Eating Disorders and Trauma: How Integrated Treatment Helps When Both Are Present
An eating disorder is not always just about food, weight, or body image. For many people, restriction, binge eating, purging, rigid food rules, compulsive exercise, or avoiding the body become ways to manage feelings or body states that feel unbearable. Fear, shame, numbness, anger, overwhelm, loneliness, loss of control, or not feeling safe in one's own body can all become tied to eating disorder symptoms.
When trauma is part of a person's story, eating disorder symptoms may be harder to let go of because they may have been serving a purpose. They may be medically dangerous and emotionally painful while also helping a person survive, disconnect, regain control, avoid memories, reduce distress, or manage a body that does not feel safe.
This does not mean trauma causes every eating disorder. No single pathway explains every eating disorder. But when trauma, post-traumatic stress disorder symptoms, adverse childhood experiences, dissociation, or complex trauma patterns are part of the picture, recovery often needs more than behavior change alone.
At Empowered Treatment, our adult eating disorder outpatient program is trauma-forward because trauma should not be treated as a side issue outside of the eating disorder focus. In our experience, people often feel more supported when eating disorder symptoms are being treated within a context that honors trauma-related fear, shame, avoidance, emotional overwhelm, or body-based distress. Trauma stabilization can begin from the very first days of care, while deeper trauma work is paced to each person's readiness. Learn more about trauma-integrated eating disorder treatment at Empowered.
- Eating disorders and trauma often overlap. The National Eating Disorders Association cites research finding that 49.3% of patients with eating disorders admitted to residential treatment had symptoms compatible with PTSD. Research also connects eating disorders with higher trauma exposure, adverse childhood experiences, PTSD, and complex trauma patterns.
- Trauma does not cause every eating disorder. Eating disorders can develop through many pathways, including genetics, temperament, mental health concerns, anxiety, depression, OCD, neurodivergence, dieting history, medical experiences, attachment wounds, bullying, cultural body ideals, and trauma.
- When trauma is part of a person's story, eating disorder symptoms may be harder to let go of. Restriction, binge eating, purging, food rules, body avoidance, or compulsive exercise may be tied to safety, control, shame, fear, numbness, body discomfort, or survival.
- Trauma-integrated eating disorder treatment goes beyond being trauma-informed. It means the role of trauma is assessed, stabilized, and addressed within the eating disorder treatment plan rather than treated as a separate issue outside of recovery.
- Trauma work needs the right pace. Stabilization can begin immediately, but deeper trauma processing should be matched to a person's medical, nutritional, psychiatric, and emotional stability.
On this page: jump to a section
- What are eating disorders?
- What is trauma?
- How common is trauma in people with eating disorders?
- Can trauma cause an eating disorder?
- A trauma-informed framework for understanding eating disorders
- What is trauma-integrated eating disorder treatment?
- Why stabilization comes before deeper trauma processing
- Eating disorder and trauma treatment at Empowered
- Frequently asked questions
What are eating disorders?
Eating disorders are serious mental and physical health conditions that affect how a person relates to food, body, emotion, control, and safety. They are not choices, phases, or problems of willpower.
Eating disorder symptoms may include:
- Restriction or chronic undereating
- Binge eating or feeling out of control with food
- Purging through vomiting, laxatives, or other compensatory behaviors
- Compulsive exercise
- Rigid food rules or fear of eating certain foods
- Fear of weight gain or intense distress about body shape or size
- Avoidance of body sensations, hunger cues, fullness cues, or certain textures
- Eating patterns that create distress, disrupt daily life, or contribute to medical risks such as nutritional deficiencies, tooth decay, osteoporosis or bone loss, liver issues, anemia, or other health complications
Eating disorder diagnoses include anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder, other specified feeding or eating disorder, and unspecified feeding or eating disorder. A person may also struggle with disordered eating patterns that do not fit neatly into one diagnosis but still deserve care. [NEDA; NEDC; APA Eating Disorder Guideline]
What is trauma?
Trauma is broader than many people realize. It can involve one overwhelming event, repeated exposure to threat, or chronic experiences that leave a person feeling unsafe, powerless, ashamed, trapped, disconnected, or unable to fully settle in their body.
Trauma may include:
- Sexual abuse or sexual trauma
- Physical abuse, emotional abuse, or verbal abuse
- Neglect or attachment injury
- Bullying, peer rejection, or social humiliation
- Relationship trauma
- Medical trauma or traumatic medical complications
- Religious trauma
- War, combat trauma, or exposure to violence
- Natural disasters, accidents, sudden loss, or other overwhelming experiences
After experiencing trauma, some symptoms are acute and may settle within the first month. Post-traumatic stress disorder is considered when post-traumatic symptoms persist beyond that early period and continue to interfere with a person's life. Some people also carry the effects of chronic trauma after repeated or prolonged exposure to threat, abuse, neglect, or lack of safety.
PTSD may involve nightmares, flashbacks, intrusive memories, strong reactions to reminders, avoidance, negative changes in mood or beliefs, shame, guilt, numbness, irritability, sleep disruption, or feeling on edge or under threat.
Complex trauma usually describes the effects of repeated, prolonged, or relational trauma, especially when it happens over time or in situations where escape was difficult. Complex PTSD, or CPTSD, is recognized in the ICD-11 and includes PTSD symptoms along with difficulties in emotion regulation, self-concept, and relationships. CPTSD is not a separate diagnosis in the DSM-5, but many clinicians find the concept useful for understanding these patterns.
Some people also experience dissociation, depersonalization/derealization, memory gaps, identity disturbances, or, less commonly, dissociative identity disorder. In eating disorder treatment, these concerns require careful pacing and specialized clinical attention.
Understanding eating disorders and trauma together does not mean reducing recovery to trauma work alone. It means seeing the whole person clearly enough to build a treatment plan that addresses eating disorder symptoms, medical and nutritional needs, psychiatric concerns, emotional regulation, and the role trauma may be playing in recovery.
How common is trauma in people with eating disorders?
Trauma is not rare in eating disorder treatment. This does not mean every person with an eating disorder has a trauma history. It means the overlap is significant enough that trauma should be asked about carefully, understood clinically, and considered when building a treatment plan.
Research points to several important patterns:
- PTSD symptoms are common in higher-acuity eating disorder treatment settings. The National Eating Disorders Association cites research finding that 49.3% of patients with eating disorders admitted to residential treatment had symptoms compatible with PTSD. [National Eating Disorders Association]
- People with eating disorders often report higher trauma exposure than people without eating disorders. A large umbrella and scoping review found higher rates of childhood trauma, later-life trauma, and marginalization-related trauma in eating disorder samples compared with healthy controls. [Moroshko et al.]
- Adverse childhood experiences are elevated in eating disorder populations. Research on treatment-seeking adults with eating disorders found higher ACE scores compared with a nationally representative adult sample. [Rienecke et al.]
- PTSD and complex trauma symptoms may be especially relevant in treatment-seeking populations. Research on eating disorder treatment-seekers found meaningful rates of PTSD and complex PTSD symptoms, with complex trauma symptoms associated with greater eating disorder severity and impairment. [Day et al.]
Across studies, the exact numbers vary because researchers define and measure trauma differently. One review reported childhood trauma histories in 21% to 59% of eating disorder samples, while post-trauma-related symptoms were reported in roughly one-third to more than half of some eating disorder samples. [Moroshko et al.]
Can trauma cause an eating disorder?
Trauma can contribute to the development or maintenance of an eating disorder for some people, but it is not a single or universal cause. Eating disorders usually develop through multiple interacting factors, including biology, genetics, temperament, mental health concerns, anxiety, depression, obsessive-compulsive disorder, or OCD, neurodivergence, dieting history, medical experiences, family dynamics, attachment wounds, bullying, cultural body ideals, and social pressure.
When trauma is part of the story, eating disorder symptoms may become tied to safety, control, shame, body disconnection, emotional regulation, avoidance, or survival. Restriction, binge eating, purging, rigid food rules, body avoidance, or compulsive exercise may temporarily reduce distress or help a person feel more in control, even while those behaviors create medical risk and reinforce the eating disorder over time.
So the better question is not only whether trauma caused the eating disorder. It is whether trauma is helping maintain the eating disorder now, and whether recovery needs to address both the eating disorder symptoms and the trauma-related patterns underneath them.
A trauma-informed framework for understanding eating disorders
Researchers have not identified one single explanation for why some people develop an eating disorder after trauma while others do not. The current evidence points to a more layered understanding: trauma can affect emotional regulation, body awareness, stress response, attachment, self-concept, and threat sensitivity. Trauma may also overlap with other mental health concerns, including anxiety, depression, and OCD, that shape how symptoms develop.
For some people, eating disorder behaviors become learned ways to manage these internal states. Restriction, binge eating, purging, compulsive exercise, body avoidance, or rigid food rules may temporarily create control, reduce distress, numb painful feelings, manage physical discomfort, or create distance from memories and emotions.
The framework below illustrates one evidence-informed pathway for understanding how trauma may contribute to the development and maintenance of an eating disorder. It does not present trauma as the direct cause of every eating disorder. Instead, it shows how trauma-related adaptations and eating disorder behaviors can interact over time.
Examples: childhood abuse or neglect, sexual assault, bullying, accidents, disasters, combat, witnessing violence, or other overwhelming events.
Traumatic experiences can overwhelm a person's capacity to cope and create lasting changes in how the brain, body, and mind respond to stress and threat.
- Emotion regulation difficulties
- Heightened stress response
- Attachment disruption
- Dissociation / numbing
- Body disconnection
- Shame and self-criticism
- Negative self-concept
- Threat sensitivity
These adaptations can make it harder to tolerate emotions, feel safe, trust others, or connect with the body.
These behaviors can serve a dual purpose: for eating disorder-related concerns, and relief from trauma symptoms.
Eating disorder behaviors may temporarily help manage painful internal states or restore a sense of control or safety.
The behavior provides short-term relief, which teaches the brain that it is effective.
Relief reinforces the behavior, increasing the likelihood of using it again in the future.
This learning process strengthens patterns over time.
Over time, eating disorder behaviors can become habitual and may persist without a clear sense of being trauma-related. Biological effects of starvation, habits, avoidance, body image concerns, anxiety reduction, and other factors help keep the eating disorder going.
Because the eating disorder and trauma-related adaptations can reinforce one another, effective treatment typically needs to address both.
Figure: An evidence-informed clinical framework illustrating one pathway through which trauma may contribute to the development and maintenance of eating disorders.
The temporary relief these behaviors provide can reinforce the cycle. Over time, eating disorder symptoms may begin to feel necessary even after the original trauma has ended. Biological effects of starvation, nutrition instability, avoidance, anxiety reduction, body image concerns, and reinforcement learning can all help keep the eating disorder going.
What is trauma-integrated eating disorder treatment?
Trauma-informed care means the treatment team understands that trauma can affect safety, trust, body experience, emotional regulation, relationships, and the way a person responds to care. A person should not feel forced to share trauma details before they are ready, pushed into overwhelming trauma work, or treated as if eating disorder symptoms are simply irrational behaviors to stop.
Trauma-integrated eating disorder treatment goes further. In integrated treatment, the care team is not viewing a person as divided into separate problems. A person's eating disorder, trauma history, medical needs, nutrition, psychiatric symptoms, and emotional regulation are understood together so care can support the whole person.
Trauma-integrated care may include:
- Assessment: understanding trauma history, PTSD symptoms, complex trauma patterns, dissociation, safety, and current eating disorder symptoms
- Stabilization: building coping skills, emotional regulation, nutrition support, structure, grounding, and relational safety
- Symptom connection: helping a person understand what eating disorder behaviors have been helping them manage
- Trauma-focused therapy: using approaches such as eye movement desensitization and reprocessing (EMDR), and other trauma-focused psychotherapy when a person has enough stability and support
- Careful pacing: matching deeper trauma work to a person's medical, nutritional, psychiatric, behavioral, and emotional stability
A person's eating disorder is still treated directly through nutrition, meal support, medical monitoring, psychiatry, individual therapy, group therapy, family work, and skills-based treatment. Trauma is addressed in a way that supports recovery rather than destabilizing it.
Why stabilization comes before deeper trauma processing
Trauma work does not have to wait until a person's eating patterns are perfectly stable. In eating disorder treatment, trauma stabilization can begin right away. A person can start building safety, emotional regulation, grounding skills, body awareness, coping capacity, trust, and language for what they have been carrying.
Deeper trauma processing is different. Approaches such as EMDR, and other trauma-focused psychotherapies can be powerful, but they also ask a person to stay connected enough to tolerate difficult memories, emotions, body sensations, and beliefs without becoming overwhelmed or increasing unsafe eating related symptoms. In eating disorder recovery, the timing and pacing of trauma processing are part of keeping treatment safe and effective.
Before deeper trauma processing, the treatment team needs to consider whether a person has enough support in several areas:
- Medical stability: Is the person medically safe enough for deeper emotional work?
- Nutritional stability: Is the person nourished consistently enough to stay regulated and present?
- Psychiatric stability: Are depression, anxiety, OCD, substance-use disorders, self-harm risk, suicidality, or other symptoms contained enough for trauma work to be safe?
- Emotional stability: Does the person have enough coping skills, grounding, support, and recovery structure to return to the present after trauma material comes up?
- Behavioral stability: Are eating disorder behaviors reduced enough that trauma work will not immediately intensify restriction, binge eating, purging, compulsive exercise, or other unsafe patterns?
This is not about withholding trauma care. It is about working together to build a foundation and the capacity for processing as the work becomes deeper. In our experience, people often respond best when trauma work is not rushed ahead of nutrition, medical safety, emotional regulation, and recovery structure. The sequencing of trauma-focused therapy is an important consideration in the American Psychiatric Association's practice guideline for eating disorder treatment and in professional guidance for working with complex trauma.
Eating disorder and trauma treatment at Empowered
Empowered Treatment is an adult eating disorder outpatient program for people whose recovery may involve more than changing eating behaviors alone. Many clients seek us out for specialized eating disorder treatment when trauma is a major factor that needs to be taken seriously within the treatment plan. Our trauma-integrated and trauma-forward approach avoids asking clients to choose which part of their experience deserves care.
Our approach is interdisciplinary because eating disorder recovery often requires therapists, dietitians, psychiatrists, and medical support working from the same clinical picture. Care is designed to address eating disorder symptoms directly while including targeted strategies for the trauma-related patterns, emotions, relational challenges, and body experiences that can shape recovery.
Depending on what a person needs, care at Empowered may include:
- Medical evaluation, labs, H&P, initial psychiatric evaluation, medical monitoring, and medication review when clinically appropriate
- Weekly dietitian sessions, nutrition support, and meal support
- Individual therapy with therapists who specialize in eating disorders and trauma
- Group therapy and support from a therapeutic community
- Family work, including education, communication support, and family-based therapy principles when appropriate
- Cognitive behavioral therapy (CBT)
- Dialectical behavior therapy (DBT)
- Eye Movement Desensitization and Reprocessing (EMDR), when clinically appropriate
- IFS-informed and parts-informed therapy
- Somatic therapy and yoga
- Continued-care planning for support after IOP
Trauma-forward treatment does not mean clients are pushed to disclose trauma details before they are ready. In groups, trauma may be discussed through themes such as safety, shame, avoidance, control, emotional regulation, body experience, relationships, and self-protection. Deeper trauma work happens in individual therapy when it is clinically appropriate and when the person has enough stability and support.
To learn whether Empowered Treatment may be the right fit for you or someone you love, call us today or read about trauma-integrated treatment at Empowered.
Frequently asked questions about eating disorders and trauma
Do I need a PTSD diagnosis for trauma to matter in eating disorder treatment?
No. A person does not need a diagnosis of post-traumatic stress disorder, or PTSD, for trauma to affect eating disorder recovery. Some people have clear PTSD symptoms such as intrusive memories, nightmares, avoidance, hypervigilance, or feeling unsafe. Others may not identify with PTSD but still notice shame, body disconnection, emotional overwhelm, dissociation, control, avoidance, or difficulty letting go of symptoms that once helped them cope.
At Empowered Treatment, trauma is considered as part of the whole treatment picture. The question is not only whether someone has a specific diagnosis. The question is whether trauma, adverse childhood experiences, complex trauma patterns, or other painful experiences are affecting recovery and need to be addressed with care.
Can I have an eating disorder without trauma?
Yes. Trauma does not cause every eating disorder. Eating disorders can develop through many pathways, including genetics, temperament, anxiety, depression, obsessive-compulsive disorder, neurodivergence, dieting history, medical experiences, family dynamics, attachment wounds, bullying, cultural body ideals, social pressure, and other mental health concerns.
You do not need to identify a trauma history to deserve eating disorder treatment. At the same time, if trauma is part of your story, it should not be ignored or treated as irrelevant to recovery.
Will I have to talk about trauma in group therapy?
No. Clients are not required to share trauma details in group therapy. Trauma-forward treatment does not mean forcing disclosure. In groups, trauma may be discussed through themes such as safety, shame, control, avoidance, emotional regulation, body experience, relationships, self-protection, and coping patterns.
More detailed trauma work happens in individual therapy when it is clinically appropriate and when the client is ready. The purpose of group is not to expose private trauma histories. It is to help clients understand patterns, build skills, reduce shame, and feel less alone in recovery.
Can EMDR be part of eating disorder IOP?
Yes, eye movement desensitization and reprocessing, or EMDR, can be part of eating disorder IOP when it is clinically appropriate. EMDR is a trauma-focused psychotherapy that may help some clients process traumatic memories, distressing beliefs, body-based reactions, or experiences connected to fear, shame, avoidance, or feeling unsafe.
EMDR is not automatically the right first step for every person. In eating disorder treatment, the timing of EMDR depends on medical stability, nutritional stability, psychiatric stability, emotional regulation, eating disorder behaviors, and the client's capacity to stay grounded during trauma work.
What if I do not remember my trauma clearly?
You do not need perfect memory or a complete trauma narrative for treatment to help. Some people remember specific events clearly. Others remember fragments, body sensations, emotional reactions, relationship patterns, or long periods of feeling unsafe, ashamed, trapped, or disconnected.
Treatment can begin with what is present now: eating disorder symptoms, body distress, fear, avoidance, shame, dissociation, emotional overwhelm, or difficulty trusting support. Trauma-integrated care does not require forcing memories or proving that something “counts” as trauma.
How do I know if I am ready for trauma processing?
Readiness for deeper trauma processing is not about being perfectly stable or never feeling distressed. It is about having enough support and capacity to stay connected to the present while difficult material comes up.
In eating disorder treatment, readiness may involve medical safety, consistent nourishment, reduced eating disorder behaviors, emotional regulation skills, grounding skills, psychiatric stability, and enough trust in the treatment relationship. Trauma stabilization can begin immediately, while deeper processing is paced according to the person's body, nutrition, symptoms, and coping capacity.
Can trauma work make eating disorder symptoms worse?
Trauma work can bring up difficult emotions, memories, body sensations, or urges. If it is rushed or done without enough stabilization, some people may feel more overwhelmed or may rely more heavily on eating disorder behaviors to cope. That is why pacing matters.
This does not mean trauma work should be avoided. It means trauma work should be integrated carefully. In our experience, people often respond best when trauma work is supported by nutrition, medical care, emotional regulation, grounding skills, therapy, group support, and a clear recovery structure.
How long does trauma-integrated eating disorder treatment take?
The length of treatment depends on the person's symptoms, medical and nutritional needs, trauma history, psychiatric concerns, support system, and recovery goals. IOP can help clients build structure, improve nutrition, reduce eating disorder behaviors, strengthen coping skills, and begin understanding how trauma may be affecting recovery.
For some people, trauma-integrated eating disorder treatment begins in IOP and continues afterward with outpatient therapy, dietitian support, psychiatry, support groups, or continued trauma-focused psychotherapy. The goal is not to complete every part of trauma work during one level of care. The goal is to build enough safety, nourishment, support, and direction for recovery to continue.
References
- American Psychiatric Association. (2023). The American Psychiatric Association practice guideline for the treatment of patients with eating disorders (4th ed.). American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890424865
- American Psychological Association, Division 56 (Trauma Psychology), & International Society for the Study of Trauma and Dissociation. (2024). Professional practice guidelines for working with adults with complex trauma histories. American Psychological Association. apa.org/practice/guidelines/adults-complex-trauma-histories.pdf
- Brewerton, T. D. (2023). The integrated treatment of eating disorders, posttraumatic stress disorder, and psychiatric comorbidity: A commentary on the evolution of principles and guidelines. Frontiers in Psychiatry, 14, Article 1149433. https://doi.org/10.3389/fpsyt.2023.1149433
- Brewerton, T. D., Perlman, M. M., Gavidia, I., Suro, G., Genet, J., & Bunnell, D. W. (2020). The association of traumatic events and posttraumatic stress disorder with greater eating disorder and comorbid symptom severity in residential eating disorder treatment centers. International Journal of Eating Disorders, 53(12), 2061-2066. https://doi.org/10.1002/eat.23401
- Convertino, A. D., Morland, L. A., & Blashill, A. J. (2022). Trauma exposure and eating disorders: Results from a United States nationally representative sample. International Journal of Eating Disorders, 55(8), 1079-1089. https://doi.org/10.1002/eat.23757
- Day, S., Hay, P., Basten, C., Byrne, S., Dearden, A., Goldstein, M., Hannigan, A., Heruc, G., Houlihan, C., Roberts, M., Tannous, W. K., Thornton, C., Valentine, N., & Mitchison, D. (2024). Posttraumatic stress disorder (PTSD) and complex PTSD in eating disorder treatment-seekers: Prevalence and associations with symptom severity. Journal of Traumatic Stress, 37(4), 672-684. https://doi.org/10.1002/jts.23047
- Larsen, S. E. (n.d.). Complex PTSD: History and definitions. National Center for PTSD, U.S. Department of Veterans Affairs. ptsd.va.gov/professional/treat/essentials/complex_ptsd.asp
- Mitchell, K. S., Mazzeo, S. E., Schlesinger, M. R., Brewerton, T. D., & Smith, B. N. (2012). Comorbidity of partial and subthreshold PTSD among men and women with eating disorders in the National Comorbidity Survey-Replication study. International Journal of Eating Disorders, 45(3), 307-315. https://doi.org/10.1002/eat.20965
- Moroshko, I., Raspovic, A., Liu, J., & Brennan, L. (2025). Trauma and eating disorders: An integrated umbrella and scoping review. Clinical Psychology Review, 119, Article 102592. https://doi.org/10.1016/j.cpr.2025.102592
- National Eating Disorders Association. (n.d.). Eating disorder statistics. nationaleatingdisorders.org/statistics
- National Eating Disorders Association. (n.d.). Types of eating disorders: Symptoms & treatment. nationaleatingdisorders.org/what-are-eating-disorders
- National Eating Disorders Collaboration. (n.d.). Disordered eating & dieting. nedc.com.au
- Rienecke, R. D., Johnson, C., Le Grange, D., Manwaring, J., Mehler, P. S., Duffy, A., McClanahan, S., & Blalock, D. V. (2022). Adverse childhood experiences among adults with eating disorders: Comparison to a nationally representative sample and identification of trauma profiles. Journal of Eating Disorders, 10, Article 72. https://doi.org/10.1186/s40337-022-00594-x
- World Health Organization. (2024, May 27). Post-traumatic stress disorder. who.int/news-room/fact-sheets/detail/post-traumatic-stress-disorder
You don't have to choose between halves of yourself.
If trauma and an eating disorder are both part of your story, call us. One confidential conversation, with a team built for exactly this.