Missing! Trauma-Informed Care: When PTSD Collides with an Eating Disorder

By Meadows Senior Fellow Jenni Schaefer

Trauma specializes in hiding. It rarely wears a sign saying, “Hey, I’m right here!” In fact, it is frequently the opposite. People who have endured trauma commonly don’t even know it themselves. One of trauma’s favorite hiding places is in our very own brain — in the form of denial, minimization, or dissociative amnesia (the inability to remember that is not associated with usual everyday forgetfulness).

One key aspect of trauma-informed care means that mental healthcare providers are aware that trauma likes to fly under the radar. As trauma hides out, it can manifest in all kinds of conditions that are paradoxically quite loud: post-traumatic stress disorder (PTSD), eating disorders, substance use disorder, dissociative identity disorder, borderline personality disorder, among many problems. Because trauma-informed care hasn’t been fully embraced and integrated throughout people-helper settings, one of trauma’s favorite hiding spots in our mental health system.

My story is only one example of trauma-informed care gone missing. When my trauma began, in the form of a sexually abusive relationship in my twenties, I was already in treatment for an eating disorder that had existed many years prior. For good reason, my treatment team was focused on the eating disorder, a life-threatening illness that certainly needed close attention. What I now know is that we needed to zoom out as well.

When the trauma began, my eating-disorders systems worsened. I also developed an exaggerated startle response, an early sign of PTSD, yet this sudden little gasp of fear was dismissed as being a side effect of a medication I had been taking to reduce binge eating. My psychiatrist hastily took me off the medication, which led to worse binge eating. And PTSD snuck in — undetected.

I hadn’t walked into anyone’s office saying specifically that I had experienced trauma, because I didn’t know. What I did walk in with was a body that was very much talking: guilt, shame, anxiety, fear, and the startle response, among others. I went to sessions completely distraught about that intimate relationship and talking about my trauma in everyway — except with my actual voice. Trauma impacts Broca’s area in the brain, which is a region in the frontal lobe that has to do with putting words together. Many of us quite literally cannot find the words on a very biological level. We need experts to help us to make sense of our experience as well as to provide us with a language, including, simply, the word “trauma.”

Ironically, earlier in my eating disorder treatment, prior to the sexual trauma, I was sent to a hypnotherapist to “find the trauma.” Since my eating disorder wasn’t improving at the speed experts had hoped, the assumption was that childhood trauma must exist. This is because childhood trauma frequently intersects with eating disorders, especially those characterized by binge eating and purging. This fact does not, however, mean that everyone with an eating disorder has childhood trauma. We never “found the trauma,” and then we missed the sexual trauma years later. Not to mention, the birth trauma that I experienced was missed altogether.

Ten years of therapy passed before “Dr. Google” set me on the healing path. I searched online for the words “exaggerated startle response,” and was surprised by the pages and pages of results all about PTSD. For me, a diagnosis is a compass pointing toward treatment. I believe that trauma-informed care could have provided me with this answer much earlier.

Sources:

Brewerton, T.D., Alexander, J. & Schaefer, J. “Trauma-informed care and practice for eating disorders: personal and professional perspectives of lived experiences.” Eat Weight Disorders 24, 329–338 (2019). https://doi.org/10.1007/s40519-018-0628-5