Trauma-Informed Approaches to Nutrition Therapy

Dr. David Wiss

April 23, 2021

Trauma

Adverse life experiences during developmental periods can have a profound impact on adult physical and mental health. Challenges faced by children that may have once been viewed as “harmless” are increasingly understood as capable of influencing health later in life. The saying “what doesn’t kill you makes you stronger” is certainly not always the case.

In this article, I provide an introduction to the links between symptoms of post-traumatic stress disorder (PTSD) and nutrition-related behavior, which may explain why so many people stress eat, binge eat, or report an addiction-like relationship with food. Links between trauma and addictions have been well described along several biopsychosocial pathways.


The Adverse Childhood Experiences (ACE) Measure

The widely accepted Adverse Childhood Experience (ACE) measure asks questions about child maltreatment (emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect) and household dysfunction (parental separation or divorce, mother treated violently, household substance abuse, household mental illness, and incarcerated household member) [1]. Other forms of adversity that have been added to ACE measures include bullying and violence, discrimination, poverty, medical trauma, among others.

In North America, one in four people have experienced at least one ACE [2]. Prolonged exposure to ACEs can create a toxic stress response, which can damage the developing brain and body of children and cause long-term health problems. From clinical practice, I have observed that some of the common health problems stem from binge eating and substance use disorders.

While many individuals exposed to ACEs can be resilient (i.e., emerge stronger afterwards), for others it has been suggested that “time does not heal all wounds” [3]. Some people develop PTSD after ACEs, while others do not. Many people blur out the memories of these experiences and thereby downplay the impact on their life, and some become entirely amnestic (i.e., don’t recall at certain times). Differences depend on individual factors (i.e., genotype) as well as what type of ACE was experienced. Did you know that trauma can have an impact on the immune system via chronic inflammation?

It has been shown that the dimension of childhood maltreatment (e.g., physical or sexual abuse) has a stronger impact on mental health than household dysfunction (e.g., parental drug use or divorce) [4,5]. In my doctoral dissertation, childhood maltreatment ACEs doubled the odds of being likely depressed or anxious in adulthood, among men who have sex with men (MSM) in Los Angeles, CA.

Associations of multiple ACEs have been determined as weak/modest for diabetes and overweight/obesity; moderate for smoking, heavy alcohol use, heart disease, cancer, and respiratory disease; strong for sexual risk-taking, problematic alcohol use, and mental ill-health; and the strongest for problematic drug use and interpersonal and self-directed violence [6]. Our research shows that being exposed to multiple ACEs increases the risk of adult obesity by nearly 50%, and this is not always due to the consumption of large amounts of food. Understanding the impact of trauma on biological systems can reduce weight bias.

ACEs represent a profound societal burden globally, which is particularly frustrating given that many exposures can be prevented. It’s now been 24 years since the original ACE study and only recently has “trauma-informed” become a buzzword. I have been teaching the principles of trauma informed nutrition for many years, particularly due to my interest in the links between early life trauma and disordered eating. For an individual seeking treatment for bulimia nervosa, getting the right trauma treatment can make all the difference. It’s not just about food choices, it’s about deep healing work.


Other Forms of Adversity

Traumatic experiences during adulthood can also be quite damaging to health. For example, trauma and adversity of any kind can lead to an unhealthy relationship with food, compromised nutritional status, and various forms of disordered eating [7]. The relationship between food, individuals, families, and communities must be treated with compassion and a holistic perspective that acknowledges individual, historical (i.e., multigenerational), and systemic (contextual features of environments and institutions) trauma. This perspective has been referred to as the Social Determinants of Health [8,9] and is the predominant conceptual approach used in Public Health.

Adverse food-related experiences can include unreliable and/or unpredictable meals (i.e., food insecurity), restriction/control over food as well as body shaming (sometimes imposed by parents or family members), loss of food traditions (e.g., migration or family separation), and manipulation, punishment, or rewarding with food (sometimes by well-intentioned caregivers).

Dietary behaviors that can result from adversity include binge-like eating disorders [10], and reliance on convenience foods high in sugar, salt, and fat, which is often referred to as food addiction [11–14]. These behaviors can also include hoarding food, impulsive decision-making, and a de-prioritization of planning and budgeting. Understanding this can be the first step in moving toward a healthy relationship with food among people with binge eating.

I have worked with many people who were baffled by their relationship with food and learned that ACEs and other forms of trauma may have contributed to their disordered eating. Yes, trauma is one of the known causes of food addiction. So instead of trying to target the sugar or food addiction, in some cases it’s best to focus on treating the trauma. Getting support from a registered dietitian nutritionist specializing in mental and behavioral health can make all the difference. Focusing on an anti-inflammatory diet is recommended, but shouldn’t become a new source of stress.


Trauma Informed Nutrition Therapy

Trauma-informed nutrition therapy acknowledges the role ACEs and other forms of adversity play in a person’s life. It recognizes symptoms of trauma and promotes resilience by not exacerbating these hidden wounds.

A trauma-informed approach is characterized by an understanding that unhealthy dietary habits, chronic disease, and poor health outcomes may be a result of adverse experiences and not necessarily a result of individual “choices.” Therefore, trauma-informed nutrition therapy aims to avoid shaming, blaming, and stigmatizing. This perspective is critical to reducing weight stigma that is so pervasive in society nowadays.

Trauma-informed approaches focus on holistic well-being rather than weight and/or BMI and recognize that some nutrition interventions can be triggering. They acknowledge the strengths and skills of clients rather than pointing to a lack of willingness, and they inspire healing and a personalized relationship to food. Additionally, trauma-informed nutrition therapy is a practice of cultural humility and aims to address both conscious and unconscious biases.

At Wise Mind Nutrition, we are proud to be on the frontline of providing a trauma-informed approach to nutrition-related behavior change. In fact, we believe this is the future. Too many people have been traumatized by nutritionists, some who were well-intentioned and others who were just improperly trained. The paradigm shift has begun.

Do you have thoughts about the relationship between trauma and nutrition? We invite you to explore this topic with us, and add to this important conversation. One way to chime in is to leave a comment on the YouTube video. I really would love to hear what you have to say.

References
1. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, 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. Am J Prev Med. 1998;14(4):245–58.
2. Bellis MA, Hughes K, Ford K, Rodriguez G, Sethi D, Passmore J. Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a systematic review and meta-analysis. Lancet Public Heal. 2019;
3. Raposo SM, Mackenzie CS, Henriksen CA, Afifi TO. Time Does Not Heal All Wounds: Older Adults Who Experienced Childhood Adversities Have Higher Odds of Mood, Anxiety, and Personality Disorders. The American Journal of Geriatric Psychiatry. 2014;22(11):1241–50.
4. Negriff S. ACEs are not equal: Examining the relative impact of household dysfunction versus childhood maltreatment on mental health in adolescence. Soc Sci Med. 2019;245:112696.
5. Negriff S. Childhood adversities and mental health outcomes: Does the perception or age of the event matter? Dev Psychopathol. 2020;1–14.
6. Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, et al. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. The Lancet Public health. 2017;2(8):e356–66.
7. Wiss DA, Avena N, Gold M. Food Addiction and Psychosocial Adversity: Biological Embedding, Contextual Factors, and Public Health Implications. Nutrients. 2020;12(11):3521.
8. Braveman P, Egerter S, Williams DR. The Social Determinants of Health: Coming of Age. Annu Rev Publ Health. 2011;32(1):381–98.
9. Braveman P, Gottlieb L. The Social Determinants of Health: It’s Time to Consider the Causes of the Causes. Public Health Reports. 2014;129(1_suppl2):19–31.
10. Micali N, Martini MG, Thomas JJ, Eddy KT, Kothari R, Russell E, et al. Lifetime and 12-month prevalence of eating disorders amongst women in mid-life: a population-based study of diagnoses and risk factors. Bmc Med. 2017;15(1):12.
11. Nunes-Neto PR, Köhler CA, Schuch FB, Solmi M, Quevedo J, Maes M, et al. Food addiction: Prevalence, psychopathological correlates and associations with quality of life in a large sample. J Psychiatr Res. 2018;96:145–52. 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. 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.
14. Brewerton TD. Posttraumatic Stress Disorder and Disordered Eating: Food Addiction as Self-Medication. J Women’s Heal. 2011;20(8):1133–4.