What are Eating Disorders?
Before we talk about the connection between trauma and eating disorders, we want to start by sharing how common eating disorders are. In the United States, it is estimated that approximately 9% of the population (~30 million Americans) will experience an eating disorder at some point in their lifetime. Of this 30 million, roughly 926,011 Georgians experience an eating disorder. Consequently, every 52 minutes, one person loses their life because of these behaviors. (Harvard T.H. Chan School of Public Health, 2020).
To understand eating disorders, we need to understand what causes them. Individuals do not engage in these behaviors solely because they struggle with body image and self-esteem; instead, they may also view these behaviors as a way to regain control, to survive, or to give themselves a sense of safety. Research highlights the connection between trauma and eating disorders. Much of the research conducted on eating disorders and the subsequent psychological effects focus on WEIRD (Western, Educated, Industrialized, Rich, and Democratic) populations. It is important to digest this research with this disparity in mind.
Luckily, some research, particularly by Dr. Sonneville and Dr. Lipson, have touched on these disparities, where it was found that individuals from higher socioeconomic backgrounds were more likely to be screened, recognized, and/or referred to receive help. Additionally, due to certain stigmatizations and stereotypes (such as college aged individuals were less likely to perceive a need for help. Addressing and recognizing these disparities is essential for developing for equitable treatment efforts across diverse populations.
What is Trauma?
Much of this may stem from traumatic experiences; the emotional and/or physiological response to experiences that overwhelm an individual’s ability to cope. Traumatic experiences, disrupt our sense of self and our sense of safety (Seya et al., 2024), and over time, those experiences become embedded in how we respond to stress and/or emotional pain. Trauma may stem from acute events, such as abuse or assault, or from chronic conditions, like neglect or household instability (Walsh et al., 2019). Understanding trauma and eating disorders together is key to understanding eating disorders.
Dr. Vincent Felitti and his team of researchers conducted a study in which he coined the phrase (ACEs). He defines ACEs as psychological, physical, or sexual abuses, domestic violence, or living with household members who may have abused substances, are mentally ill, imprisoned, or suicidal (Felliti et al., 1998). With this in mind, we can begin to see how early developmental trauma and ACEs can shape emotional regulation, self-concept, and body image: the key factors in the development and maintenance of eating disorders.
How Trauma and Eating Disorders Affect the Brain and Body
There are various types of eating disorders an individual may find themselves engaged in. Anorexia Nervosa (or restriction) is characterized by self-starvation, or an extreme fear of weight gain (Fitzgerald & Keel, 2023). Purging (Bulimia) can be another form of Anorexia Nervosa, where an individual will eat, but often forces themselves to vomit, or purge, to avoid weight gain. Individuals with Anorexia Nervosa may often feel like nothing is wrong; an exclusive symptom to this type of eating disorder.
There also exists (or bingeing), and is often characterized by rapid eating and overindulgence, and eating past the point of feeling full, or not hungry at all (Brownley et al., 2016; Moini et al., 2024). While many forms of eating disorders exist, these are three of the most common.
When an individual suffers a traumatic experience(s), that trauma disrupts the body’s sense of safety. When this sense of safety is in jeopardy, we may find ourselves restricting, bingeing, and/or purging to regain control and dampen the distress our body feels. Dr. Hanna Eielsen and her colleagues examined eating disorders in a longitudinal study (17 years) and found that childhood trauma predicts trajectories of eating disorders; especially in cases of sexual abuse (Eielsen et al., 2023). The persistent symptoms in individuals who experience ACEs indicate that eating disorders are not solely about weight or struggling body-image but, instead, may be our answer to psychological survival, the strategies and mental processes we may engage in to endure trauma (Brenner et al., 2025; Sousa et al., 2021).
Consequently, trauma may have many impacts on our brain’s neural networks; specifically, the limbic system. The limbic system is the neural network in our brain that controls not only our basic emotions, but also hunger (Faraone et al., 2018). When trauma affects our limbic system, we may experience emotional dysregulation, the difficulties in regulating emotions once they arise, with hunger being one such emotion.
It has been found that individuals who experience ADHD (attention deficit hyperactivity disorder) or ADD (attention deficit disorder) may be at higher risk for emotional dysregulation, which are also common mediators for OCD (obsessive compulsive disorder) and perfectionism; two traits also common in those with eating disorders. If an individual experiences ADD, ADHD, OCD, or have had a history of trauma, it is crucial to watch for symptoms of eating disorders (Faraone et al., 2018).
Additionally, individuals with Anorexia Nervosa were found to have reduced brain volume in relation to lower body mass index (BMI) scores. Affected areas of the brain included the amygdala, hippocampus, thalamus, and putamen; all areas associated with emotion and hunger. In fact, the amygdala, hippocampus, and parts of the thalamus are all parts of the limbic system. But, as BMI increases, brain thickness begins to increase (ENIGMA Eating Disorders Working Group et al., 2022).
It is important to understand that although the brain is suffering, the brain can get better. The brain is what is commonly referred to as plastic; meaning that the brain can mold, form, and learn in response to experience, learning, and injury. The connections of neurons in the brain weaken, form, reform, reorganize, and strengthen over time. What this means is that if things can get worse, they can also get better!
While we have extensively discussed the neurobiological effects of Anorexia Nervosa, it should be discussed the neurobiological effects of binge-eating disorders. Those affected by binge-eating disorder may find themselves depressed, in heightened tension in their relationships, and have decreased social functioning. Individuals may also experience chronic pain and obesity. (Brownley et al., 2016). Additionally, there may be obsessive thoughts and compulsions; and many of these symptoms are resolved through not just therapy, but medications, which can help curb some of these negative mood symptoms (Brownley et al., 2016).
How Therapy for Trauma and Eating Disorders Can Help
As discussed earlier, eating disorders cause many physical and physiological changes. When you notice your eating behaviors start to change, it is crucial to seek professional help.. It is important to understand is that eating behaviors are symptoms, not permanent changes. Understanding trauma and eating disorders allows treatment to focus not only on behaviors but also on healing underlying experiences.
Treatment is multidisciplinary; not only will you work with a therapist, but also a dietician or medical doctor. Therapists who specialize in this field are trained day in and day out to offer extensive care and interventions to individuals who experience eating disorders. During your time with a specialized therapist, you will engage in exercises to help, not only your therapist, but also yourself, understand the history of your traumatic experiences.
Processing the trauma that leads to eating behaviors is important because, without it, relapsing in these behaviors is likely. Your time in therapy will be spent restoring the sense of safety that has since been stripped away, while also regaining control in your mind and your body.
Through these approaches, you can expect to regain trust with yourself and your body, engage in emotional rebalancing, and begin to understand how to respond to emotions rather than curbing them with food.
Why Therapy Matters
Again, eating disorders are fatal. One person loses their battle to their eating disorder every 52 minutes—that’s 10,100 deaths per year; a large number that can be drastically reduced through professional help. One major caveat is that many individuals may seek therapy only seeking the “what” behind their eating disorders. Essentially, they may want to only understand what is causing their eating disorder.
But therapy will help them understand why a traumatic experience led to these behaviors. The individual may finally answer “why this experience led to me engaging in these behaviors” or “why this experience led me to feeling the way that I do.” Once this trauma gets addressed, what may have once been framed as survival patterns can begin to evolve into healthy coping strategies and acceptance.
While traumatic experiences may lead us down a road of unhealthy eating habits, it is important to understand that there are solutions. While trauma and its associated behaviors may feel permanent (mainly due to the biological changes), help does exist. Remember, the brain is plastic; these changes are not permanent—the brain molds to its environment. Through the help of trained professionals, the question of “what is wrong with me?” will be reframed into “what happened to me?”
At Best Within You Therapy & Wellness, a staff of rigorously trained Atlanta based therapists and dietitians are here to help. Our integrated care model addresses trauma and eating disorders through therapy, nutrition counseling, and medical collaboration. Together, our team will help your long-term recovery and support your goal in re-trusting, regaining confidence, and re-orienting your relationship with food from survival to physical regulation.
Thank you to Dr. Sindhu Singh, PsyD, Atlanta trauma and eating disorder specialist, at Best Within You Therapy & Wellness and her intern Judson Gauthier. If you would like to meet with Dr. Singh or anyone on our team you can reach out to schedule an appointment or complementary consultation.
