The Impact of Trauma History on Eating Disorders
Trauma history significantly impacts eating disorders by increasing symptom severity, complicating treatment outcomes, and requiring trauma-informed approaches to achieve optimal recovery. 1, 2
Relationship Between Trauma and Eating Disorders
Trauma history profoundly affects eating disorders in several key ways:
Increased prevalence: 18.6% of eating disorder patients report at least one traumatic event, with sexual trauma being the most common form (6.3%) 3
Greater symptom severity: Patients with trauma histories experience more severe eating disorder symptoms compared to those without trauma 4
Comorbid conditions: Trauma-exposed eating disorder patients show higher rates of:
- Anxiety and depressive symptoms
- Experiential avoidance
- Anxiety sensitivity
- Lower mindfulness 4
Treatment complications: Trauma and PTSD negatively affect eating disorder treatment completion rates and post-treatment outcomes 2
Clinical Presentation Differences
Eating disorder patients with trauma histories present differently than those without:
PTSD impact: Patients with current PTSD show even greater symptom severity than those with trauma history but no PTSD 4
Psychosocial impairment: Trauma exposure is linked to more secondary psychosocial impairment and negative self-image 3
Diagnostic distribution: Interestingly, there is no significant difference in overall traumatic exposure between diagnostic subgroups (AN, BN, EDNOS, BED) 3
Assessment Recommendations
Proper assessment of trauma in eating disorder patients is crucial:
Screening tools: Use standardized trauma assessments alongside eating disorder evaluations 5
Comprehensive evaluation: Include assessment of:
- Trauma history (physical, sexual, emotional abuse)
- Current PTSD symptoms
- Emotional regulation capacity
- Anxiety and depression symptoms 6
Sensitive approach: Use patient-friendly language when inquiring about trauma, such as: "It is very common for people with your history to have experienced trauma in their lives — have you had any experiences that you consider traumatic, such as physical or sexual abuse, a natural disaster or medical trauma?" 6
Eating disorder assessment: Evaluate for avoidant-restrictive food intake disorder, which is increasing among patients with gastrointestinal conditions and is a contraindication for restrictive dietary therapy 6
Treatment Implications
Trauma history necessitates specific treatment approaches:
Trauma-informed care: Implement core principles of safety, trustworthiness, choice, collaboration, and empowerment 6
Individualized approach: Treatment should address both eating disorder symptoms and trauma-related issues 6
Evidence-based options: Consider trauma-specific services such as:
- Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
- Child and Family Traumatic Stress Intervention (CFTSI)
- Child Parent Psychotherapy (CPP)
- Parent Child Interaction Therapy (PCIT) 6
Integrated treatment: Address both conditions simultaneously rather than sequentially 1
Important Clinical Considerations
Trauma-focused treatment safety: Contrary to common belief, trauma-focused treatments can be safely and effectively used with patients with complex presentations, including eating disorders 6
Affect regulation: Trauma-focused treatment can improve emotion dysregulation often seen in trauma patients, which may benefit eating disorder symptoms 6
Avoiding treatment delays: Evidence does not support the need for extensive stabilization before addressing trauma; delaying trauma-focused treatment may prolong suffering 6
Family involvement: For younger patients especially, family therapy is crucial to long-term prognosis 6
Common Pitfalls to Avoid
Overlooking trauma: Failing to assess for trauma history can lead to ineffective treatment approaches 6
Sequential treatment: Treating only the eating disorder without addressing trauma may result in poorer outcomes 2
Assuming fragility: Avoiding trauma-focused treatment due to fears of symptom exacerbation is not supported by evidence 6
Ignoring comorbidities: Depression, anxiety, and obsessive-compulsive disorder may be comorbid with or a consequence of both trauma and eating disorders 6
By understanding and addressing the complex relationship between trauma and eating disorders, clinicians can provide more effective, comprehensive care that improves long-term outcomes for these patients.