Trauma has been linked to numerous negative health behaviors, including disordered eating and eating disorders. Trauma can include interpersonal violence such as bullying, domestic violence, social violence (wars and terrorism), natural disasters (earthquakes, fires), and chronic social stressors (poverty, racism, sexism, homophobia) [1].
In this way, marginalized identities, such as racial and ethnic minorities, women, LGBT clients, and so forth, are vulnerable to a layered experience with trauma. It is important to note that trauma work inherently requires multicultural competency because it is necessary to understand the role that systemic and institutional systems have on a client’s lived experience.
Trauma and Eating Disorders
The eating disorder community understands that eating disorders can also serve as a coping mechanism, typically as a means for emotion regulation such as reducing anxiety or “numbing out” emotions. Trauma survivors often rely on coping skills that help them regain control or autonomy, and disordered eating and eating disorders are an example of an unhealthy coping mechanism.
Eating disorder clients that have experienced trauma may connect to food as a way to regulate their emotions or gain a sense of control. Marginalized identities such as women or people of color/women of color have historically been asked to “shrink themselves,” and eating disorders embody both a physical and symbolic image of that social stressor [2].
Trauma Food
Eating disorder clients that have experienced trauma often struggle with “trauma foods” or food aversions that, when exposed to the food, may trigger a trauma response in the client. This can be a texture-based/sensory-related trigger, or these foods may serve as a tangible reminder of a traumatic event(s). Registered dietitians work with the client to develop a safer relationship with these food items and facilitate a path to desensitize food-related trauma.
Dietitians often utilize prolonged exposure therapy to work on reintroducing these trauma foods. “The term prolonged exposure (PE) reflects the fact that the treatment program emerged from the long tradition of exposure therapy for anxiety disorders in which patients are helped to confront safe but anxiety-evoking situations to overcome their unrealistic, excessive fear and anxiety” [3].
It can be emotionally overwhelming to start to reintroduce these trauma foods into the diet. It is important that the dietitian works closely with the therapist so that the client can create a thoughtful and methodical plan and be provided the space to safely process these exposure responses.
Food exposures may start with the dietitian and the client sitting in the same room as the food or having the food on the plate without eating it. As time goes on, the dietitian will support the client in eating the trauma food and promoting a new experience with it.
Trauma foods and food aversions are just one of many opportunities for dietitians and therapists to really utilize a treatment team model and apply these two scopes of practice (dietary and clinical) to best serve our clients.
Addressing Trauma
Cognitive behavioral therapy, also known as CBT, is also an evidenced-based practice in addressing trauma in eating disorder clients. CBT is a form of psychotherapy that focuses on modifying dysfunctional emotions, behaviors, and thoughts by interrogating and uprooting negative or irrational beliefs [4].
Initially, dietitians utilize CBT to establish short term goals to address and decrease eating disorder behaviors. Clients must be able to use CBT skills to decrease maladaptive behaviors related to the eating disorder before starting food-based trauma work.
Working through trauma is a necessary part of eating disorder recovery, and dietitians serve a vital role in collaborating with the client to heal the relationship with food and restoring connection to the body. It is imperative that dietitians understand the impact that trauma has on the client and use trauma-informed practices.
There is a need for more training and education about trauma-informed care for dietitians as well as a need for research targeted at benefits of trauma-informed care with a trauma-informed registered dietitian as a part of the multidisciplinary team.
References:
1. Herron, K. (2016, December 27). How Trauma Can Affect Nutrition. MSU Extension. https://www.canr.msu.edu/news/how_trauma_can_affect_nutrition
2. Small, C. (2016). African-American Women on Predominantly White College Campuses: In the Shadows of Eating Disorders. iaedp Foundation Membership Spotlight, 1
3. Rothbaum, B. O., & Schwartz, A. C. (2002). Exposure therapy for posttraumatic stress disorder. American journal of psychotherapy, 56(1), 59-75.
4. Taibi, R. (2019, March 5). Quick Guide to Cognitive Behavioral Therapy (CBT). Psychology Today. https://www.psychologytoday.com/us/blog/fixing-families/201903/quick-guide-cognitive-behavioral-therapy-cbt
