Why Trauma-Informed Care Is Essential in Eating Disorder Treatment

The journey to recovery from an eating disorder is challenging enough, but when trauma is part of the equation, a specialized approach becomes essential—enter trauma-informed care.

The Link Between Trauma and Eating Disorders

Eating disorders often develop as a response to trauma, serving as an unhealthy coping mechanism for overwhelming stress. When individuals feel powerless due to traumatic experiences, they may turn to controlling their food intake or engaging in other eating disorder behaviors to regain a sense of stability. This creates a cycle where the person uses these behaviors to escape emotional distress, but ultimately, it leads to increased distress over time. Even after the initial trauma has passed, this cycle can persist, reinforcing the need for continued eating disorder behaviors as a means of managing emotions.

Research shows that trauma and eating disorders are frequently interconnected:

• Nearly half  of adults admitted to residential eating disorder treatment have posttraumatic stress disorder (PTSD).
• On average, individuals in eating disorder treatment report at least two adverse childhood experiences (ACEs).
• About one in four people in treatment report four or more ACEs.

These statistics highlight the prevalence of trauma among those struggling with eating disorders, emphasizing the need for specialized care.

What is Trauma-Informed Care?

Trauma-informed care (TIC) is an approach that recognizes the widespread impact of trauma and integrates this knowledge into all aspects of its operations, actively working to avoid re-traumatization while promoting healing and recovery.

1. Understanding the effects of traumatic events
2. Integrating this understanding into treatment policies
3. Recognizing trauma symptoms
4. Avoiding re-traumatization
5. Adhering to key principles like safety, transparency, collaboration, and empowerment

Why is Trauma-Informed Care Essential?

1. Improved Treatment Outcomes: Addressing underlying trauma can lead to more effective eating disorder treatment. Patients with PTSD often show more severe symptoms, but with proper care, they can achieve similar improvements to those without PTSD.
2. Reduced Dropout Rates: Trauma and PTSD may increase the likelihood of patients dropping out of treatment. By providing additional support, trauma-informed care can help keep patients engaged in their recovery journey.
3. Holistic Healing: Trauma-informed care addresses not just the eating disorder symptoms but also the underlying emotional wounds, promoting more comprehensive healing.
4. Preventing Re-traumatization: This approach ensures that treatment practices, such as weigh-ins or medical interventions, are conducted with sensitivity to avoid triggering traumatic responses.
5. Empowerment: Trauma-informed care emphasizes patient empowerment, giving individuals a sense of control in their recovery process.

Inside the Therapy Room: Working Together Towards Recovery

Effective trauma-informed care in eating disorder treatment may include:

• Creating a roadmap: Your therapist will help you create a timeline of important events in your life, including traumatic experiences and when your symptoms began.
• Education is key: They’ll explain both conditions to you and your family, ensuring everyone understands what you’re dealing with.
• Connecting the dots: Your therapist will help you see how your eating behaviors might be attempts to cope with trauma-related feelings.
• Safety first: They’ll address any immediate health risks to keep you safe.
• Fueling your recovery: Your therapist will work on establishing healthy eating patterns before diving into deeper emotional work.
• Stabilizing eating habits: They’ll focus on improving your eating disorder symptoms to prepare you for trauma work.
• Building your emotional toolkit: Your therapist will teach you coping skills to handle difficult emotions without using eating disorder behaviors.
• Tackling trauma: Once you’re ready and have the necessary coping skills, your therapist will guide you through addressing the trauma directly.

By integrating trauma-informed care into eating disorder treatment a more comprehensive, sensitive, and effective approach is cultivated  towards recovery. This method not only addresses the visible symptoms of eating disorders but also helps heal the underlying wounds that may have contributed to their development.

References:

Brewerton, T. D., Gavidia, I., Suro, G., & Perlman, M. M. (2023). Eating disorder patients with and without PTSD treated in residential care: discharge and 6-month follow-up results. Journal of Eating Disorders, 11(1), 48.

Rienecke R. D., Blalock D. V., Duffy A., Manwaring J., Le Grange D., Johnson C., Mehler P. S., McClanahan S. F. (2021). Posttraumatic stress disorder symptoms and trauma-informed care in higher levels of care for eating disorders. International Journal of Eating Disorders, 54(4), 627–632. 10.1002/eat.23455

Day S, Hay P, Tannous WK, Fatt SJ, Mitchison D. A Systematic Review of the Effect of PTSD and Trauma on Treatment Outcomes for Eating Disorders. Trauma Violence Abuse. 2024 Apr;25(2):947-964. doi: 10.1177/15248380231167399. Epub 2023 Apr 26. PMID: 37125723; PMCID: PMC10913314.

Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach (HHS Publication No. (SMA) No. 14–4884)

Brewerton, T. D. (2018). An Overview of Trauma-Informed Care and Practice for Eating Disorders. Journal of Aggression, Maltreatment & Trauma, 1–18. doi:10.1080/10926771.2018.1