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

PTSD and Trauma in hiding

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).

Trauma specializes in hiding. It rarely wears a sign saying, “Hey, I’m right here!”

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.”

Since my eating disorder wasn’t improving at the speed experts had hoped, the assumption was that childhood trauma must exist.

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.


The only reason I can write and speak about trauma today is because of my eventual treatment for PTSD. It included included Eye Movement Desensitization and Reprocessing (EMDR) and Prolonged Exposure (PE) — both evidence-based PTSD treatments. Other therapies like Somatic Experiencing (SE), Acceptance and Commitment Therapy (ACT), and Dialectical Behavior Therapy (DBT) helped, too, and so did yid yoga, mindfulness, and acupuncture. All in all, I worked with many trauma-informed providers to shine a light on my trauma. We slowly put my PTSD recovery puzzle together over a period of many years.

Trauma is no longer hiding in my life, so it is no longer thriving. And, importantly, thanks to all of those clinicians I worked with who were trauma-informed, I have found my words. Today, I even get to work with The Meadows Ranch, where trauma-informed care is surely not missing, and I am honored to connect with patients as they find their words and put their own recovery puzzles together. What I know from my experience and that of others is that, without a doubt, healing is possible.


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

Jenni Schaefer

About Senior Fellow Jenni Schaefer

A Meadows Senior Fellow and advocate for The Meadows Ranch, Jenni Schaefer is a bestselling author, sought-after speaker, and she also leads our Life Without Ed® workshop at Rio Retreat. For more information on her or her work visit JenniSchaefer.com.