Trauma’s Impact on Eating Disorder Treatment: Understanding the Link

Understanding the relationship between trauma and eating disorders is essential, as these conditions frequently overlap and influence one another in powerful ways. Trauma whether from early adverse experiences, acute events, or chronic stress can profoundly shape how individuals regulate emotions, cope with distress, and relate to their bodies. For many, disordered eating becomes a way to manage overwhelming feelings linked to traumatic memories, while the physical and psychological consequences of an eating disorder can, in turn, intensify trauma symptoms. Recognising this bidirectional connection helps guide more effective, compassionate, and trauma-informed treatment approaches.

Q1. How are trauma and eating disorders connected?

Trauma, including childhood abuse, neglect, or major life stressors, is a major risk factor for developing eating disorders (EDs). People with PTSD often experience intrusive memories, hyperarousal, and emotional dysregulation, which can worsen eating behaviours like bingeing, restricting, or purging. These behaviours often act as coping mechanisms to manage trauma-related stress [1,2].

Q2. Can eating disorders make PTSD worse?

Yes. Eating disorders themselves create chronic stress and physical strain, which can amplify PTSD symptoms. For instance, individuals with PTSD and an ED often have slower recovery and higher treatment dropout rates compared to those without trauma histories. This creates a cyclical relationship, where trauma worsens ED symptoms and ED behaviours worsen trauma symptoms [1,3].

Q3. Does trauma affect recovery from eating disorders?

Absolutely. Research shows that having PTSD alongside an eating disorder is linked to poorer treatment outcomes. Trauma-related symptoms can reduce remission rates, increase the risk of relapse, and lower overall quality of life after treatment. Key barriers include:

• Emotional dysregulation: difficulty managing emotions interferes with therapy [1,2]

• Hypervigilance: heightened alertness makes engaging in therapy harder [1,2]

• Avoidance behaviours: avoiding distressing memories slows recovery [1,2]

  
  

Q4. What treatments can address trauma and eating disorders together?

Integrated trauma-informed care is essential. Trauma-focused therapies, like Eye Movement Desensitisation and Reprocessing (EMDR) or trauma-focused Cognitive Behavioural Therapy (CBT), can reduce PTSD symptoms while supporting eating disorder recovery [1,4].

Additionally, Dialectical Behaviour Therapy (DBT), which improves emotional regulation and distress tolerance, can be combined with evidence-based ED treatments like Family-Based Therapy (FBT) or Enhanced CBT (CBT-E) to improve outcomes [1,3].

Q5. What role does nutrition play in treating EDs with trauma?

Nutrition is a foundational part of recovery, especially when PTSD is present. Balanced diets tailored to individual needs help correct malnutrition, stabilise physical health, and improve emotional regulation. For example:

• Omega-3 fatty acids reduce inflammation and support brain health [5,6]

• Micronutrients like zinc and vitamin B12 aid mood stabilisation and neurotransmitter synthesis [5,6]

Dietitian-led interventions also support regular eating patterns, which are vital for long-term recovery and stabilising mental health [5,6].

References

1. Day S, Hay P, Tannous WK, Fatt SJ, Mitchison D. A systematic review of the effect of PTSD and trauma on treatment outcomes for eating disorders. Trauma Violence Abuse. 2024 Apr;25(2):947–964. doi:10.1177/15248380231167399

2. Brewerton TD. Eating disorders, trauma, and comorbidity: focus on PTSD. Eat Disord. 2007 Jul-Sep;15(4):285-304. doi:10.1080/10640260701454311

3. Mitchell KS, Mazzeo SE. Mediators of the association between abuse and disordered eating in undergraduate men. Eat Behav. 2005 Dec;6(4):318-27. doi:10.1016/j.eatbeh.2005.03.004

4. Leppanen J, Brown D, McLinden H, Williams S, Tchanturia K. The Role of Emotion Regulation in Eating Disorders: A Network Meta-Analysis Approach. Front Psychiatry. 2022 Feb 23;13:793094. doi:10.3389/fpsyt.2022.793094

5. Grajek M, Krupa-Kotara K, Białek-Dratwa A, Sobczyk K, Grot M, Kowalski O, Staśkiewicz W. Nutrition and mental health: A review of current knowledge about the impact of diet on mental health. Front Nutr. 2022 Aug 22;9:943998. doi:10.3389/fnut.2022.943998

6. Bozzatello P, De Rosa ML, Rocca P, Bellino S. Effects of Omega 3 Fatty Acids on Main Dimensions of Psychopathology. Int J Mol Sci. 2020;21(17):6042. https://doi.org/10.3390/ijms21176042