their behaviors, emotions, and thoughts, to reduce eating disorder behaviors and trauma-related symptoms.
• Cognitive processing therapy: Patients learn to challenge their false beliefs related to the medical trauma (e.g., they experienced a medical emergency because they are a terrible person).
• Interpersonal psychotherapy: Patients learn to understand how their medical trauma and the eating disorder affect their relationships and how they can address grief related to the terrifying medical event or survival.
• Acceptance and commitment therapy: Patients establish their core values, create goals aligned with those values, and learn to accept their reality and feelings.

Treatment for people who have experienced medical trauma may also include pain management strategies to help patients deal with pain related to the medical event, such as an accident, injury, or ongoing pain, like pain caused by cancer.²

If you have experienced medical trauma, know that you are not alone—many people have experienced distressing and disturbing medical events. In addition to receiving treatment, you may want to consider joining a support group where you can provide and receive emotional support, encouragement, and empowerment.