Why Treating Just the Eating Disorder Isn't Enough: The Intersection of Eating Disorders & Trauma

Picture trying to heal a broken leg while ignoring the chronic pain condition that caused someone to fall in the first place. That is often what happens when we focus solely on treating eating disorders without addressing the underlying trauma that frequently fuels them. In the eating disorder treatment community, there is an ongoing debate about what should come first - addressing the eating disorder or treating the trauma. But this debate misses a crucial point: these issues are often inseparable.

The Complex Web of Eating Disorders

Research indicates that up to 95% of individuals with eating disorders have at least one additional psychiatric illness. This isn't a coincidence. Eating disorders often develop as a coping mechanism - a way to deal with overwhelming emotions, traumatic experiences, or a sense of losing control. They're rarely just about food or body image; they're complex responses to deeper psychological wounds.

Trauma leaves a mark on both mind and body. Studies have consistently shown that emotional abuse, physical neglect, and sexual trauma are significant predictors of eating disorder development. When someone experiences trauma, especially during formative years, they often develop coping mechanisms to survive. Sometimes, these coping mechanisms manifest as disordered eating behaviours.

The Problem with Single-Focus Treatment

Traditional eating disorder treatment often emphasises weight restoration and normalised eating patterns above all else. While these are crucial goals, treating only these visible symptoms while ignoring underlying trauma is like putting a bandaid on a deep wound. Here's why this approach falls short:

1. It doesn't address the root cause. If trauma drove the development of the eating disorder, those same triggers remain even after renourishment
   ‍
2. It can be retraumatising. Forcing someone to change their coping mechanisms without adequately identifying and treating trauma or without providing alternative ways to handle trauma responses can leave them feeling vulnerable and unsafe.
   ‍
3. It increases the risk of relapse. Without addressing underlying trauma, many individuals return to disordered eating behaviours when facing stress or triggers.

Behind the statistics and clinical debates are real people struggling to move forward. Many individuals report cycling through multiple rounds of eating disorder treatment, achieving renourishment only to relapse when underlying trauma resurfaces. This cycle isn't just frustrating - it's potentially dangerous and emotionally exhausting for both clients and their loved ones.

A More Compassionate Approach

Instead of viewing eating disorders and trauma as separate issues requiring separate treatments, we need to understand them as intertwined aspects of a person's experience.

This means:

• Recognising that eating disorders often serve as survival mechanisms
• Understanding that physical recovery alone isn't complete recovery
• Acknowledging that healing happens at different paces for different people
• Accepting that addressing trauma might temporarily slow eating disorder recovery, but leads to more sustainable healing

When we integrate trauma-informed care with eating disorder treatment, we create space for true healing. This doesn't mean ignoring the serious medical complications of eating disorders or delaying necessary interventions. Instead, it means creating treatment plans that acknowledge and address both the visible and invisible aspects of recovery.

Moving Forward

The eating disorder treatment community is gradually shifting toward more integrated approaches. This shift recognises that humans are complex beings whose healing journeys rarely follow a straight line. By acknowledging and treating both eating disorders and trauma simultaneously, we offer people the best chance at lasting recovery.

The question shouldn't be whether to treat the eating disorder or the trauma first. Instead, we should ask: How can we best support the whole person in their journey toward healing?

Because at the end of the day, recovery isn't just about changing eating patterns - it's about helping people build lives worth living, free from both their eating disorder and the weight of unresolved trauma.

Behind every eating disorder is a person with a story. When we make space for these stories and treat them with the same urgency as physical symptoms, we open the door to deeper, more lasting healing. After all, true recovery isn't just about changing behaviours - it's about working with and empowering the whole person.

Want to Upskill in this Area?

Check out our free resource Navigating Eating Disorders and Trauma

Or for more online on demand training Working With Highly Complex Eating Disorder Presentations

References

Brewerton, T. D. (2007). Eating Disorders, Trauma, and Comorbidity: Focus on PTSD. Eating Disorders. 15(4) p285–304

Kong S, Bernstein K (2009) Childhood trauma as a predictor of eating psychopathology and its mediating variables in patients with eating disorders. J Clin Nurs. 18(13) p1897–1907

Levinson, C.A, et al. (2022). A network approach can improve eating disorder conceptualization and treatment. Nat Rev Psychol. 1 p419–430

Delgadillo, J, Huey, D, Bennett, H, McMillan, D. (2017). Case complexity as a guide for psychological treatment selection. Journal of Consulting and Clinical Psychology. 85(9) p835-853

‍