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PTSD and eating disorders

16 June 2022

Eating behaviour can vary greatly due to stress or specific traumatic events. Of course, war is one of them. Sometimes, even those who are relatively safe "eat the war"

Why so?

Acute stress suppresses appetite. After the signal enters the body, adrenaline is released - blood supply improves, blood pressure rises, heart rate increases. While the work of the digestive system slows down, because it interferes with rapid reactions. There is no appetite at all.

After the danger we have experienced, when we feel relatively safe, we need to regain our strength. At this time, cortisol is released, which increases appetite. When the stress goes away, cortisol levels usually drop to normal.

But if the stress lasts a long time, as we have with you now, the body constantly has elevated levels of cortisol. Accordingly, the appetite may remain increased.

At the same time, people with eating disorders have a higher susceptibility to post-traumatic stress disorder. Find the detailed information about PTSD in a separate article.


The link between PTSD and eating disorders

At least 52% of people with an eating disorder diagnosis have a history of trauma.

Eating disorders generally fall into four categories; however, you can also have a mixture of these.

  • Anorexia nervosa – when someone is fearful of gaining weight and eats too little.
  • ARFID (avoidant/restrictive food intake disorder). People with this condition have no interest in food, have sensory problems with taste, smell or texture, or are concerned about feeling unwell after eating.
  • Bulimia nervosa – overeating due to psychological factors, followed by cleansing the body by vomiting. At the same time, there is an excessive dependence of self-importance on weight or body shape.
  • Binge-eating disorder (BED) – when someone eats large amounts in a short time, feeling unable to stop this due to heightened anxiety. 
  • OSFED (other specified feeding or eating disorder)

Statistics on PTSD and eating behaviour

  • Men with bulimia nervosa have a 66% higher rate of post-traumatic stress disorder than the general population.
  • Approximately 37 to 40% of people with bulimia nervosa experience co-occurring PTSD.
  • Approximately 26% of women with Binge Eating Disorder (BED) meet criteria for PTSD.
  • Approximately 23% of people with anorexia nervosa meet the criteria for PTSD.
  • 11.8% of women with other types of eating disorders also meet the criteria for PTSD.
  • Among patients attending eating disorder residential treatment, up to 52% met criteria for PTSD.

Can PTSD cause eating disorders?

Spoiler: "Yes!".

  • Trauma can create a negative body image or a poor sense of self-worth. There are also times when individuals blame themselves, and their appearance, for what happened to them. If this is the case, then the individual with PTSD may use food to modify their body shape, as a defensive mechanism, or to relieve their feelings of self-loathing.
  • Anorexia may be a way of expressing one’s anger and a way to distract oneself from feeling painful emotions. It is like a desire to hide, cover up and disappear.
  • In some cases, people turn to disordered eating as a way to cope with painful experiences. Both PTSD and eating disorders have high rates of dissociation — a feeling of being disconnected from oneself. It is possible that people who suffer from both disorders are attempting to use their eating habits as a means to disconnect from or numb the traumatic memories and emotions.”

While PTSD and eating disorders often co-occur, the direction of this relationship can go either way. Some individuals may struggle with PTSD and utilise eating disorder behaviours as maladaptive coping skills, attempts to gain feelings of control, or attempts to disconnect from or punish the body.

Conversely, it is also possible that an individual with an eating disorder can be more vulnerable to trauma events because of their disorder. For example, some individuals with an eating disorder are severe enough to warrant inpatient hospitalisation and tube feeding for medical stabilisation. Such severe health complications can cause a trauma response afterward.


Peculiarities of Therapy

Finding the psychological causes of eating disorders is vital to effective treatment and support. So, if post-traumatic stress disorder is playing a role in an eating disorder, that should be addressed as soon as possible, to create recovery.

If you – or someone you know – feel that trauma has significantly altered your relationship with food, it is vital to get help quickly.

Among the methods of PTSD treatment, the use of the following psychological methods is recommended: trauma focused cognitive behavioural therapy and Eye Movement Desensitisation Reprocessing.


Popular treatments

There is no single standard for treating eating disorders with PTSD.

You need to understand that the path to recovery can be long and difficult.

The care program may include the following treatments:

  • Check-up, provision of information and coordination of the assistance plan.
  • Individual cognitive-behavioural therapy.
  • Psychological support or, if necessary, family psychotherapy.
  • If necessary - drug therapy.

If you notice symptoms of PTSD and a change in your attitude towards yourself or your loved ones, be sure to consult a professional to find the best methods that are right for you.


Sources:

  1. Klas Backholm, Rasmus Isomaa & Andreas Birgegård (2013) The prevalence and impact of trauma history in eating disorder patients, European Journal of Psychotraumatology, 4:1, 22482, DOI: 10.3402/ejpt.v4i0.22482
  2. Co-Occurring PTSD and Eating Disorders

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