Eating Disorders, Trauma & PTSD: How EMDR, CPT & PE Support Recovery

By Jamie Manwaring, PhD

PTSD and eating disorders frequently co-occur, with trauma often preceding disordered eating behaviors. Research shows that individuals with eating disorders are more likely to have PTSD. Eating disorders may develop as a way to cope with overwhelming emotions tied to trauma, and trauma can also negatively impact eating disorder treatment outcomes, increasing the risk of relapse. Effective treatments for PTSD, such as CPT, PE and EMDR, can help individuals process trauma as they heal from both conditions.

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a psychiatric disorder that occurs in people who have experienced or witnessed a traumatic event.

People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may:1,2

  • Relive the event through flashbacks or nightmares
  • Feel sadness, fear or anger
  • Feel detached or estranged from other people
  • Avoid situations or people that remind them of the traumatic event
  • Have strong negative reactions to certain stimuli

PTSD & eating disorders

Individuals with an eating disorder are significantly more likely to develop PTSD or meet the criteria for PTSD diagnosis. The lifetime prevalence of PTSD in adults is 6.8%2 while prevalence of PTSD in anorexia nervosas and bulimia nervosa patients hovers around 24%.3

Eating disorders and history of trauma

Eating disorders don’t always develop with the intent to control body weight or shape but can also develop as a maladaptive coping mechanism to stress or trauma.4,5

At least 52% of those with an eating disorder diagnosis have a history of trauma, with traumatic events often taking place before the onset of an eating disorder.4 When a person experiences a traumatic event, they may develop eating disorder behaviors to manage overwhelming feelings, like sadness, loneliness, guilt, shame or powerlessness.

Trauma can also exacerbate feelings that contribute to disordered eating, like:6,7

  • Low self-esteem
  • Self-criticism
  • Perfectionism
  • Impulsivity
  • Compulsiveness
  • Dissociation
  • Poor body image

PTSD & the impact on eating disorder treatment

Traumatic events can also have a negative impact on eating disorder treatment outcomes.4,8,9 Patients with eating disorders who have experienced traumatic events have an increased likelihood of:

  • Treatment dropout
  • Increased likelihood of relapse
  • Poorer outcomes

Treating PTSD & Eating Disorders

A clinician or team skilled in treating both PTSD and eating disorders can help an individual determine whether the eating disorder or trauma symptoms need to be prioritized, or whether they can be treated simultaneously. All treatments for PTSD can be difficult in the short-term as they all involve reprocessing the trauma, so engaging with a therapist with whom the patient trusts and feels safe is important.

Cognitive processing therapy

Cognitive Processing Therapy (CPT) can help individuals identify and challenge negative thoughts and beliefs about a traumatic event, with the goal of changing their perception of the experience and allowing better management of the symptoms of PTSD. CPT has been found to be effective, but may be more well-suited to specific traumatic incidents instead of addressing complex PTSD (e.g., from a childhood of neglect).10

Prolonged exposure treatment

Prolonged Exposure Treatment (PE) involves individuals gradually and repeatedly confronting trauma-related memories, feelings, and situations they've been avoiding to allow them to process their trauma and reduce their symptoms in a safe environment with a trusted therapist. Similar to CPT, PE has been found to be effective but may be more well-suited to specific traumatic incidents.11

Eye movement desensitization and reprocessing

EMDR uses bilateral stimulation (eye movements, sounds or taps) to help individuals focus on a traumatic memory that can then help individuals reprocess the memory and reduce its emotional impact.

Learn more about psychotherapy for eating disorders here.

Find Help for Dual Diagnosis

Living with both an eating disorder and PTSD can feel especially overwhelming, but you don’t have to navigate it alone. Integrated care that addresses both conditions at the same time is essential for lasting recovery. With the right support team and evidence-based treatment, recovery is possible.

References

  1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
  2. Post-Traumatic Stress Disorder (PTSD). (n.d.). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd
  3. Tagay, S., Schlottbohm, E., Reyes-Rodríguez, M. L., Repic, N., & Senf, W. (2014). Eating Disorders, Trauma, PTSD, and Psychosocial Resources. Eating Disorders, 22(1), 33–49. https://doi.org/10.1080/10640266.2014.857517
  4. Blais, R. K., Brignone, E., Maguen, S., Carter, M. E., Fargo, J. D., & Gundlapalli, A. V. (2017b). Military sexual trauma is associated with post‐deployment eating disorders among Afghanistan and Iraq veterans. International Journal of Eating Disorders, 50(7), 808–816. https://doi.org/10.1002/eat.22705
  5. Brewerton, T. D. (2007). Eating Disorders, Trauma, and Comorbidity: Focus on PTSD. Eating Disorders, 15(4), 285–304. https://doi.org/10.1080/10640260701454311
  6. Convertino, A. D., & Mendoza, R. R. (2023). Posttraumatic stress disorder, traumatic events, and longitudinal eating disorder treatment outcomes: A systematic review. International Journal of Eating Disorders, 56(6), 1055–1074. https://doi.org/10.1002/eat.23933
  7. Brustenghi, F., Mezzetti, F. a. F., Di Sarno, C., Giulietti, C., Moretti, P., & Tortorella, A. (n.d.). Eating Disorders: the Role of Childhood Trauma and the Emotion Dysregulation. PubMed, 31(Suppl 3), 509–511. https://pubmed.ncbi.nlm.nih.gov/31488781
  8. Rodríguez, M. M., Pérez, V. a. F., & García, Y. (2005). Impact of traumatic experiences and violent acts upon response to treatment of a sample of Colombian women with eating disorders. International Journal of Eating Disorders, 37(4), 299–306. https://doi.org/10.1002/eat.20091
  9. Mahon, J., Bradley, S. N., Harvey, P., Winston, A., & Palmer, R. D. (2001). Childhood trauma has dose-effect relationship with dropping out from psychotherapeutic treatment for bulimia nervosa: A replication. International Journal of Eating Disorders, 30(2), 138–148. https://doi.org/10.1002/eat.1066
  10. Asmundson, G. J., Thorisdottir, A. S., Roden-Foreman, J. W., Baird, S. O., Witcraft, S. M., Stein, A. T., ... & Powers, M. B. (2019). A meta-analytic review of cognitive processing therapy for adults with posttraumatic stress disorder. Cognitive Behaviour Therapy, 48(1), 1-14.
  11. Powers, M. B., Halpern, J. M., Ferenschak, M. P., Gillihan, S. J., & Foa, E. B. (2010). A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clinical psychology review, 30(6), 635-641.

ACUTE Earns Prestigious Center of Excellence Designation from Anthem
In 2018, the ACUTE Center for Eating Disorders & Severe Malnutrition at Denver Health was honored by Anthem Health as a Center of Excellence for Medical Treatment of Severe and Extreme Eating Disorders. ACUTE is the first medical unit ever to achieve this designation in the field of eating disorders. It comes after a rigorous review process.

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