The majority of people who struggle with an eating disorder also struggle with one or more other mental illnesses, such as depression, anxiety, and/or other issues. Because many people who have eating disorders are also survivors of abuse and traumatic events, many sufferers also suffer from post-traumatic stress disorder or PTSD.
What is Post-Traumatic Stress Disorder?
PTSD is a set of symptoms commonly seen after someone suffers a traumatic event, such as physical or sexual abuse, rape, warfare, or witnessing something traumatic happen to someone else. It is characterized by three categories of symptoms that occur after a person experiences the traumatic event.
- Flashbacks, or feeling as though the traumatic event is reoccurring in the here and now.
- Nightmares or distressing dreams about the event.
- Feeling as though the event is recurring. This may include episodes of flashbacks or dissociation.
- Intense reactions to triggers or cues that resemble some aspect of the event. This may include reacting to a noise, such as a car backfiring, or to a specific smell, such as food or a particular perfume.
- Avoiding thoughts and feelings associated with the event.
- Avoiding activities and/or relationships that cause the person to remember the event.
- Feeling detached or withdrawn from other people.
- Difficulty remembering parts or all of the event.
- Difficulty falling or staying asleep.
- Hypervigilance or an urge to always stay alert and "on guard."
- Difficulty concentrating.
- Easily startled.
How Does PTSD Relate to Eating Disorders?
Although PTSD might seem to be a very different type of problem than an eating disorder, the two are typically intertwined for people who suffer from both. For example, someone may struggle with PTSD and turn to eating disorder behaviors as a way to cope with the difficult emotions and symptoms related to experiencing trauma.
Bulimia nervosa is the most common eating disorder experienced by people who have also experienced trauma. It has also been found that people who have eating disorders and PTSD are likely to have experienced multiple episodes of trauma or abuse over a period of time (as opposed to a single traumatic event).
It has also been shown that victims of childhood sexual abuse are more likely to struggle with self-criticism, body image issues and self-harm behaviors, which are all common issues within eating disorder populations. Unfortunately, people struggling with these issues also often experience borderline personality disorder.
How Does it Affect Treatment?
PTSD and eating disorders are often treated concurrently (at the same time). However, some therapists may recommend treatment for PTSD first and then working on the eating disorder behaviors. Research has shown that symptoms and issues related to the trauma should be addressed in order for recovery from the eating disorder to be most helpful. Many sufferers report that the eating disorder is actually another way to cope with the abuse, so treating the eating disorder without treating PTSD is unlikely to be successful.
It is important for people seeking treatment to find a treatment provider who is familiar and experienced in treating both trauma and eating disorder symptoms. It is also important for sufferers to be honest with their treatment providers about their history. It will affect your treatment goals and what issues you need to address first.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author.
Brewerton, T.D. (2007). Eating disorders, trauma, and comorbidity: Focus on PTSD. Eating Disorders, 15. 285-304.
Sansone, R.A., & Sansone, L.A. (2007). Childhood trauma, borderline personality, and eating disorders: A developmental cascade. Eating Disorders, 15. 333-346.
Vandereycken, W., & Claes, L. (2007). Is there a link between traumatic experiences and self-injurious behaviors in eating-disordered patients? Eating Disorders, 15. 305-315.