Eating Disorders Are An Active Trauma, Not A Maladaptive Coping Strategy
By Danielle Grossman
April 18, 2021
This article was published by the Association for Size Diversity and Health. Click here to view the original article.
‘Binge eating is about using food to numb emotions and stuff feelings.’
‘Anorexia is about control.’
‘Disordered eating and eating disorders are about acting out self-hate with food.’
The narrative that eating disorders are rooted in psychological issues and that people act out with food and ‘use’ eating disordered behaviors for coping or control was made up by eating disorder theorists decades ago. It did not originate in diverse voices or first-person narratives. It is not supported in scientific research. It is not born from an understanding of trauma and oppression. It has just been around for so long now that it has become internalized as the truth.
This is a problem.
People deserve accurate information about their own brains and bodies. While we certainly do not have all the answers about eating disorders, contributions from the fields of neuroscience, neurobiology, trauma, and social justice gives us an emerging clarity.
An eating disorder is an active trauma. When a person experiences ongoing distress around a fundamental survival need like eating, there is an activation of the nervous system into a heightened survival mode. The distress around eating could occur due to a varied range of stressors. For example, there could be a lack of consistent access to food, negative cultural consequences of eating freely, a medical issue that affects digestion or absorption of nutrients, an embodied anxiety around eating because of the systematic dehumanization of white supremacy and/or a neurobiologically driven terror around food triggered by energy deficit.
In this active trauma, the brain and body sense ‘there’s a problem with my food situation’. This drives the person’s thoughts and behaviors toward surviving that problem. These survival responses, mediated through the person’s life experiences and genetics, could be avoidance of food, fixation on food, binge eating, continual mental calculations about food and/or compensations around eating like exercise or forced vomiting.
When we frame eating disorder behaviors as maladaptive coping strategies for psychological problems or life stressors, we pathologize these normal, healthy responses around eating. Even if we frame the narrative in the most compassionate way possible, such as, ‘it makes sense you turned to food to manage your emotions–you were being hurt and oppressed’ the message is still ‘your personal issues are at the root of your eating disorder, you have a pathological problem with food, and you need to work on your thoughts and behaviors.’
In an eating disorder, people are responding just as they should to the distress around eating that they have either fallen into unintentionally or that has been inflicted upon them. Naming their thought and behavior patterns with food as the root of their suffering and the path out of their suffering is wrongful victim blaming and gaslighting. It also sets them up to fail and feel like it’s their fault and that they are inherently broken when they are unable to change their behaviors around food.
An understanding of eating disorders as an active trauma allows us to move away from these harms. It also allows us to move away from the harms of our narrow focus in eating disorder assessment and treatment. A trauma lens gives us the ability to recognize all who suffer around eating, not just those who fit a certain set of diagnostic criteria or stereotypes. We can ask, ‘who amongst us is likely to experience fear and lack of safety around food?’ and bring those who are currently invisible or at the margins of eating disorder treatment into the center.
This eating disorder as an active trauma framework also helps us to provide effective treatment. We can seek to identify the causes of the person’s distress around eating and do our best to offer the support and resourcing they need to have a way out of the trauma. We can hold space for them when that support or resourcing is not available or sufficient. We can take responsibility to change the oppressive systems that cause suffering around eating.
Of course we continue to work with whole people and attend to all of the feelings or experiences or needs that they bring to the table. Trauma – not just food trauma – can be a vulnerability and perpetuating factor for eating disorders and trauma focused therapies are often needed for those suffering around food. And of course it’s up to the person who is suffering with food to decide how to tell their own story. What needs to change is how clinicians frame and describe eating disorders so that we can move into a narrative that is more accurate, ethical, inclusive and effective.