Trauma
June 1, 2021
TLDR: Post-Traumatic Stress Disorder (PTSD) and Nutrition - A Complex Relationship
This article explores the connections between PTSD, nutrition, and eating disorders. Key points include:
The distinction between trauma and PTSD
The link between PTSD and binge-type eating disorders
The concept of complex trauma and its impact on eating behaviors
Key takeaways:
PTSD can lead to altered brain reward pathways, potentially causing food addiction
Dissociation, a PTSD subtype, is associated with binge eating behaviors
Complex trauma can result in a range of psychological problems beyond PTSD symptoms
Understanding the biological embedding of adversity can help reduce anxiety and depression
Wise Mind Nutrition's stance:
Advocates for a trauma-informed approach to nutrition counseling
Uses a biopsychosocial model of health and disease
Believes nutrition can play an essential role in the recovery process
Focuses on the present while remaining open to future possibilities
The article concludes that addressing trauma-related biological and behavioral manifestations is crucial for successful treatment of eating pathology. A trauma-informed approach to nutrition is essential for managing anxiety and promoting overall mental health.
[Read full article for detailed explanations of PTSD symptoms, dissociation, complex trauma, and their relationships to eating behaviors, as well as full references]
The Links Between Post-Traumatic Stress Disorder and Nutrition
Post-Traumatic Stress Disorder (PTSD) is a mental disorder resulting from exposure to (witnessing or experiencing) a traumatic event. Such events can include violence (actual or threatened), sexual assault, traffic accidents, and other dangerous situations or terrifying incidents.
In this article, we discuss links between PTSD and nutrition, which point to the topic of trauma-informed nutrition education. Importantly, we discuss links between trauma and eating disorders, as well acknowledge the role of adverse childhood experiences (ACEs) in shaping eating behavior. But first, we’ll discuss a little bit more background on PTSD.
Trauma vs. PTSD
Importantly, trauma itself is distinct from PTSD, representing a lived experience rather than a clinical disorder. More than a third of people exposed to intentional trauma develop PTSD [1]. Although some traumatized individuals develop trauma-related psychopathology, others do not [2]. More research is needed to understand why some people “bounce back” quickly, others have negatively altered trajectories, and some never fully recover from PTSD. In some cases, individuals develop bulimia nervosa symptoms and have body image disturbances that are persistent over the lifespan, if not properly treated.
The theory of latent vulnerability suggests that an individual’s genotype interacts with social and environmental stressors to differentiate one’s susceptibility to psychiatric outcomes (e.g., PTSD), particularly when the adversity is experienced early in life [3]. Resilience involves unique biological processes, not simply a reversal of pathological mechanisms. Among those with PTSD, only about one-third remit after three months [1], suggesting that the impact of trauma can be enduring.
PTSD and Binge Eating Disorders
One known correlate of PTSD is binge-type eating disorders [4–6]. More research is needed to elucidate biological mechanisms. However, several studies suggest this pathway is mediated by altered brain reward pathways [7–10], which can be a cause of consequence of “food addiction” [11,12]. Food addiction (increasingly referred to as ultra-processed food addiction) has been linked to all forms of trauma. These new findings may help to inform treatment for binge eating disorder.
Mental health recovery usually involves reducing guilt or shame around thoughts and behaviors. Understanding the biological embedding of adversity can help to reduce anxiety and depression among those seeking treatment.
PTSD symptoms fall into four categories:
1) Intrusion; which includes intrusive thoughts that are difficult to control, such as flashbacks
2) Avoidance; which can be a conscious or subconscious avoidance of any reminders of the traumatic event, including talking about or even remembering the incident
3) Altered cognition and mood; which can include distorted thoughts about the cause or consequence of the event and negative emotions leading to social disconnection and
4) Altered arousal and reactivity; which can include anxiety symptoms and increased threat vigilance, as well as sleep difficulties. It makes sense that symptomatic individuals will consume highly palatable food as a form of self-medication [13].
Dissociation, an automatic disconnection from one’s memories, feelings, behaviors, perceptions, and/or sense of self (e.g., an “out of body” experience) is a PTSD subtype. The dissociative subtype is associated with high PTSD severity, derealization and depersonalization, a more significant history of early life trauma, and higher levels of psychiatric comorbidity [14].
Several studies have documented relationships between dissociation and binge eating [15,16]. In some cases, when individuals are affected by the overvaluation of shape and weight, dissociation may promote the initiating of binge behavior, decreasing self-awareness and negative emotional states linked to the long-term consequences of these actions [16]. Thus, treatment for pathological eating should address dissociative disorders whenever present. These issues are often overlooked in treatment.
Complex Trauma
The concept of complex trauma (or cPTSD) is growing in clinical circles. However, it has not yet been established as an official diagnosis. Complex trauma is not defined by a single event but instead occurs repeatedly and cumulatively, over time and within specific relationships and contexts [17].
This concept contributes to an expanding understanding of trauma, including psychological problems not included in the diagnosis of PTSD, including anxiety, self-hatred, risk-taking behaviors, and problems with interpersonal and intimate relationships (including parenting) [17]. Thus, even in the absence of an identifiable “event,” complex trauma can be characterized by a failure to heal wounds and thus the living legacy of adverse experiences.
Summary
After trauma and PTSD, we remember it with our bodies. It is often not experienced as memory. The “raw data” can remain unprocessed and encoded in the amygdala (part of the limbic system responsible for emotional responses including fear). According to Dr. Janina Fisher, there can be sensitization to subtle reminders, with the “smoke detector” (amygdala) picking up signs of imminent danger. If these biological and behavioral manifestations are not addressed in treatment for eating pathology, interventions are unlikely to be successful. Thus, trauma-informed nutrition is the best diet for anxiety.
At Wise Mind Nutrition, we use a trauma-informed approach to nutrition counseling. We use a biopsychosocial model of health and disease. For this reason, our treatment program is designed for individuals with hyperactivate autonomic nervous systems and disorganized attachment patterns.
We believe in resilience and take the position that nutrition can play an essential role in the recovery process at biochemical and behavioral levels. We focus on the here-and-now and stay curious about the possibilities ahead of us. We help people recover one day at a time and one bite at a time!
References
1. Santiago PN, Ursano RJ, Gray CL, Pynoos RS, Spiegel D, Lewis-Fernandez R, et al. A Systematic Review of PTSD Prevalence and Trajectories in DSM-5 Defined Trauma Exposed Populations: Intentional and Non-Intentional Traumatic Events. Plos One. 2013;8(4):e59236.
2. Danese A. Annual Research Review: Rethinking childhood trauma‐new research directions for measurement, study design and analytical strategies. J Child Psychol Psyc. 2020;61(3):236–50.
3. McCrory EJ, Viding E. The theory of latent vulnerability: Reconceptualizing the link between childhood maltreatment and psychiatric disorder. Development and Psychopathology. 2015;27(2):493–505.
4. Brewerton TD. Eating Disorders, Trauma, and Comorbidity: Focus on PTSD. Eat Disord. 2007;15(4):285–304. 5. Brewerton TD. Posttraumatic Stress Disorder and Disordered Eating: Food Addiction as Self-Medication. J Women’s Heal. 2011;20(8):1133–4.
6. Brewerton TD, Perlman MM, Gavidia I, Suro G, Genet J, Bunnell DW. The association of traumatic events and posttraumatic stress disorder with greater eating disorder and comorbid symptom severity in residential eating disorder treatment centers. Int J Eat Disorder. 2020;
7. Novick AM, Levandowski ML, Laumann L, Philip NS, Price LH, Tyrka AR. The effects of early life stress on reward processing. Journal of psychiatric research. 2018;101:80–103.
8. McCutcheon RA, Bloomfield MAP, Dahoun T, Mehta M, Howes OD. Chronic psychosocial stressors are associated with alterations in salience processing and corticostriatal connectivity. Schizophrenia Research. 2018; 9. Bloomfield MA, McCutcheon RA, Kempton M, Freeman TP, Howes O. The effects of psychosocial stress on dopaminergic function and the acute stress response. Elife. 2019;8:e46797.
10. Osadchiy V, Mayer EA, Bhatt R, Labus JS, Gao L, Kilpatrick LA, et al. History of early life adversity is associated with increased food addiction and sex‐specific alterations in reward network connectivity in obesity. Obes Sci Pract. 2019;5(5):416–36.
11. Mason SM, Flint AJ, Roberts AL, Agnew-Blais J, Koenen KC, Rich-Edwards JW. Posttraumatic Stress Disorder Symptoms and Food Addiction in Women by Timing and Type of Trauma Exposure. JAMA Psychiatry. 2014;71(11):1271–8.
12. Mason SM, Flint AJ, Field AE, Austin BS, Rich‐Edwards JW. Abuse victimization in childhood or adolescence and risk of food addiction in adult women. Obesity. 2013;21(12):E775–81.
13. Brewerton TD. Posttraumatic Stress Disorder and Disordered Eating: Food Addiction as Self-Medication. J Women’s Heal. 2011;20(8):1133–4.
14. Huijstee J van, Vermetten E. The Dissociative Subtype of Post-traumatic Stress Disorder: Research Update on Clinical and Neurobiological Features. Curr Top Behav Neurosci. 2017;229–48.
15. GDipPsych MF-TB, Mussap AJ. The Relationship Between Dissociation and Binge Eating. J Trauma Dissociatio. 2008;9(4):445–62.
16. Mela CL, Maglietta M, Castellini G, Amoroso L, Lucarelli S. Dissociation in eating disorders: relationship between dissociative experiences and binge-eating episodes. Compr Psychiat. 2010;51(4):393–400.
17. Courtois CA. Complex trauma, complex reactions: Assessment and treatment. Psychotherapy Theory Res Pract Train. 2004;41(4):412.
