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Trauma-informed care for eating disorders

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There is a strong link between eating disorders, like anorexia nervosa (AN), binge eating disorder (BED), and bulimia nervosa (BN) and trauma, such as abuse, neglect, or sexual assault. Because many eating disorder patients have a history of trauma, it’s vital that treatment teams provide trauma-informed care. This is a framework that acknowledges and understands how trauma has affected the patient’s life, mental health, and eating disorder symptoms and prognosis. Providing trauma-informed care can ensure a patient’s safety during treatment and lead to better outcomes.

 minutes read
Last updated on 
December 22, 2022
In this article

What is trauma-informed care?

Trauma-informed care (TIC) is a treatment approach in which clinicians assume an eating disorder patient is more likely to have gone through some type of trauma than not. Trauma-informed care, in and of itself, is not a type of treatment specifically for trauma—rather, it informs a clinician’s approach to care. Namely, they are respectful, compassionate, and provide appropriate support for those who have experienced trauma. Providing trauma-informed care can greatly reduce the risk of retraumatizing or triggering eating disorder patients. (1)

There are five core principles of TIC that guide a clinician’s treatment approach, including: (1)

  • Empowerment: Fostering an affirming and validating treatment setting that emphasizes the patient’s strengths and ability to develop and utilize new strategies and skills
  • Trustworthiness: Establishing a trusting relationship, setting professional and respectful boundaries, and promoting transparency within the therapeutic relationship
  • Collaboration: Giving the patients the power to make choices related to their eating disorder evaluation and planning
  • Choice: Allowing the patient to guide and control their treatment planning, modalities, and experience
  • Safety: Ensuring patients feel physically and emotionally safe while in treatment

Ultimately, trauma-informed care is respectful, compassionate, patient-centered, and strengths-based, prioritizing the patient’s safety, mental health, and the effect their trauma has on their functioning, well-being, and symptoms.

How does trauma-informed care help treat eating disorders?

Trauma is common among people with eating disorders, with traumatic events greatly increasing the risk of developing an eating disorder. This is especially true for people who experience childhood trauma (often known as adverse childhood events, or ACEs), such as emotional, sexual, or physical abuse, neglect, witnessing violence, or having family members who misuse substances or have a severe mental health disorder. (2)

Some people who experience trauma, whether a singular event or complex trauma, develop posttraumatic stress disorder (PTSD), a complex and severe psychiatric condition. Much like a history of trauma, there are higher rates of PTSD in eating disorder patients, especially those with bulimia or bulimia symptoms, than in the general population. (3) Prevalence rates for these co-occurring disorders are as high as 52% in some studies. (4)

Not everyone who experiences a traumatic event develops PTSD; however, their history of trauma will still affect their eating disorder and recovery.

Trauma-informed care can help someone in an eating disorder program by first understanding how trauma can disrupt functioning, emotional regulation, body image, shame, and beyond. Having a deep knowledge of the long-lasting effects of trauma can help to contextualize a patient’s thoughts, feelings, and behaviors, as well as help guide treatment planning.

The goal of trauma-informed care is to help clinicians create a physically and emotionally safe space in which patients can recover without worrying about being retraumatized. Patients cannot meet their full potential, heal from their relationship with food and movement, and build and practice new skills if they don’t feel safe and cared for. 

Creating a safe physical and social-emotional space for eating disorder patients

Feeling unsafe can cause significant distress, anxiety, and fear in eating disorder patients with a history of trauma. On the other hand, a safe environment can be healing and transformative.

Here are ways in which a trauma-informed treatment program creates a safe social-emotional space: (5)

  • Following consistent schedules and routines
  • Giving appropriate notice when changes will be implemented
  • Staffing culturally responsive and culturally affirming providers
  • Practicing open, compassionate, and transparent communication
  • Setting healthy interpersonal boundaries
  • Making sure patients feel supported and respected

A safe physical space may include: (5)

  • Making sure common areas are well lit
  • Ensuring patients have easy access to treatment rooms and a clear exit
  • Utilizing welcoming and inclusive language on signs
  • Keeping noise levels at an appropriate volume
  • Staffing security personnel (who are trained in safe, non-traumatizing de-escalation practices and understand mental health and trauma)
  • Monitoring all visitors
  • Forbidding loitering at exits and entrances

What are the benefits of trauma-informed therapy?

There are many benefits to using a trauma-informed approach to eating disorder recovery, including: (5)

  • Improved patient engagement
  • Stronger relationship with clinician
  • Improved long-term health outcomes
  • Improved treatment adherence
  • Reduce staff turnover and provider burnout

When using a trauma-informed approach, providers amend the question of “what’s wrong with you?” to “what happened to you?” This question reduces shame and guilt and acknowledges the patient's lived experience. (5)

Receiving trauma-informed care at Within Health

Within Health is a virtual eating disorder treatment program committed to providing patients with high-frequency quality care in a safe and welcoming environment. We understand how trauma can affect everything in a person’s life, from eating habits and exercise to mental, physical, and social-emotional health. We also value a person’s lived experience and welcome them to be active participants in their eating disorder treatment planning, not only at the beginning of the program but throughout. Treatment plans are not set in stone—our patients are empowered to communicate their needs with us, and we will collaborate with them to adjust their plan accordingly. 

Trauma-informed care guides every aspect of our treatment program, from screening for trauma and PTSD at intake to creating a plan that involves trauma therapies, such as prolonged exposure therapy. We are also aware of the complex trauma associated with prejudice, such as racism, transphobia, homophobia, ableism, weight stigma, fatphobia, and more, and how discrimination and shame can prevent someone from seeking the treatment they need to recover. That’s why we are committed to providing an inclusive environment for our virtual treatment programming, so people feel respected, seen, and safe without having to worry about being triggered or further traumatized.

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.


  1. What is trauma-informed care? University at Buffalo School of Social Work - University at Buffalo. (2022, October 24). Retrieved December 21, 2022, from https://socialwork.buffalo.edu/social-research/institutes-centers/institute-on-trauma-and-trauma-informed-care/what-is-trauma-informed-care.html 
  2. Centers for Disease Control and Prevention. (2021). Preventing Adverse Childhood Experiences. Retrieved November 8, 2022. https://www.cdc.gov/violenceprevention/aces/fastfact.html 
  3. Brewerton, T.D. (2018). An Overview of Trauma-Inforced Care and Practice for Eating Disorders. Journal of Aggression, Maltreatment & Trauma, 28(4): 445-462. Retrieved November 8, 2022. https://www.tandfonline.com/doi/abs/10.1080/10926771.2018.1532940?journalCode=wamt20 
  4. Reyes-Rodríguez, M. L., Von Holle, A., Ulman, T. F., Thornton, L. M., Klump, K. L., Brandt, H., Crawford, S., Fichter, M. M., Halmi, K. A., Huber, T., Johnson, C., Jones, I., Kaplan, A. S., Mitchell, J. E., Strober, M., Treasure, J., Woodside, D. B., Berrettini, W. H., Kaye, W. H., & Bulik, C. M. (2011). Posttraumatic stress disorder in anorexia nervosa. Psychosomatic Medicine, 73(6), 491–497. Retrieved November 8, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3132652/ 
  5. Substance Abuse and Mental Health Services Administration. (2016). Key Ingredients for Successful Trauma-Informed Care Implementation. Retrieved November 8, 2022. https://www.samhsa.gov/sites/default/files/programs_campaigns/childrens_mental_health/atc-whitepaper-040616.pdf


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