PTSD and Eating Disorders

How Trauma Relates to Eating Disorders

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Post-traumatic stress disorder (PTSD) and eating disorders often co-occur. This may not be too surprising given that a number of psychiatric disorders have been found to co-occur with PTSD, including major depression, anxiety disorders, borderline personality disorder, and substance use disorders.

Understanding Eating Disorders

Eating disorders are characterized by severe problems in eating behaviors.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) recognizes three eating disorders: Binge eating disorder, anorexia nervosa and bulimia nervosa.

Anorexia nervosa is a condition where a person refuses to maintain a healthy body weight, which is determined by a person's age and height.

Bulimia nervosa, on the other hand, is characterized by a cycle of uncontrolled food bingeing behaviors followed by purging, such as vomiting or using laxatives, restricting behaviors, for example, fasting, or excessive exercise.

Binge eating disorder occurs when a person engages in eating more in a short amount of time than most people would, while also feeling unable to control the eating. These episodes are often followed by feelings of guilt, embarrassment or disgust 

Trauma, PTSD, and Eating Disorders

People with eating disorders often report a history of trauma. Childhood sexual abuse, in particular, has been found to be a risk factor for the development of an eating disorder.

There is also evidence that having PTSD may increase a person's risk for developing an eating disorder. Specifically, it has been found that people with PTSD are more likely than people without PTSD to develop an eating disorder, particularly bulimia nervosa. Likewise, people with bulimia nervosa or binge eating disorder may be more likely to have co-occurring PTSD than people with anorexia nervosa.

How Are Eating Disorders and PTSD Related?

In regard to bulimia nervosa, it has been suggested that the behaviors associated with this eating disorder may be a way of managing or regulating uncomfortable and distressing emotions. For example, it has been found that depression and anxiety may be connected to the development of bulimia nervosa-related behaviors.

People with PTSD often experience many strong unpleasant emotions, such as shame, guilt, sadness, and fear, and to the extent that people with PTSD do not have healthy ways of managing these emotions, they may develop or rely more on unhealthy behaviors, such as bingeing or purging.

The behaviors connected with anorexia nervosa may be a way of establishing a sense of control over one's body and life. This may be especially important if you have not felt as though you have had this control, for instance, if you've experienced a traumatic event. Likewise, if you have been abused, you may be more likely to be dissatisfied with your body and have a low self-image, leading to the unhealthy behaviors of anorexia nervosa.

Treatments for PTSD and Eating Disorders

There are currently no combined treatments for PTSD and eating disorders. However, there are effective treatments for both conditions individually, and learning how to better manage symptoms of PTSD may reduce a person's reliance on unhealthy behaviors, such as those found in an eating disorder.

If you have an eating disorder, it is important to seek out treatment immediately. Eating disorders are serious conditions and can result in death. You can find information on treatments for eating disorders at the National Eating Disorders Association.

Sources:

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: Author.

Brewerton, T.D. (2007). Eating disorders, trauma, and comorbidity: Focus on PTSD. Eating Disorders: The Journal of Treatment & Prevention, 15, 285-304.

Swinbourne, J.M., & Touyz, S.W. (2007). The comorbidity of eating disorders and anxiety disorders: A review. European Eating Disorders Review, 15, 253-274.

Stice, E., Burton, E.M., & Shaw, H. (2004). Prospective relations between bulimic pathology, depression, and substance abuse: Unpacking comorbidity in adolescent girls. Journal of Consulting and Clinical Psychology, 72, 62-71.

Mitchell, K.S., Mazzeo, S.E., et. al, "Comorbidity of partial and subthreshold ptsd among men and women with eating disorders in the national comorbidity survey-replication study." International Journal of Eating Disorders 45 (3), 2012.

Brewerton, T.D., Dansky, B.S., et al. "The Number of Divergent Purging Behaviors Is Associated With Histories of Trauma, PTSD, and Comorbidity in a National Sample of Women ." Eating Disorders: The Journal of Treatment & Prevention 23 (5), 2015.

"Feeding and Eating Disorders." American Psychiatric Association (2015).

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