What is post-traumatic stress disorder?
Post-traumatic stress disorder is a severe mental health condition caused by witnessing or being involved in a terrifying, dangerous, or life-threatening event.1 Sometimes it’s a singular event or traumatic experience but when many traumatic events occur over long periods of time it is known as complex trauma. Complex trauma often develops from ongoing trauma, such as physical, emotional, or sexual abuse. Anyone who experiences a dangerous or scary event is at risk of developing PTSD, from veterans and active military personnel to children and civilians.
Some examples of traumatic events that can cause PTSD include:1
- Sexual assault
- Physical assault
- Natural disaster
- Death of a loved one
- Witnessing violence
- Human trafficking
- Military deployment
- Living in war zones
- Concentration camps
Not everyone who experiences a dangerous or scary event will develop PTSD, which is chronic, severe, and negatively interferes with a person’s ability to function. Some common symptoms of PTSD include:1
- Nightmares or terrifying dreams
- Flashbacks, which involve re-experiencing the traumatic event
- Profound sweating and rapid heartbeat
- Inability to remember details of the trauma
- Negative beliefs about yourself
- Profound guilt or shame
- Loss of interest in previously enjoyed hobbies or activities
- Avoiding places, objects, or people related to the trauma
- Avoiding feelings or thoughts related to the terrifying event
- Problems sleeping
- Hypervigilance (constantly aware of threats around you)
- Intense anger
Many people may experience some of these symptoms shortly after the trauma, but they often dissipate. If you experience symptoms that persist for over a month and they’re significantly disrupting your day-to-day life, you could have PTSD.
How does PTSD affect your eating habits?
PTSD and its accompanying symptoms can negatively affect your eating habits and patterns in several ways.
First, traumatic experiences can disturb your nervous system’s functioning, which can lead to emotional regulation issues. If you are having trouble regulating your emotions, you may experience mood swings, severe anger, depression, anxiety, suicidal ideation, and intense shame. You may also be unable to deal with and manage upsetting emotions or thoughts related to the traumatic event. In an attempt to regulate your emotions, you may turn to disordered eating behaviors, such as binging, purging, or restricting, in order to alleviate your distress.
Even though disordered eating behaviors are harmful, they can provide some temporary relief for those who are struggling, which in turn can create an ongoing cycle of negative emotions, disordered eating, and subsequent shame, guilt, and distressing feelings.
Trauma may also cause negative body image or body dissatisfaction, which could increase a person’s risk for engaging in disordered eating behaviors in an attempt to change their body weight or shape.
The link between PTSD and eating disorders
There is a significant relationship between PTSD and eating disorders, especially bulimia nervosa.2 Experts aren’t exactly sure why the two commonly co-occur together, but it is theorized that eating disorders and PTSD share similar genetic and biological overlapping factors that increase the chance of comorbidity.
Research has revealed that many types of trauma can increase the risk of an eating disorder diagnosis, such as:2
- Sexual assault
- Emotional and physical neglect
- Physical abuse
One study found that women who have experienced sexual trauma, such as sexual abuse or sexual assault, are more likely to experience mental health complications, including PTSD and eating disorders.2
Adverse childhood experiences (ACEs), which involve traumatic events that occur in children and teens, also increase the risk of developing PTSD and eating disorders, as well as other psychiatric issues like substance misuse.3
Adverse childhood experiences may include:3
- Witnessing violence
- Experiencing emotional, sexual, or physical abuse
- Experiencing neglect
- Having a loved one die by suicide
- Living with family members who have psychiatric conditions or substance use disorders
- Experiencing instability related to familial incarceration
However, not everyone who experiences an adverse childhood experience or traumatic event will develop PTSD and/or an eating disorder. Much like other mental health conditions, eating disorders and PTSD development is due to many influences, such as biological, sociological, and psychological risk factors.
Prevalence of PTSD and eating disorders
Additional research estimated the prevalence between 9% and 24% across all eating disorders while one study found the rate of co-occurrence to be as high as 52%.6,7
How PTSD and eating disorders affect each other
Eating disorders and PTSD can influence the prognosis of both as well as the maintenance of both. While researchers often suggest that trauma causes contribute to the development of eating disorder behaviors, others have ascertained that it's the symptoms of PTSD, as opposed to the actual trauma, that causes eating disorder development and maintains eating disorder symptoms. As such, it is thought that specific symptoms of each disorder interact with each other to maintain and worsen both conditions.8
One recent study determined three different pathways between eating disorder symptoms and PTSD symptoms:8
- Irritability and binge eating: Irritability is a common symptom of PTSD that can lead to binge eating episodes as a means of regulating upsetting emotions and specifically, irritability.
- Trauma reminders and desire for thinness Trauma reminders, such as nightmares or terrifying memories, can trigger body dissatisfaction and criticism, as well as a preoccupation with thinness or an “ideal” body type Body dissatisfaction and concentration problems: Issues with concentration and memory, which are symptoms of PTSD, are connected to body and shape dissatisfaction, while the reverse can also be true—eating disorder symptoms like shape and weight-related concentration problems are connected to concentration and memory problems seen in those with PTSD.
Ultimately, the development and maintenance of both of these psychiatric disorders are complex and multi-faceted and can’t be attributed to one cause, risk factor, or symptom.
Tips for managing your eating
If you struggle with PTSD and a co-occurring eating disorder, you may benefit from some tips on managing your eating patterns and developing a balanced relationship with food. Here are some tips to keep in mind during your recovery:
- Keep a journal of your triggers and coping skills you can use during these hard times
- Cut back on caffeine, which can increase stress and anxiety
- Learn and practice mindfulness to cope with distressing emotions
- Practice self-care that works best for you
- Create a gratitude practice
- Learn distress tolerance strategies, such as radical acceptance, improving the moment, and distracting yourself
- Practice body neutrality or body positivity
- Build and foster a healthy support network
- Ask for help when you need it
- Make sure to check in with yourself to see how you’re feeling
- View food as fuel for your body
You may also want to learn to practice intuitive eating or mindful eating unless you are on a prescribed meal plan by your treatment team. Intuitive eating involves listening to your body’s hunger and satiety cues and eating accordingly. That means you eat what and how much you want, as long as you’re listening to your body’s needs. Practicing intuitive eating can greatly improve your mental well-being and increase the pleasure you gain from consuming food.
Meanwhile, mindful eating, much like mindfulness in general, involves being aware of your food, what you’re tasting, smelling, and touching while you eat your meal which can also help if you are having symptoms of trauma. Focus on the joy you feel while eating, as well as gratitude for where the food came from and the work it took to make that food. It can help you heal your relationship with food and eating.
PTSD and eating disorder treatment
Treating co-occurring PTSD and an eating disorder requires integrated, trauma-informed care that fully addresses both conditions and how they influence and interact with each other. Trauma-informed care means understanding and recognizing the far-reaching consequences of trauma and how it can affect a person’s mental health, physical health, and relationship to food and eating. Clinicians experienced in providing trauma-informed care are mindful to avoid re-traumatizing or triggering patients, and they prioritize patient safety, choice, collaboration, gaining the patient’s trust, and empowering the patient.
Co-occurring eating disorder and PTSD treatment may involve a variety of treatment approaches, therapies, and interventions to provide comprehensive and individualized care. Therapies to treat eating disorders and PTSD include:
- Prolonged exposure therapy: Helps patients to safely approach memories, situations, feelings, and thoughts related to their trauma, which gradually teaches them not to avoid them.
- Eye movement, desensitization, and reprocessing: Can reduce the distress and stress associated with traumatic and terrifying memories.
- Cognitive processing therapy: Challenges and rectifies unhelpful beliefs related to their trauma.
- Interpersonal psychotherapy: Helps individuals understand how their eating disorder affects their relationships while also addressing interpersonal problems like isolation.
- Cognitive behavioral therapy: Analyzes the link between thoughts, emotions, and behaviors in order to reduce disordered eating behaviors and PTSD symptoms.
- Acceptance and commitment therapy: Helps patients to determine their values, set goals that align with those values, accept all emotions—bad and good—and commit to changing their behaviors.
At Within Health, our clinicians utilize a trauma-informed approach to treat all patients with respect and compassion. We also take a strengths-based and person-centered approach, which means we empower patients to collaborate with us on their recovery plans.