Posttraumatic Stress Disorder and Eating Disorders: There Is A Real Connection

NEDA_Icon_WhiteI wasn’t always a posttraumatic stress disorder and anorexia survivor. First I was a regular girl in a loving family. Then, at the age of thirteen I survived a horrific physical trauma: An undetected allergy to a medication turned me into a full-body burn victim. In a quarantined burn unit hospital room I lost 100% of the first two layers of my skin. By the time the painful illness ended I found myself trapped in my body I hated and distrusted.

Like many trauma survivors as I resumed “life after trauma” I started developing habits designed to make me feel safe and secure. One of these was starvation. While I couldn’t control the world at large or my body’s hidden biological secrets by restricting food I could exercise an element of control that made me feel less afraid: The more I controlled what I ate the more I felt my body was unlikely to surprise me again.

While we don’t talk about it much eating disorders (ED) are actually a very common component in the PTSD experience. Understanding the basics of PTSD and ED, plus how often they appear together can be a first step to unraveling their tangled thread.

What Is Trauma?

While trauma with a capital ‘T’ is easy to spot being traumatized does not necessarily begin with a earth-shattering experience. Trauma occurs equally in all races, cultures and demographics and is a universal human experience.  PTSD causes include several situations from obvious events (military combat, car accidents, violent assaults, physical and sexual abuse) to other less violent but equally traumatic moments found in circumstances that fall into such categories as:

  • Anything less than nurturing
  • An experience that overwhelms your ability to cope
  • An event that changes how you see your place in the world

With a new perception of the world—and yourself shockingly unsafe in it—a natural consequence becomes an extreme focus on two things:

  1. Safety
  2. Control

Partly this shift is driven by emotional needs tied to reclaiming a whole and protected sense of self. Partly, too, this shift results from the neurophysiological changes that trauma causes. When the sympathetic nervous system gets stuck in survival mode the chemical composition of your body alters and continues to drive survival-oriented behaviors long after the threat has passed. These biological, physiological, emotional and psychological alterations that trauma creates change your relationship with both your mind and your body and lead to behavioral changes in how you relate to and care for both.

What Is PTSD?

Your brain constantly changes due to experience. After trauma your body and mind acknowledge, integrate and organize the chaos of experience into a new perceptions, understanding and beliefs about the world. Although PTSD is a reasonable response to trauma it is not a universal outcome. For example, studies suggest that up to 70% of all U.S. adults will experience trauma in their lifetime but only 20% of those survivors will develop PTSD.

If you are in the 20% understanding PTSD symptoms and how they present becomes an important part of the recovery process. Diagnosis of posttraumatic stress disorder comes from assessing four major categories of symptoms and is applied when they have lasted for more than four weeks:

  1. Avoidance of all things related to the trauma, including memories, places, people and things.
  2. Re-experiencing elements/aspects of the trauma, including intrusive thoughts, nightmares and flashbacks.
  3. Hyperarousal, including hypervigilance (always on the look out for danger) and exaggerated startle response.
  4. Negative alterations in cognition and mood, including distorted sense of self-blame, negative thoughts or beliefs about yourself and the world, feeling detached or disconnected from yourself or others, and a reduced interest in pre-trauma activities.

(Take the PTSD self-test to see if you might be experiencing symptoms.)

The PTSD lifestyle outlined by these symptoms is all about survival. Eating links to survival too. Satiating or depriving your body’s hunger places you at the nexus of your body’s daily experience. In a way this gives you the ultimate power: Your actions hold the key to whether you live or die. This is a comforting feeling for a survivor who’s experienced what it means not to be the one in charge of what happens to your body.

The Link Between PTSD and ED

It’s normal and even reasonable (to a certain extent) to engage emotional eating habits: You learned from a young age that eating (and even overeating) certain foods can change how you feel physically and psychologically. From quelling the hunger drive to comfort foods that create biological changes that (temporarily) lift your mood you have always experienced food as a change agent in how you feel.

Much evidence-based research connects PTSD and ED, including these facts:

  • 66% of all ED patients have trauma in their history.
  • Research suggests that trauma alone is a strong predictor for ED behavior.
  • Studies confirm that PTSD itself is a risk factor for ED.

It all makes sense: Controlling your relationship to yourself feels proactive and in charge in an out of control world. Plus, controlling eating relates to your interaction with others. Obesity or emaciation alter how you engage with and are treated by those around you. Excessive fat or too visible bones can provide a layer of protection and boundaries.

There are three main types of eating disorders:

Anorexia nervosa: excessive food restriction that leads to extreme weightloss.

Bulimia nervosa: excessive overeating followed by bouts of depression, guilt shame and purging via vomiting or fasting.

Binge eating disorder: compulsive overeating enormous amounts of food while feeling powerless and unable to stop.

(Take this eating disorder screening to assess your own behavior.)

Controlling your food intake creates an immediate sense of safety and self-efficacy, your belief in your ability to succeed in specific situations—which is a positive outcome in the realm of healing trauma. The problem is that ED behaviors lead to increased health issues and can even lead to death. So, while the desire to feel a sense of control is good it needs to be achieved through actions that aim at preserving both mental and physical health. This is where healing happens and has the greatest affect on surviving the long-term effects of trauma.

Healing Can Happen

My own battle with PTSD and ED spanned over twenty painful years. Both my mind and body suffered from frequent emotional meltdowns, hair loss, digestive and organ dysfunction and even a diagnosis of advanced osteoporosis at the young age of thirty-five. It all finally ended when I completed what I call my “healing rampage,” a period of time I solely devoted to recovery with courage, commitment and a desperate fearlessness that drove me to do whatever it took to break my bonds with the past.

It’s possible to heal and change who we are. Even if we’ve struggled in the darkness for decades it’s possible to come out into the light.


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