By: Caitlin Weese LCSW-C, 200 RYT
Eating disorders are complex mental health struggles that are often characterized by an unhealthy relationship, and preoccupation, with food, body image, and/or weight. As we have begun to learn more about eating disorders its clear they don't exist in a vacuum. They often coexist with other issues such as anxiety, depression or C-PTSD. In my own practice I have seen this connection, specifically between C-PTSD and eating disorders, emerge. Because of the prevalence of these conditions and the lack of discussion about their connection, I think its important to draw attention to this. In this blog, we will explore this relationship and how it impacts individuals who are struggling with symptoms of both conditions.
What is Complex PTSD?
C-PTSD is a type of post-traumatic stress disorder that is caused by repeated and prolonged exposure to traumatic events, such as abuse, neglect, or violence. Most often, this is the result of traumatic experiences in our childhood. It’s important to note that C-PTSD is currently not a diagnosis in the DSM, however this may change moving forward. Oftentimes, clients struggle to identify with their experiences being “traumatic” and may feel that they weren’t bad “enough.” Because of this, I think its important to note that with PTSD, either complex or single-incident, what is defined as traumatic is relative to the person experiencing it. C-PTSD often leads to chronic feelings of anxiety, depression, and dissociation. People with C-PTSD may also have a hard time connecting to or regulating their emotions and struggle with issues related to trust, safety, and self-worth.
The Research Behind the Connection
Research into the relationship between trauma and eating disorders has supported the theory they are connected. This research largely began by focusing on the impact of childhood sexual abuse on the prevalence of eating disorders, however the breadth of research has expanded through the years. While there isn't a ton of research into the role complex PTSD plays in eating disorders, there is a greater body of research about PTSD and its impact that I'll refer to. Here’s what one researcher says about this connection, “essentially any experience that can produce PTSD, partial PTSD, or any form of clinically significant anxiety may increase the probability of developing an ED" (Brewerton, 2007). Research also suggests that women who experience repeated traumatic experiences (which would likely lead to C-PTSD) are more likely to engage in behaviors such as restriction, purging, overexercising etc. Research also suggests that individuals with complex PTSD are at an increased risk of developing eating disorders. One study found that among women with complex PTSD, 35% had a lifetime history of anorexia nervosa and 50% had a lifetime history of bulimia nervosa. Another study found that women with complex PTSD were more likely to have binge-eating disorder than women without complex PTSD. From these studies we can see a connection between to these two struggles emerging. But "why" you might ask? Read on to find out!
Why Might They Be Connected?
A Way to Soothe Yourself or to Let Loose
The link between C-PTSD and eating disorders is, well, complicated. Eating disorders can serve a number of purposes for anyone, especially individuals struggling with C-PTSD. Oftentimes, it serves as a coping strategy and a way to manage difficult emotions they may be experiencing as a result of their trauma. This can vary based on the situation, however I like to think of an eating disorder as a way to feel in control or to let go of control in some way. For example, one person may use food as a way to numb their emotions, “let loose” or as a form of self-soothing. One example of the way this might look is binging. “The National Eating Disorder Association defines binging as Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. As well as experiencing a lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).”
A Way to Feel In Control
On the opposite side of the spectrum, individuals with C-PTSD may also engage in restrictive eating behaviors. This can be a way for us to feel in control of our environment, which can be especially important when we've experienced complex trauma. This is because trauma can often lead to feelings of helplessness and powerlessness. By controlling what we eat and how much of it we eat, we can feel a false sense of control over our body and environment. However, restrictive eating behaviors can quickly spiral into an eating disorder. When someone with C-PTSD engages in disordered eating behaviors, we may find it difficult to stop. The behaviors may become an ingrained part of our coping mechanisms and can ultimately lead to a serious eating disorder, such as anorexia or bulimia.
Shame and low Self- Esteem
People with C-PTSD often struggle with feelings of shame and low self-esteem as a result of our trauma. These feelings can make us more vulnerable to viewing our bodies negatively. This can make us more prone to the intense focus on weight and body image that often accompanies eating disorders. When we are constantly comparing ourselves to others and feeling inadequate because of our body shape or size, it can trigger intense feelings of anxiety and depression. As a result these feelings can exacerbate the symptoms of C-PTSD, creating a vicious cycle.
Moreover, many people with C-PTSD also struggle with dissociation. Dissociation is a mental process we all engage in during which a person disconnects from their thoughts, feelings, and surroundings. When we struggle with complex PTSD we typically experience a higher level of dissociation than people without it. This is because it can be a coping mechanism our brain uses that allows us to disconnect ourselves from triggers and uncomfortable feelings. However, it can also make it difficult for us to connect with our body and emotions. This can lead to a disconnect between an individual's hunger cues and their eating, which can result in overeating or under-eating.
Treating both C-PTSD and eating disorders can be a complex process that requires specialized care. It is also important to note that individuals with C-PTSD and eating disorders often have co-occurring mental health conditions. For example, they may also struggle with depression, anxiety, or substance abuse. These conditions can further complicate the treatment process and make it even more important to find a provider with expertise in this area.
Treatment typically involves a combination of therapy, medication, and support groups. Eye Movement Desensitization and Reprocessing (EMDR) and Internal Family Systems (IFS) are two common types of therapy that are often used to treat C-PTSD. EMDR can help them process and overcome traumatic memories while IFS can help to foster a great sense of peace and a deeper understanding of oneself. These therapies can help individuals process and cope with trauma-related symptoms, which can reduce the likelihood of using disordered eating behaviors as a coping mechanism.
In addition to trauma-focused therapy, individuals with complex PTSD and eating disorders will benefit from specialized eating disorder treatment. This can include working with a registered dietitian to develop a meal plan that supports physical and emotional health, as well as individual or group therapy to address disordered eating behaviors and body image issues. CBT can help individuals with eating disorders learn new coping skills and challenge negative thought patterns, while creating a healthier self-image.
Another type of therapy that may be particularly beneficial for individuals with both complex PTSD and eating disorders is dialectical behavior therapy (DBT). DBT is a type of therapy that emphasizes mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. It has been shown to be effective for individuals with a range of mental health conditions, including eating disorders and PTSD. Regardless of what approach you pursue its important to work with a provider that understands the intersections between these struggles.
Eating disorders and complex PTSD are two mental health conditions that can occur alongside one another. Due to the cause of complex PTSD, and its symptoms, individuals with complex PTSD are more likely to struggle with an eating disorder. If you or someone you know is struggling with an eating disorder you can contact NEDA at www.nationaleatingdisorders.org for support.
Are you struggling with these issues and looking for support? I offer online therapy for Complex PTSD and Eating Disorders to all Maryland residents. Book a free consult today.