What is the Relationship Between Sexual Abuse and Eating Disorders? A Conversation Between Jenni Schaefer and Dr. Tian Dayton

Tian: What is working for you at The Meadows? What in the programming is facilitating change? I ask this because I work with your population using experiential therapy RTR (Relationship Trauma Repair) to be exact….when I am at The Meadows and they seem happy, cared for and upbeat.

In the eating disorders field, we are learning that PTSD must be addressed in order for people to fully recover from their eating disorders. One reason is that PTSD seems to significantly predict poor prognosis in eating disorder recovery. Unlike most treatment centers, The Meadows Ranch specializes in eating disorders, trauma, and PTSD. In fact, we even have four therapists certified in EMDR (Eye Movement Desensitization and Reprocessing). EMDR, which is an evidence-based treatment for PTSD, helped me to recover.

Prior to tackling the challenging work of trauma, our patients need safety and stabilization. This, of course, includes nourishment. Importantly, malnutrition can happen in all eating disorders and in people of all shapes and sizes. Uniquely, at The Meadows Ranch, we even have a commercial kitchen where our patients learn to cook and nourish themselves.

The cutting-edge Brain Center at The Meadows Ranch also sets us apart. Our patients love going to the Brain Center for biofeedback and neurofeedback, which help to decrease their oftentimes debilitating anxiety.

I had the chance to try out the Brain Center while attending the incredible Survivors I workshop at our Rio Retreat Center recently, and I was blown away by how calm I felt after what felt like having alpha waves pumped into my brain!

Tian: I tend to use psychodrama to move clients towards deep healing, I know you’ve experienced psychodrama, would you share how it helped you in your eating disorder?

As long as I have been in therapy myself (a long time), I have found psychodrama to be very helpful. For those who aren’t familiar with psychodrama, it is a role-playing method of therapy. As an example, when I was struggling with an eating disorder, someone in my group might play the role of my eating disorder, which I called “Ed.” I dialogued with Ed, ultimately helping me to distinguish between my eating disorder and myself. I realized that I had my own thoughts and personality separate from Ed. I am not Ed. That was a huge realization for me. In my PTSD treatment, psychodrama helped me to face my trauma. An experience with psychodrama actually helped me to break out of denial and accept the fact that I had been raped.

One day, I hope to attend your THRIVE workshop at the Rio Retreat Center, which I know uses psychodrama to help people move toward posttraumatic growth and a more actualized life. I have heard that people are having breakthroughs in your workshop! I am always open to experiencing a breakthrough: I often say that I am fully recovered from my eating disorder—but not from life.

I am excited that our first Life Without Ed^® workshop, which is also trauma-based, is taking place at Rio Retreat soon.

Tian: Is there anything you’d like to say that I haven’t asked?

Over the past several years, I have presented a lot about the comorbidity of PTSD and eating disorders. Some key facts that might interest people reading this are:

• Research suggests that it is PTSD, not the trauma itself, which contributes to the development of an eating disorder.
• Higher rates of lifetime PTSD exist in combination with bingeing and purging. The lifetime prevalence of PTSD is 37-45 percent in bulimia nervosa and 22-26 percent in binge eating disorder—compared to 5-12 percent in those without an eating disorder. Individuals with anorexia nervosa who binge and purge (like I did) also have a higher lifetime rate of PTSD.
• Individuals with both PTSD and an eating disorder share significantly greater comorbidity and are more likely to engage in multiple forms of purging than those with eating disorders who don’t have PTSD.
• A hurdle in treating patients with a sexual abuse history (or any trauma history) and an eating disorder is the fact that relatively few clinicians are trained in both trauma as well as eating disorder therapies. Again, The Meadows Ranch leads by treating both.
• The majority of eating disorder therapists are not familiar with evidence-based treatments for PTSD. While eating disorder clinicians believe trauma-related symptoms are a key obstacle to recovery and that it is important to address PTSD, they are also concerned about integrating treatment. Many fear that trauma therapies will worsen the eating disorder, prevent eating recovery or lead to an increase in self-harm. Yet, findings from a 2017 pilot study support the opposite: integrated treatment works—without decompensating patients. At The Meadows Ranch, we find great success with integrating treatment. I sought PTSD treatment after I was fully recovered from my eating disorder. Even though trauma therapy was possibly the hardest work I have ever done, I did not—not even once—relapse into eating-disordered behaviors.
• Most clinicians receive little training on how to assess and treat eating disorders and, thus, are not equipped to manage life-threatening illnesses. Anorexia nervosa has the highest mortality rate of any psychiatric illness.
• Clinicians who are not specialized in eating disorders often have negative reactions to the illness. They feel frustrated and hopeless; they worry they lack competence. (Clinicians who do specialize in eating disorders love their jobs, enjoy their patients, and know firsthand that recovery can and does happen.)

I want to emphasize that although obstacles exist along the road to recovery, there is indeed a road to recovery. I have walked it—with many others. Healing is possible. Reach out for help. We are here for you. Never give up.

Tian: Thanks for bringing in the intersection between PTSD and eating disorders. In my own experience working with addiction, we have gone through many evolutions on when to pay attention to trauma and we observed the same thing that the study you mention finds. While treating PTSD issues could be evocative, it was also deeply relieving and helped to prevent relapse.