Trauma
January 7, 2024
TLDR: Trauma and Bulimia Nervosa - Understanding the Connection
This article explores the complex relationship between trauma and bulimia nervosa. Key points include:
Defining bulimia nervosa and trauma/PTSD
Risk factors and stressors that contribute to bulimia
Treatment options for co-occurring PTSD and bulimia
Key takeaways:
Bulimia involves recurring binge eating and compensatory behaviors
PTSD affects 3.5% of American adults annually
Trauma can alter brain reward systems, potentially leading to eating disorders
Strong link exists between PTSD and bulimia specifically
Genetics, adverse childhood experiences, and societal pressure are key risk factors
Wise Mind Nutrition's stance:
Recognizes the critical connection between trauma and eating disorders
Promotes trauma-informed, eating-disorder-friendly approaches
Emphasizes safety and inclusivity in treatment
Supports multiple treatment modalities including CBT and EMDR
Acknowledges the role of protective factors like positive childhood experiences
The article concludes by highlighting various treatment options, including traditional therapy, EMDR, and emerging treatments like psychedelics, while emphasizing the importance of a compassionate, multi-faceted approach to healing.
[Read the full article for detailed explanations of the trauma-bulimia connection, treatment options, and paths to recovery]
In the complex landscape of mental health, the intersection between trauma and eating disorders unveils a profound connection, notably evident in the case of bulimia nervosa. This exploration delves into the intricate link between trauma and bulimia nervosa. Understanding how trauma influences the onset and manifestation of bulimia behaviors is a crucial step toward fostering empathy, awareness, and targeted interventions.
First, let’s define both bulimia nervosa and trauma:
What is Bulimia Nervosa?
Bulimia nervosa (BN) is an eating disorder characterized by bingeing (consuming large amounts of food in a short period), followed by compensatory behaviors such as purging [1]. Purging is often (but not always) engaged to prevent weight gain and may be done by inducing vomiting and/or laxative use [2]. Excessive exercise can also be viewed as a form of purging. Diagnosis is based on the criteria from the Diagnostic and Statistical Manual (DSM-5) [1].
Recurrent episodes of binge eating at least once a week for three months
Recurrent compensatory behaviors to prevent weight gain (e.g., vomiting) at least once a week for three months
What is Trauma?
Post-traumatic stress disorder (PTSD) is the clinical name for trauma, which can occur as a result of exposure to adversity in life. Trauma is not what happens but the living legacy of it. Classic examples of PTSD include being in a car accident, going to war, and experiencing natural disasters [3]. PTSD can also stem from relational rupture and emotional abuse and is sometimes referred to as complex PTSD. Trauma can happen to anyone, regardless of age, gender, and ethnicity [3]. PTSD affects 3.5% of all American adults every year [3]. PTSD can lead to intrusive thoughts, avoidance, alterations in cognition and mood, and/or alterations in reactivity [3].
Risk Factors and Possible Stressors for Bulimia Nervosa
Genetics
The theory of latent vulnerability may explain how genetics increase the risk for bulimia nervosa in the face of adversity. This theory suggests that one’s genetic composition interacts with a stressful environment and may create a different phenotype in which reward processing is altered [4].
Adverse childhood experiences (ACEs)
Individuals experiencing multiple ACEs are more likely to develop an eating disorder or addiction [5].
Depression/anxiety
People with bulimia nervosa are more likely to have depression and/or anxiety; however, in some cases, BN can cause depression/anxiety, and in other cases, it is the other way around [6]. Although causality is unclear, depression/anxiety and bulimia nervosa frequently co-occur [6].
PTSD
Those who have PTSD are more likely to develop bulimia nervosa [7]. One possible explanation for why people with PTSD are more likely to meet the criteria for BN is turning to binge/purge behaviors to self-medicate and reduce the negative affective states associated with trauma [7].
Societal pressure
From the media to comments at school and home, society does tend to idealize a thin body, which puts tremendous pressure on people to look a certain way, and some go to great lengths to achieve these ideals.
Linking Trauma to the Development of an Eating Disorder
The development of an eating disorder does not occur overnight, it may take months or even years to develop. Post-traumatic stress disorder may trigger the onset of disordered eating, specifically binge-type eating disorders such as bulimia nervosa. Trauma exposure has been linked to increased inflammatory activity, which negatively affects cognitive function [9]. The dopamine system can be altered via a pro-inflammatory phenotype, crossing the blood-brain barrier to impact immune cells in the brain (microglia), ultimately altering the reward system [8]. This alteration in the dopamine system can increase impulsive behaviors, which may eventually lead to binge eating and then full-blown bulimia nervosa [9].
Even though trauma may be a risk factor for the development of all eating disorders, the most robust link is between PTSD and bulimia nervosa [7]. Purging behaviors can have a “numbing” and calming effect and help people with PTSD to better cope with their trauma [7]. It is essential to consider trauma treatment for those diagnosed with bulimia nervosa.
Trauma and Substance Use Disorder
Bulimia nervosa and substance use disorder share many similarities. Many eating disorders display addiction-like symptoms, such as ritualistic behaviors, impulsivity, and compulsivity [10]. Purging can be soothing to the vagal tone, which may lead to developing dependencies [10].
Also, there is a possibility that ritualistic behaviors in BN and the consumption of high-sugar foods can cause neurochemical effects similar to those seen in people struggling with substance use disorder [11].
Protective Factors and Treatment Options for Co-occurring PTSD and Bulimia Nervosa
Positive Childhood Experiences
Positive childhood experiences may act as buffers in the development of bulimia nervosa. Although less is known about positive experiences than ACEs, positive experiences may enhance resilience to negative experiences and trauma [5].
Cognitive Behavioral Therapy
This form of evidence-based psychotherapy is the most common treatment for bulimia nervosa [11]. Cognitive behavioral therapy helps to develop a regular eating pattern and reduce bingeing/purging by targeting mood, self-esteem, perfectionism, and interpersonal difficulties during therapy sessions [11, 14, 15, 16].
Eye-Movement Desensitization and Reprocessing (EMDR)
EMDR is a form of psychotherapy in which patients primarily suffering from PTSD perform a sequence of eye movements that help to stimulate the brain and reduce the symptoms of PTSD [12]. Research has shown that the combination of cognitive behavioral therapy and EMDR can be a powerful tool in the treatment of eating disorders [13].
Psychedelics
Utilizing psychedelics in the treatment of mental conditions similar to eating disorders has proven to be efficacious [17]. Even though the use of psychedelics for the treatment of EDs needs further investigation, research has suggested so far that the use of psychedelics in conjunction with standard treatments (e.g., cognitive behavioral therapy) may increase the efficacy rate of the treatment of eating disorders [17].
Wise Mind Nutrition App
Prioritizing safety and inclusivity, our app is eating-disorder-friendly and trauma-informed. It's a safe haven for exploring your relationship with food and mental health without judgment. Wise Mind Nutrition strikes a compassionate balance, ensuring a secure resource for individuals with disordered eating. Download now.
As we strive to better understand, support, and treat individuals facing the intricate link between trauma and bulimia nervosa, continued research and a compassionate, multi-faceted approach are essential for fostering healing and resilience.
Blog Collaborator:
Leticia Nunes
References
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Bulimia nervosa - National Eating Disorders Association. National Eating Disorders Association. Published December 18, 2023. https://www.nationaleatingdisorders.org/bulimia-nervosa/
What is Posttraumatic Stress Disorder (PTSD)? https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd
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VJ Felitti, RF Anda, D Nordenberg, DF Williamson, AM Spitz, V Edwards, et al., Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study, American Journal of Preventive Medicine 14 (1998) 245–258.
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Tursich M, Neufeld RWJ, Frewen PA, Harricharan S, Kibler JL, Rhind SG, Lanius RA (2014) Association of trauma exposure with proinfammatory activity: a transdiagnostic meta-analysis. Transl Psychiat 4:e413–e413.
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