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Post-traumatic stress disorder (PTSD) and eating disorders commonly co-occur, which can complicate recovery due to how the two psychiatric disorders can fuel one another. If you’ve been diagnosed with PTSD and also struggle with disordered eating or an eating disorder, recovery is possible. You can heal your relationship with food and learn strategies to manage your eating habits and anxiety disorders.
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
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
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.
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.
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
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
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.
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
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
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.
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:
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.
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:
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.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
