While PTSD often manifests through symptoms such as hyperarousal, intrusive thoughts, and emotional numbness, it can also intersect with a range of other mental health issues, including eating disorders.
The connection between PTSD and eating disorders, including binge eating disorder (BED) and restrictive eating patterns, is complex and multifaceted.
The Co-Occurrence of PTSD and Eating Disorders
Individuals with PTSD often experience a range of emotions, from helplessness and guilt to anger and shame. As these intense emotions overwhelm their ability to cope, many may turn to maladaptive coping mechanisms, including disordered eating. Eating disorders, such as binge eating disorder, anorexia nervosa, and bulimia nervosa, can develop as individuals seek to regain a sense of control or comfort in response to trauma (Herman, 1992).
Research has shown a significant overlap between PTSD and eating disorders. Studies indicate that individuals with PTSD are at a heightened risk for developing disordered eating behaviors, which they may use as a way to manage the psychological impact of trauma (Swinbourne & Touyz, 2007).
This complex relationship highlights the need for a holistic approach to treatment that addresses both the traumatic experiences and the disordered eating patterns that emerge as a result.
Binge Eating Disorder: A Common Coping Mechanism for PTSD
One of the most prevalent eating disorders among individuals with PTSD is binge eating disorder (BED). BED is characterized by recurrent episodes of consuming large amounts of food within a short period, accompanied by feelings of loss of control and distress. For those with PTSD, binge eating often serves as a temporary means of emotional relief, helping to numb the emotional pain caused by trauma (Fairburn et al., 2008).
The link between PTSD and BED is particularly striking, as many individuals with PTSD use food as a way to distract themselves from intrusive thoughts, flashbacks, or overwhelming feelings of fear and sadness. This emotional eating provides a brief escape from the intensity of trauma-related symptoms, yet it can also exacerbate the distress by introducing feelings of shame, guilt, and physical discomfort. These negative emotions, in turn, can worsen PTSD symptoms, creating a cyclical pattern of trauma, food-related behaviors, and emotional distress (Vaughn et al., 2015).
Does Eating Disorder Cause Weight Gain?
While weight gain is often a byproduct of binge eating due to the excessive consumption of food, it is important to recognize that weight fluctuations are not the sole concern. For many individuals, the psychological distress caused by eating disorders is the more pressing issue (Grilo et al., 2005).
In the context of PTSD, weight gain can become an additional source of anxiety and self-criticism. For those already struggling with trauma, changes in physical appearance can increase feelings of shame, exacerbating PTSD symptoms. The emotional distress caused by weight gain or changes in body image can lead to further emotional eating, creating a vicious cycle that can be difficult to break without professional intervention (Duarte et al., 2017).
Importantly, weight gain is not an inevitable outcome for every individual with an eating disorder. Some individuals with PTSD may exhibit restrictive eating behaviors or engage in extreme dieting, which can lead to weight loss or physical deterioration. These behaviors, while different from binge eating, can still have severe physical and psychological consequences and may further complicate the trauma recovery process (Guss et al., 2019).
The Psychological Impact of Trauma on Eating Behaviors
The psychological connection between PTSD and eating disorders is rooted in the emotional toll of trauma. Individuals with PTSD often feel disconnected from their bodies, and this disconnection can manifest in distorted relationships with food (Van der Kolk, 2014). Many individuals use food-related behaviors to regain a sense of control over their lives or to manage overwhelming emotions that they may feel unable to process otherwise.
For some individuals, food may serve as a temporary coping mechanism to escape from intrusive memories or to numb painful emotions. In these cases, food provides a momentary reprieve from the emotional distress caused by trauma. For others, restrictive eating behaviors may emerge as an attempt to exert control over a body that feels foreign or out of control in the wake of trauma. Whether through overeating or undereating, food-related behaviors become intertwined with the emotional struggle of PTSD (Brewin et al., 2000).
Impact on Physical and Mental Health
The combination of PTSD and eating disorders can take a significant toll on an individual’s physical health. Binge eating disorder can lead to weight gain, which may increase the risk of obesity-related health problems, including cardiovascular disease, diabetes, and high blood pressure. However, the physical impact of eating disorders is not limited to weight alone. Individuals with PTSD and disordered eating may also experience gastrointestinal issues, sleep disturbances, and other health complications, all of which can further intensify the emotional burden of PTSD (Polusny et al., 2011).
On the other hand, restrictive eating behaviors can result in malnutrition, electrolyte imbalances, and weakened immune function. These physical consequences can contribute to feelings of physical weakness or vulnerability, further complicating the emotional and psychological challenges faced by individuals with PTSD. The stress caused by trauma can also exacerbate the physical toll of eating disorders, creating a cyclical relationship between the body and mind that is difficult to overcome without integrated treatment (Cohen et al., 2016).
Treatment and Recovery
Given the intricate relationship between PTSD and eating disorders, it is crucial that treatment plans address both conditions simultaneously. Cognitive-behavioral therapy (CBT) is one of the most effective therapeutic approaches for treating both PTSD and eating disorders. CBT helps individuals identify and challenge the negative thought patterns that contribute to trauma-related distress and disordered eating behaviors (Fairburn & Harrison, 2003). By providing tools to manage emotional regulation and coping strategies, CBT offers a comprehensive approach to healing.
In addition to CBT, trauma-focused therapies such as Eye Movement Desensitization and Reprocessing (EMDR) have shown promising results for individuals with PTSD and eating disorders. EMDR targets the root causes of trauma, helping individuals process distressing memories and reduce the emotional intensity associated with them (Shapiro, 2018). By addressing the trauma directly, individuals can begin to heal and break free from the cycle of emotional eating.
Medication may also play a role in treatment, particularly for individuals with complex PTSD having symptoms of anxiety, depression, or intrusive thoughts. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to alleviate these symptoms, which can make it easier for individuals to engage in therapy and make progress toward recovery (Hofmann et al., 2012).
Building a Support System for Recovery
A strong support system is a cornerstone of recovery for individuals with both PTSD and eating disorders. Family, friends, work colleagues and mental health professionals can provide crucial emotional support, helping individuals feel understood and validated as they work through the complexities of trauma and disordered eating. Support groups, both in-person and online, can also offer individuals the opportunity to connect with others who share similar struggles, reducing feelings of isolation and providing additional coping strategies (Brewin et al., 2000).
Education and awareness about the interrelationship between PTSD and eating disorders are also essential for both individuals and their support networks. Understanding how trauma impacts eating behaviors can empower individuals to seek help and engage in recovery efforts that address both conditions simultaneously.
Conclusion
The intersection of PTSD and eating disorders is a complex and often overlooked aspect of trauma recovery.
Addressing both PTSD and eating disorders requires a comprehensive treatment plan that combines therapy, medication, and a strong support system. Through evidence-based treatments like CBT and EMDR, individuals can begin to heal from both trauma and disordered eating, reclaiming their physical and emotional well-being.
References
- Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 68(5), 748-766.
- Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2016). Treating trauma and traumatic grief in children and adolescents (2nd ed.). Guilford Press.
- Duarte, C., Oliveira, C., & Santos, J. (2017). The role of body image in the emotional distress of individuals with PTSD and eating disorders. Psychiatry Research, 247, 147-153.
- Fairburn, C. G., & Harrison, P. J. (2003). Eating disorders. The Lancet, 361(9355), 407-416.
- Fairburn, C. G., & Welch, S. L. (2008). Binge eating disorder: Clinical features and treatment. The Journal of Clinical Psychiatry, 69(3), 479-487.
- Guss, J., Whitaker, K., & Cohen, L. (2019). The interaction of trauma and eating disorders in adolescents. Journal of Traumatic Stress, 32(1), 53-61.
- Herman, J. L. (1992). Trauma and recovery: The aftermath of violence—From domestic abuse to political terror. Basic Books.
- Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and Research, 36(5), 427-440.
- Polusny, M. A., Erbes, C. R., Thrasher, S. L., et al. (2011). PTSD and physical health: The role of somatization. Journal of Traumatic Stress, 24(4), 433-441.
- Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). Guilford Press.
- Swinbourne, J., & Touyz, S. (2007). The comorbidity of eating disorders and anxiety disorders: A review. Journal of Eating Disorders, 15(1), 63-70.
- Vaughn, S. M., et al. (2015). Binge eating in patients with post-traumatic stress disorder: A cross-sectional study. Journal of Clinical Psychiatry, 76(7), 900-905.
- Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.
