Trauma is a common cause of eating disorders, around 10-15%, but represents an important subset because the treatment needs are very different.
Starvation for those with a traumatic history often has a very specific and personal meaning commonly related to both denying oneself care and comfort and serving as a way to re-experience the pain of the past.
Starvation has long been used as a weapon, and that experience is connected to the role of an eating disorder in coping with trauma. Individuals turn to hunger strikes as a public demonstration of opinion or outrage. Captors starve prisoners to yield information. Prisoners starve in protest. Starving an entire population can force people into submission. The populations of many countries starve while others have enormous excess food, which is not a direct expression as much as a sign of the meaning of food in disparate parts of the world.
As starvation has taken on many meanings in the world, from the individual to the collective, it's not surprising that eating disorders have become an increasingly common syndrome associated with trauma.
Eating disorder symptoms caused by trauma tend to be more chaotic and driven by a strong urgency. These people experience daily life happening in ways they cannot manage or alter. Much like the actual experience of trauma, daily events feel like they unfold on their own. These people never felt agency in their lives and still don't. Although many eating disorder symptoms feel as if they happen on their own, most people with eating disorders feel that there is always a part of themselves not swallowed by the illness. People with a history of trauma feel completely consumed by the eating disorder largely to escape the dread associated with the traumatic memories.
Safety is the primary focus of treatment for people with trauma. They need to believe therapy is a safe place to start to address the feelings and experiences associated with their past and memories. At the same time, the person needs to be safe enough in their eating disorder not to be in medical danger. Often the line between medical safety and emotional safety can be tricky and confusing.
The treatment needs to focus on trauma therapy from the start. That pain cannot be avoided in order to look at the eating disorder. They both need to be faced simultaneously. Since starvation can affect physical and emotional stability, the treatment is difficult and needs to constantly monitor all aspects of the person's well-being. However, any other approach for help will backfire.
The most important aspect for the treatment is to combine that safety with compassion. The suffering both through trauma and through the eating disorder is great. Health and recovery are real possibilities, and therapy needs to start with that hope and reinforce it at every turn.