Trauma Talks Series: Demystifying Eating Disorders

I mostly conceptualize eating disorders (ED’s) to be an extreme way to deal with trauma. The trauma may stem from biological, environmental, developmental, epigenetic, and/or energetic variables that contribute to the individual not being able to process emotional experiences in an adaptive way, and therefore the ED develops as a way to manage, cope, and survive. ED’s therefore entail extreme emotions, urges, attitudes, and behaviors that focus obsessively on weight, body, and/or food issues as an attempt to regulate and cope with unprocessed emotions and experiences. It becomes a vicious cycle, the longer it is in place and the more extreme it becomes, the need for the ED behaviors increase to protect and cope AND at the same time, the more dangerous and life threatening it becomes. This cycle can be traumatizing in itself, as the internal conflict to protect and cope at all costs versus the need to survive and be healthy consume the individual, and dysregulates their nervous system over and over again. Thus, often leaving them exhausted, frustrated, depressed, and feeling hopeless to stopping.

It is important to be educated about the dangers and at the same time to understand there is hope and healing that is very possible.

Eating disorders can have serious emotional, social, behavioral, cognitive, and physical consequences on an individual’s life. Behaviorally you may observe, whether in yourself or in someone you care about, preoccupations and obsessions with food and body. Collecting of recipes, cookbooks, menus, and/or data about food, as well as unusual eating habits and rules, increased consumption of coffee, tea, or spices, binge eating, excessive exercise, escaping after eating, and/or restrictive eating. Other common behavioral compulsions include compensatory/undoing behaviors, avoidance, escape, reassurance seeking, checking, and other rituals.

Emotional and social changes may include depression, heightened anxiety, irritability and anger, labile emotions and overwhelm, personality changes, and/or social withdrawal. As the ED progresses changes in cognitive function can also occur, such as: decreased concentration, poor judgment and decision making, and apathy.

Physical changes can be significant as well, and may include: sleep disturbance, weakness, gastrointestinal disturbances, development of autoimmune disorders, hypothermia, dental problems/decay, damage to nerves (tingling/prickling), heart abnormalities and murmurs, sores on knuckles, discoloration, swollen checks, edema, decreased basal metabolic rate, dizziness, decreased sexual interest, brittle nails and hair, and fatigue/malaise. In addition, rapid changes in weight may or may not occur.

Due to the complexity and impact ED’s have on an individual, comprehensive treatment includes a team of professionals and caring loved ones to support. Healing of body, mind, and heart, and ultimately at the emotional, social, behavioral, cognitive, and physical levels is crucial. With collaboration from a compassionate, trauma-informed, and effective team that understands what the person is dealing with, healing is more than possible.

Like addictions, those with ED’s have obsessions and compulsions that drive them into extreme behaviors that can be life threatening and the individual may feel they have no control over the behaviors that threaten their health. In addition, like OCD and addictions, these obsessions and compulsions take over, the person feels trapped, and internal conflicts pursue and build up.

In the absence of appropriate emotion regulation strategies, individuals may engage in unhealthy eating behaviors in an attempt to control, stifle, or escape unwanted emotions, which can lead to the onset of an eating disorder (Wolz; Tubingen, 2015). Therefore, effective treatment works on building healthy emotional regulation skills. Emotion regulation is a person’s ability to adaptively manage and respond to an emotional experience. The extreme ways of coping are to be gently and patiently replaced with effective coping skills that enhance heathy emotional regulation. It is important to not shame or overcontrol the individual, and to support the individual in gaining a sense of control for themselves in terms of healing.

Commonly, rumination, avoidance, and suppression have been wired in as ways to regulate emotions, and in turn aggravate the eating disorder behaviors, as well as other extreme ways of coping such as: self-harm, dissociation, aggression, restriction, addictions, and/or self-destructive behaviors. In addition, there is a high prevalence of Alexithymia; an impaired ability to recognize or discuss one’s emotions. This complicates the ability to regulate, and process through difficult emotional experiences that may be at the root of the disorder and therefore is an essential piece of treatment. Again, patiently and gently, building greater tolerance to emotions and to the ability to be present and mindful is healing.

Furthermore, co-occurring depression is common and must be addressed compassionately and effectively. Stabilization of weight and reduction of harmful behaviors are often initial targets. And admittedly it is not an easy process and a team of professionals may be needed to support the healing process. Yet, it can be a rewarding process for the individual and everyone involved, although it may not feel that way in the beginning. From my experiences those who have endured, suffered, and overcame an ED are, and have always been, some of the most resourceful, capable, empathic, creative, intelligent, and extraordinary individuals who bring much light to this world. It is well worth the time and investment.

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