Trauma-Informed Care vs. Trauma-Forward Treatment

Trauma-informed programs are everywhere, but what exactly does that mean?

When most people hear “trauma-informed care” they think:

They understand trauma.

They can help me with trauma.

This will be a safe place to work on my trauma.

A person holding out their hand in a comforting manner.

These are all important factors that are necessary to actually work through trauma. However, trauma-informed does not mean your trauma will actually be treated. Having a history of trauma is extremely common in those who have an Eating Disorder (ED). Relapse risks are reduced when underlying trauma is addressed during ED treatment, as ED behaviors frequently function as an attempt to manage trauma symptoms.

Specifically, ED behaviors including excessive exercise, and obsessive thoughts about food and body, can provide distraction from intrusive memories, numb emotional overwhelm, or create a temporary sense of safety and control. Sometimes people who have experienced trauma might cling to their ED because of beliefs like: “If I make myself small, invisible, or acceptable, I won’t be hurt again”. To be in a battle with all of this and be in a place that doesn’t actually address your trauma can have dire effects. Although trauma-informed care is important, if this is where trauma acknowledgment ends, the ED can persist or return after the completion of treatment.

How Does Trauma Show Up In Eating Disorders

While trauma can involve serious bodily injury and near-death experiences, it definitely isn’t limited to that.

Trauma can be:

Being bullied or shamed for your body, your looks, your ethnicity, or your lifestyle.

Growing up in a home where you felt unsafe or unseen.

Abandonment, emotional abuse, neglect, or living in a chaotic environment for years.

Living under constant threat or marginalization.

Significant or ongoing embarrassment to the extent of wishing you could be invisible.

When we encounter these experiences, our bodies and minds respond. Our nervous system is flooded to the point where overreactions and under-reactions (Fight, Flight, Freeze) occur. Our mind creates belief systems to drive our thinking so that we can be on guard, always stay safe, or disconnect and numb.

Some examples of underlying functions of the ED might look like:

Numbing or Escape

“I can tune out overwhelming emotions or intrusive memories by turning to food or away from food.”

Control

“I didn’t have control to prevent or stop the trauma, but I can control eating, my exercise routine and my body.”

Self-Punishment

“The trauma was my fault, I deserve to suffer and I will take it out on my body.”

Dissociation

“I can disconnect while bingeing or compulsively exercising when being present in my body feels unsafe or triggering”

ED behaviors often “seem” to offer a more comfortable focus than the experiences of guilt, shame, fear, and anger from trauma. Unfortunately, this produces short term relief and the cycle gets reinforced. Overtime, the very behaviors we used to avoid and control, take control of us and we avoid healing altogether.

This problem evolves into our own internal prison. Before too long, we are essentially institutionalized by it, and the thought of not having it becomes scarier than the reason we started using it.

When treatment focuses mainly on stopping or curving ED behaviors, the experience can feel like:

You are being denied the very thing that made you feel safe and provided peace in a world of pain.

You want me to “give up” my armor while I am still in a fight and I don’t have anything else to protect me.

This is where “trauma-informed care” shows its limitations.

Where “Trauma-Informed Care” Falls Short

In many programs the inclusion of trauma-informed care is based on good intent and is important in creating a safe environment for clients with a history of trauma:

Trauma-informed care means:

The team is trained in the basic understanding of trauma, trauma responses, and how to prevent re-traumatizing clients.

The team is mindful of their language and mannerisms to avoid triggering clients.

The team is taught to recognize when a client is triggered or dissociated.

Teaching coping skills like grounding and mindfulness for deescalation.

The structure of the programming and environment promotes safety.

Sadly, most of the time the trauma work stops there. This leaves several gaps:

Your trauma is acknowledged and validated, but there is no concrete work and/or action-orientated plan for trauma therapy and its involvement in ED behaviors.

Clinical groups stay at surface level to avoid triggering you and/or others.

Trauma is treated as something to be worked on later so you can focus on stabilizing and eating.

You leave the program with some symptom and response relief, but no real resolution to your underlying traumatic experiences.

Your chances for sustained recovery have not been fully supported. Relapse risk is higher and you may bounce from program to program feeling like nobody really addresses the whole picture.

What Does Trauma-Forward Treatment Look Like

Importantly, this doesn’t mean digging into every traumatic experience in the first week or being forced to share in detail your worst life experiences in a group setting.

It does mean:

We assume trauma is part of your journey and create an intentional plan on when and how we are going to work through it.

We complete assessments that show the connections between your trauma and your ED.

Therapy and real life practices around trauma symptoms, responses, and triggers.

Groups go deeper than just facts about food or grounding. They cover how trauma presents and how to work through the trauma in the following contexts:

Emotional Awareness and Regulation

Somatic Awareness and Regulation

Attachment and Interpersonal relationship issues

Identity and growth

Trauma-Integrated Treatment isn’t just symptom management, it’s a place to heal your trauma and learn to live life without trauma and ED behaviors running the show.

How To Know If A Program Is Trauma-Forward

When you are looking into a program or therapist, you should look for and ask about:

Will I actually work on my trauma while there, or just work on stabilizing/maintaining symptoms?

What trauma therapy modalities and approaches are you able to fully utilize in your program?

How do you determine if or when someone is ready to actually start trauma therapy?

Do your groups talk about trauma, shame, relationships and identity, or focus solely on nutrition and healthy coping?

You need and deserve clear answers to these questions to decide on the right treatment setting for you.

If your eating disorder is deeply tied to a traumatic experience, trying to change behaviors without addressing what created the need for those behaviors is like building a house of cards. It won’t take much for everything to come crashing down.

Trauma-forward treatment doesn’t mean you walk out the door “fixed,” but it does mean you leave with the foundation to continue working towards resolution around your trauma and a set of skills that go far beyond basic grounding techniques.

You deserve treatment that says,

“We see and understand what you have been through and how your eating disorder has helped you through. We’re here to help you reach a place where you no longer rely on your ED to live your life.”

If you have ever left treatment or a therapist’s office and felt like the real issue was never addressed, you are not alone or “broken”. What you may be craving is true freedom from your trauma. Trauma-Integrated Treatment is about addressing what is truly keeping you stuck, and giving you the tools to work through it.