Surfacing After Silence

Life. After.

trauma and eating disorders

Someone left a comment on my Topics page:

I recently learned there is a high correlation between those who have experienced rape/sexual assault or domestic violence and those who have eating disorders. I wonder why this is not addressed more often when talking about eating disorders – is it something you’ve heard talked about? How can we (as people who want to make change in our culture/world/etc.) work to address these issues? I’ve been frustrated lately because I was raped and then developed an eating disorder but feel this was never addressed in any of my treatment (and though I recognize it not as solely causal, I think it is important to recognize as there is such a high correlation)!

To answer your first question, this is an issue that is addressed and talked about, both among professionals and in treatment centers.  Some eating disorder treatment centers also have some type of trauma program or track for individuals who need it.  One of the places I went to had a trauma track and we had separate groups on certain days of the week.

One of the reasons trauma may not be brought up in certain cases is because often, addressing trauma issues is usually extremely intense and emotionally draining and takes a lot of energy.  Often, in an inpatient setting, the focus is on restoring physical health and quite often, that’s all that can be accomplished inpatient because of insurance time constraints.  But also, sometimes restoring physical health is a necessary priority because it keeps the individual alive.  And also, it’s difficult to address trauma issues in the early stages of treatment because there is so much anxiety, fear, confusion, anger, and a whole bunch of other feelings.  And if an individual is malnourished-regardless of weight-physical health has to be restored before he or she will have the cognitive ability to deal with the trauma.

Here’s what happened to me.  I finally told my therapist about the abuse and rape that went on during my early childhood years.  I hadn’t ever repressed memories, but if I happened to have one, I’d push it away before I could really think about it.  I was in a partial program for the eating disorder at the time.  My therapist, who specialized in early childhood trauma, suggested I read Courage to Heal, an excellent book for survivors of childhood abuse and rape.  It’s pretty damn thick and includes stories of survivors, strategies for coping, and questions to ask yourself about where you are at with healing.  I bought the book and read it in a day.  I do not recommend that anyone do this. I relapsed immediately–it was ugly and fast.  I tried dealing with too much at once and I ended up back in the hospital.

Healing from the eating disorder is important.  Healing from sexual trauma is important.  But you need to have priorities clearly outlined when you are working on both.  And if you decide to work on both at the same time, there needs to be a plan for what to do if dealing with the sexual trauma begins to affect your recovery from the eating disorder.  In my case, this meant taking a break from the trauma work from time to time.  Even if there is no eating disorder in the picture, I think taking a break is a necessary way to regain strength and energy again.

As for why this isn’t talked about  more, I think it may have to do with the tendency for survivors to keep the knowledge of what happened to themselves out of fear or shame or confusion.  It may have to do with our society’s tendency to not really want to talk about such issues.  I think there’s a great deal of isolation when it comes to sexual based trauma.  We often feel that we are alone, not realizing that if we walked down a city street a great number of the women also have similar histories and are feeling just as alone.

If you have experienced sexual based trauma, I would recommend finding a trauma specialist as a therapist.  Something Fishy has an excellent treatment finder, and treatment centers will often have a list of area resources as well.


March 4, 2010 - Posted by | Eating Disorders, recovery, trauma | , , , , , , , , , , , , , ,


  1. I’m surprised you hadn’t heard this before! I’ve actually heard women complain that clinicians have assumed they were survivors of rape/assault/abuse because they have eating disorders.

    That said, the correlation is high. Personally, speaking, almost all of the women that I know who have/have had eating disorders (including myself) are survivors of some sort of abuse, usually sexual abuse.

    I have only recently starting really doing trauma work with my therapist. For quite a while, I simply wasn’t ready, and then I needed to find the right therapist. Because of the high correlation between trauma and eating disorders, all of the clinicians at my treatment center and trained to do trauma work. My therapist has giving me exactly what I’ve needed her to, and has really prioritized creating a safe space for me to heal for both my eating disorder and my experiences of abuse.

    I know that a lot of treatment literature says that a client must be fully weight/nutritionally restored before embarking on trauma work. Certainly, if a client is severely malnourished, drowning in behaviors, etc., that needs to be managed first and given priority. And, when one’s physical and mental health is so poor that she/he cannot process or think clearly, trauma work won’t be productive. However, I think the work can begin before 100% restoration. For me, the work HAD to begin before that point. I needed to begin the trauma work to see that there were other ways of handling it (healthy coping mechanisms, grounding techniques, etc.) and somewhere else the trauma could “go” (with my therapist, not with me alone) before I could really commit to working toward total behavior cessation. And, I found, once I was given these techniques and once I shared the trauma with my therapist, the behaviors have started gradually resolving themselves.

    One mistake that I have often heard other people with eating disorders talk about is when a therapist embarks on trauma work with a client BEFORE helping them learn the skills to deal with it. For example, they start talking about the trauma before they help their client practice grounding techniques that can help prevent or tolerate a flashback. Then they’re surprised when the client relapses! Of course the client will relapse if they don’t have other ways to deal with the trauma! And of course they may be more hesitant to work toward resolving behaviors if they have not been able to talk about a huge part of why they’re holding onto them in the first place!

    Comment by sayhealth | March 4, 2010 | Reply

    • Whoops. I meant to say that I’m surprised the commenter hadn’t heard it before. Okay. I’ll stop now. lol

      Comment by sayhealth | March 4, 2010 | Reply

  2. Oh! Also, I second what you said about Courage to Heal. My therapist has it, and we have looked at parts of it together in session, but she has not offered to lend it to me (as she often does with other books), and she has even warned me about reading it on my own. It seems like it has a lot of great info, but it can be mighty overwhelming!

    I also second what you said about needing to take breaks from trauma work if it starts consistently triggering e.d. behaviors. Trauma work is HARD, and my guess is that everyone – eating disordered or not – may need to take breaks from it!

    Comment by sayhealth | March 4, 2010 | Reply

  3. As sayhealth said, some therapists believe that ALL eating disorder sufferers must have a history of trauma. This can be harmful if the patient feels she doesn’t “deserve” to have a disorder, because she hasn’t been through that.

    I know many women (and men) with EDs who have been abused, and many who have not.

    Comment by Millie | March 5, 2010 | Reply

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