A high prevalence of post-traumatic stress disorder (PTSD) and trauma exists among patients with eating disorders, according to Timothy D. Brewerton, M.D., with the Medical University of South Carolina in Charleston. Researchers have hypothesized that eating disorder behaviors develop as a way for these individuals to avoid certain traumatic memories, numb symptoms of hyperarousal and help them to cope with the intense emotional pain associated with a traumatic experience, Brewerton said.
Essentially, any experience — including sexual assault or harassment, physical neglect (e.g., food deprivation), teasing or bullying — can be extremely traumatic and lead to the development of acute traumatic stress, PTSD or other significant anxiety problems. This trauma exposure can potentially trigger compulsive behaviors of using food as a means of coping with the traumatic event and can increase an individual’s susceptibility for developing an eating disorder.
A strong association with trauma
A recent study conducted by Cynthia M. Bulik, Ph.D., and her colleagues found that 13.7 percent of women with anorexia nervosa met the diagnostic criteria for PTSD. An earlier study found that 10 percent of patients with anorexia nervosa and 14.1 percent of patients with bulimia nervosa met the criteria for a diagnosis of PTSD, and 63 percent of women with anorexia nervosa and nearly 58 percent of women with bulimia nervosa had experienced at least one trauma in their lifetime.
Due to the strong association between trauma, PTSD and eating disorders in the literature, researchers have suggested that clinical interventions for traumatized eating disorder patients may benefit from treating PTSD symptomology. One such possibility for treating co-occurring trauma and eating disorders includes eye movement desensitization reprocessing (EMDR) therapy. Although EMDR therapy is not considered to have a direct benefit for people with eating disorders, it may be potentially useful for treating patients with eating disorders if their behaviors were triggered by a traumatic event.
Effectiveness of EMDR for treating eating disorders
EMDR is a psychotherapeutic approach that was originally developed to eliminate the distress associated with trauma. EMDR utilizes bilateral stimulation (rapid eye movements, touch or sound stimuli) to help unlock traumatic memories from the unconscious mind and facilitate more adaptive processing of trauma-related images, sensations, beliefs, feelings and emotions. This therapeutic approach was originally developed to treat PTSD. However, the uses of EMDR therapy have been expanded to include depression, anxiety, attachment disorders, eating disorders and more.
Recent studies have investigated the effectiveness of using EMDR for treating eating disorders and body dysmorphia (i.e., preoccupation with a perceived flaw in appearance). One study provided evidence for the usefulness of EMDR therapy in treating patients with body dysmorphic disorder. The researchers found that EMDR led to improvements in six of seven patients with body dysmorphic disorder, and five of the patients experienced a complete resolution of their symptoms.
Another study by Rachel M. Calogero, with the University of Kent, and Andrea Bloomgarden investigated the short- and long-term effects of EMDR in 86 women receiving residential treatment for eating disorders. Women were randomly assigned to treatment as usual and EMDR, or to treatment as usual only. Compared to the women who received treatment as usual only, the women who received the addition of EMDR therapy reported less distress related to negative body image memories and less body dissatisfaction at the three-, six- and 12-month follow-ups.
DaLene Forester Thacker, Ph.D., an EMDR International Association approved consultant and trainer, reported the results of a study conducted in a clinical, private practice setting. The study investigated the use of EMDR for treating the underlying complex trauma symptoms in patients with bulimia nervosa. In the study, participants were randomly assigned to the EMDR group or the wait list group. Of the six participants, EMDR successfully reduced trauma symptoms, and three participants (50 percent) no longer met the diagnostic criteria for bulimia nervosa at the end of the study. Thacker reported that all participants reported a reduction of bulimic episodes following EMDR treatment.
Addressing the underlying issues
EMDR allows patients with eating disorders to address the underlying issues of trauma, making it less likely that they will relapse or rely on maladaptive coping mechanisms (e.g., substance abuse, self-harming behaviors, extreme exercising and other high-risk behaviors) associated with eating disorders. EMDR therapy may also assist patients with eating disorders by developing more effective coping mechanisms to deal with stress, which can lead to a reduction in symptoms. Given the strong connection between trauma and eating disorders, it appears reasonable to assume that individuals with an eating disorder would benefit from a trauma treatment such as EMDR.
Overall, it appears that EMDR can be a potentially useful tool for patients with co-occurring trauma or PTSD and eating disorders. Although empirical evidence for the effectiveness of EMDR is currently lacking, most researchers who have examined the efficacy of EMDR treatment in patients with eating disorders have found promising results.
Sovereign Health of California provides evidence-based treatments for patients with eating disorders, substance abuse, mental illness and co-occurring disorders. Patients in the eating disorders program receive individualized treatment plans and treatments based on their specific needs. For more information on the programs offered at Sovereign Health, please contact our 24/7 helpline to speak to a member of our team.
About the author
Amanda Habermann is a writer for the Sovereign Health Group. A graduate of California Lutheran University, she received her M.S. in clinical psychology with an emphasis in psychiatric rehabilitation. She brings to the team her background in research, testing and assessment, diagnosis and recovery techniques. For more information and other inquiries about this article, contact the author at firstname.lastname@example.org.