When a traumatic event occurs, a person experiences a disruption in their sense of safety in the world. In response, they may utilize a variety of coping mechanisms in attempts to manage the fear, anxiety, shame, and other difficult emotions associated with that trauma. This could include avoiding situations related to the traumatic event, substance abuse, or the development of disordered eating behavior. According to one study, 74% of patients in a residential eating disorder treatment setting reported experiencing some type of significant trauma.
Although it is difficult to identify the exact reason for this strong association between trauma and eating disorders, many common themes arise. Some people view an eating disorder as a distraction from traumatic memories, focusing their attention toward calories and weight. Others will utilize eating disorder behaviors such as restriction to regain a sense of control – many individuals remark that controlling food intake restores the feeling of power over their bodies. People may manipulate their bodies, either by making them smaller to “disappear” or bigger to appear threatening. Bulimia specifically can be viewed as a way to provide comfort and cleansing through the binge/purge cycle. Regardless of the reasons, utilizing eating disorder behaviors to cope with trauma leads to long-term distress for the individuals stuck in this cycle.
The process of overcoming trauma can take many years, but residential treatment is a great place to start, especially for people with eating disorders. According to Judith Herman, author of the groundbreaking book Trauma and Recovery, the first stage of trauma recovery is establishing safety and stabilization. Residential treatment is designed to create such parameters. In such a contained environment, individuals can disconnect from the dangers, either real or perceived, of the external world and establish safety with the help of a full treatment team and access to 24/7 staff support. Walden’s own residential program, for instance, has designed and implemented a six-week trauma group focused on skill building and psychoeducation in the service of helping individuals reestablish safety.
Trauma-informed treatment focuses on trauma recovery across all types of programming, including individual sessions, group therapy and beyond. In a trauma-informed setting, all staff members are educated on proper therapeutic interventions and practices that account for an individual’s trauma history. Here are a few of these best practices, much of which I learned from a presentation by Christopher L. Green, LICSW:
1. Establish a safe environment: This practice refers to both physical and emotional safety. If there are dangers in the external environment, either real or perceived, the treatment setting should focus on eliminating any sort of stressor that might trigger or exacerbate feeling unsafe. For example, in a trauma-informed setting, physical restraints are always a last resort.
2. Build healthy coping skills: Due to the nature of post-traumatic stress disorder (PTSD), certain symptoms require specific coping skills. For instance, in a dissociative episode, the individual becomes disconnected from the present moment and has an out-of-body experience. This symptom requires grounding techniques, which refers to anything that helps bring the person back to the present moment and consciously back into their bodies. Trauma-informed settings teach both staff and clients these skills to better cope with trauma-specific symptoms.
3. Support the development of healthy relationships: Individuals who have been abused in some way by others have a difficult time rebuilding positive relationships. Trauma can disrupt trust and a sense of safety, even with people not associated with the abuse. Thus, trauma-informed care focuses specifically on creating reparative relationships. Treatment providers can provide empathy and nurturance, and treatment should include safe and supportive family or friends to rebuild healthy connections.
4. Use an empowerment model: Trauma recovery focuses on the person taking back power. Trauma-informed treatment should build from the individual’s strengths and treatment goals. The client should feel that they are an integral part of the treatment team and that their opinions and decisions will be honored. The client should never feel forced.
Trauma recovery takes time and may be especially difficult for the many people who use eating disorder behaviors to cope with these events. Residential treatment can provide a contained, nurturing environment where individuals can begin the process of interrupting negative coping mechanisms and re-establishing a sense of safety in the world. When treatment programs are trauma-informed, individuals feel safe, skillful, supported, and strong.
If you are seeking support for both trauma and eating disorder recovery, we’d be happy to help you.
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Bethany Kregiel is a clinician in the adult residential program at Walden Behavioral Care, providing individual and group counseling to people with eating disorders. She received her Bachelor’s degree in Psychology from John Carroll University and her Master’s degree in Mental Health Counseling from Boston College. Bethany is particularly interested in working with individuals with eating disorders and obsessive-compulsive disorder, and she incorporates aspects of acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), and exposure therapy into her work with her clients.
