Trauma Signs and Symptoms
What compels a person to feel that they need to restrict calories so severely that they grow weak, exhausted and eventually put their life at risk? Why might someone put their body through the agony of binging and purging? Why might someone prepare delicious meals for their friends and families and not join in, or maintain an intensive exercise regimen, and not refuel their body with necessary nutrients afterwards?
Many factors contribute to eating disorders, including genetic, psychological and social factors. More often than not, past experiences contribute to the break down of people’s relationship to food and eating.
Studies show that eating disorders and trauma are strongly linked. Understanding the signs and symptoms of trauma, and the connection to anorexia, bulimia and binge eating disorder, can help individuals in getting help they need to move beyond past traumatic experiences and reestablish eating habits that support good mental and physical health.
What is Trauma?
Trauma is generally defined as a deeply disturbing event (or events) that make the individual feel out of control of the situation. Trauma can lead to prolonged behaviors and physical manifestations that can negatively affect the individual for years to come, if not addressed and treated correctly.
Trauma can affect behavior and health and can come in a variety of forms. For example, trauma can include abuse, neglect, violence, bullying, disaster, terrorism, or war. These broad categories of trauma can negatively affect individuals, their families, and their communities.
When most people hear the term trauma, they automatically think of major traumatic events, such as assault or rape. While these events are certainly traumas that can have a profound impact on the way that people think, behave and feel for a long time afterwards, people can also be impacted by smaller, but still influential, traumas.
Types of Trauma
In professional circles, trauma is often categorized into “big T” trauma and “little T” trauma. “Big T” trauma include events in which an individual is put into danger. “Big T” trauma could include sexual or other violent assault, serving in wartime situations, or witnessing a school shooting. These are terrifying events that are dangerous and put the body into fight or flight mode. Individuals with “big T” trauma are under immediate distress and can show signs of post-traumatic stress disorder (PTSD) quickly after the incident. In many cases, individuals with “big T” trauma are offered counseling or mental health assistance because the event, and the aftermath, are easier to spot.
“Little T” trauma are smaller, everyday occurrences that exceed the individual’s ability to cope. “Little T” trauma could include smaller – but significant – events like dealing with a bully at the workplace, emotional abuse from a significant other, discovering a partner is unfaithful, or dealing with the heartache of failed fertility treatments. Repeated exposure to “little T” traumas harm the body and psyche in many of the same ways as major trauma. However, people with “little T” trauma often receive less support from family, friends or loved ones because others don’t understand the gravity of what the individual is going through. The person going through “little T” trauma may also feel ashamed of what they’re dealing with or how much its upsetting them, leading to stress, anxiety and unhealthy ways of coping.
Trauma can vary in type – big T versus little T – as well as in intensity and duration. Some types of trauma happen once, like being in a terrible car accident. Other types of trauma happen for an extended period of time, like being abused every time you visited a relative’s house during your childhood. Both types of trauma can negatively affect individuals in many ways.
It is crucial for individuals with trauma, as well as their professional and family support team, understand that all trauma can have significant impact on mental and physical health. To properly recover, and to have a better chance at long-term success, all trauma should be counted as valid. In individuals who are living with eating disorders, it is especially important to uncover any past or ongoing trauma, as it could be contributing to their unhealthy relationship with food.
What are the Signs and Symptoms of Trauma?
Trauma can be challenging to diagnose, especially if the trauma is in the “little T” variety. Sometimes, individuals do not even realize they are suffering from the aftermath of trauma. While every individual is different, there are some signs that could indicate trauma, or prompt a thorough assessment to determine the cause of the behavior or symptoms.
Physical signs and symptoms of trauma
Trauma can manifest physically in the body. These signs can occur regularly or sporadically and can include outward signs of anxiety such as shaking or trembling, inability to pay attention, sleep disturbances such as insomnia, and a racing heartbeat. People exhibiting signs of trauma can also experience aches and pains throughout the body, which can sometimes stump medical professionals who are unaware that the individual has suffered a traumatic event or series of events.
Individuals experiencing signs of trauma can also tense their muscles, and always appear to be on edge or hyper observant. This physical manifestation of feeling anxious can lead to crashing hard or feeling exhausted or fatigued. Further, people living with trauma can also have high blood pressure.
Physical signs of trauma can also include disturbed routines with food. Loss of appetite or binge eating can be a physical sign of trauma and can lead to an eating disorder.
Emotional or psychological signs and symptoms of trauma
Not all trauma signs are physical. Instead, trauma shows up in the emotions, or the way people interact with others. Feeling anxious or depressed can be a sign or past or current trauma but there are other emotional signs to look for as well.
- Anger, irritability, mood swings, including emotional or violent outbursts.
- Anxiety and fear.
- Panic attacks.
- Guilt, shame, self-blame.
- Withdrawing from others.
- Feeling disconnected or numb.
- Obsessive and compulsive behaviors.
Obsessive compulsive behaviors are usually treated as a disorder in and of itself, but obsessive compulsive disorder can be an outgrowth of trauma. Research indicates that certain repetitive behaviors can be ways of coping with the anxiety that results from trauma.
Substance abuse and trauma
Another side effect of trauma is substance abuse. Studies of adolescents in treatment for addiction demonstrate that over 70% cite histories of trauma exposure. Teens who have been sexually abused or assaulted are three times more likely to abuse substances than their peers.
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The Connection Between Trauma and Eating Disorders
The link between trauma and eating disorders is a strong one. Recent studies have demonstrated that rates of eating disorders are high among people who also experienced trauma or post-traumatic stress disorder. A study in 103 women with eating disorders found that 23% of those with anorexia and 25.5% of those with bulimia also met criteria for post-traumatic stress disorder. The rates of having experienced any sort of past trauma, even if the individual hasn’t developed post-traumatic stress disorder specifically, has been estimated to be as high as 100%.
Trauma associated with childhood sexual abuse has long been a known risk factor for eating disorder. Other studies have found that women who have been victims of sexual assault are also more likely to have an eating disorder. But eating disorders professionals now understand that many types of trauma – any type of physical or emotional abuse, teasing, bullying, parental divorce, or the death of a family member – can significantly increase the risk of developing an eating disorder.
Though the exact reasons why are unclear, traumatic events cause individuals to feel a loss of control over their lives or situation. The accompanying stress and anxiety may lead to unhealthy coping mechanism, behaviors and obsessions. For some, that can be fertile ground for eating disorders if the behaviors include restricting food intake, developing unhealthy rituals around food, preoccupations with weight and body image, binging or purging are among them.
Research also shows that individuals with PTSD and individuals with eating disorders often demonstrate dissociation, or a tendency to withdraw from emotions, which may fuel the disconnect between hunger or satiety signals and what is actually being eaten, or not eaten.
Treating Eating Dsorders and Trauma Together
At Rosewood Centers for Eating Disorders, our experienced team is trained to assess eating disorders as well a post-traumatic stress disorder and trauma-related symptoms. Trauma and eating disorder need to be treated together, to give patients the best chances of long-term health and happiness.
Revealing past traumas and talking about one’s past can be scary, emotional and very difficult. We use a trauma-informed approach to care, which involves deliberately avoiding re-traumatizing the individual during assessment, treatment and therapy. That means people are never pressured to talk about distressing situations – for some it’s helpful to talk about the past, and for others, it’s not. Each person is treated as an individual, with each situation and circumstance handled with compassion.
Principles of Trauma-Informed Care
- Ensuring people feel physically and emotionally safe.
- Ensuring that personnel interacting with the individual are trustworthy and maintain proper boundaries.
- Taking a collaborative approach to care so that individuals have a sense of control and are involved in decision-making.
- Empowering patients to share their voice and make choices for themselves.
- Ensuring care is culturally sensitive, taking into account how an individual’s beliefs can impact their response to trauma and path to recovery.
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Healing From Trauma and Eating Disorders
For individuals living with an eating disorder and “little T” trauma, the identification of the trauma can take time. At the start of treatment, individuals may not connect past experiences to current eating disorders behaviors. But often, a person has internalized the trauma and is stuck in a circle of unhealthy coping skills. Once the source of trauma is determined, individuals and their treatment team can start to recognize the physical and emotional affects of trauma, and understand how those experiences have shaped their current anxiety and unhealthy relationship with food.
Through therapy and counseling to help process the trauma and start to take away the power of those memories to cause emotional distress, individuals start to heal. By recognizing the physical and emotional symptoms triggered by trauma, individuals also develop healthier and more effective ways of dealing with it.
Dialectical behavior therapy (DBT), using a trauma-informed approach, can help people overcome trauma side effects, and counteract negative or distorted thought processes, feelings and behaviors.
Eye Movement Desensitization and Reprocessing (EMDR), is a technique that research shows helps the brain reprocess the disturbing memory, and in doing so, take away the power of the memory to continue to cause physical symptoms and emotional distress.
Peer support is also a major part of a recovery, especially for those who have the trauma-eating disorder connection. In group therapy, feeling understood and cared for by others facing similar struggles helps people feel less alone.
Individuals can also find success in decreasing the effects of trauma through mindfulness activities such as meditation and yoga. These practices help the individual connect to the present moment, which can decrease anxiety or depression surrounding the past.
Experiential therapies, including art therapy and animal-assisted therapy, provides ways of connecting with others and expressing emotions without having to use words. In animal-assisted therapy at Rosewood, patients spend time with our gentle horses and friendly goats, whose playful and accepting nature help people feel relaxed, safe, happy and more comfortable opening up.
Finally, family support is crucial to healing, and family members often need help to facilitate their own healing. Our Family Program includes a Family Week, in which loved ones are invited to participate in therapy and other activities at Rosewood, sharing thoughts and feelings honestly. Understanding how trauma contributed to eating disorders can help families rebuild trust, create an environment of safety, learn new ways of communicating with one another, and support the healing of their loved one and their own.