Eating Disorders and Trauma

This research paper explores publications that report on outcomes of studies conducted on the relationships between eating disorders and trauma. The paper digs into the different types of eating disorders, their causes, symptoms, and signs and possible treatment approaches. This research – based paper also looks into physical, mental and psychological trauma regarding the aspects that distinguish these types of trauma, the signs and symptoms, causes and effects and the ways of coping and dealing with the trauma. The paper reviews appraise and critiques literature published by researchers who have carried out studies on the aspects of eating disorders and traumas mentioned above and the links that exist between them. These publications have given an elaborate description of the people who are at the highest risk of developing eating disorders as a result of going through traumatic situations. These people include, amongst others, victims of sex abuse (especially child sex abuse - CSA), victims or people who have had first-hand experiences with domestic violence, and those who have Post-Traumatic Stress Disorder (PTSD).

Understanding eating disorders 

An eating disorder is a serious illness characterized by irregular eating habits and grievous distress and concern over the victim’s appearance, body weight and their shape. These disturbed feeding habits include eating too much or too little food, eating unhealthy foods and unbalanced diets, which causes adverse effects on a person’s physical, psychological, mental and emotional health. Contrary to popular belief, eating disorders are not outcomes of lifestyle choices, but rather grave and fatal diseases that cause significant interruptions to a person’s eating behaviors, and just like any other disease out there, they require serious attention care and treatment approaches to assist the people who suffer from them. Anyone can be affected by eating disorders, but the condition is most prevalent amongst children, teenagers, and young adults. Eating disorders are often coupled with anxiety disorders, depression and drugs and substance abuse.

Causes and Risk Factors of Eating Disorders 

There is a wide array of factors that cause eating disorders. These risk factors can be attributed to a person’s physical/biological makeup, their psychological status and the environment surrounding a person. Biological factors include irregular hormone functioning, genetics, and nutritional deficiencies. On the genetic prospect, research shows that eating disorders run in families and studies are being conducted to determine the Deoxyribonucleic Acid (DNA) variations that are associated with the heightened risk of developing eating disorders (Eating Disorders, 2016). The psychological risk factors are comprised of negative body image and low self-esteem. Environmental factors that are possible contributors to the occurrence of eating disorders include functionally impaired family setups, careers that require people to maintain certain body weights and shapes, for instance, dancing, modelling sporting professions that call for lean body statuses for the standard performance; family and childhood traumas and pressure that comes from peers, colleagues at work and the cultural society.

Types of Eating Disorders 

Anorexia Nervosa 

This condition is characterized by the deep concern and worries about being overweight. People suffering from anorexia usually view themselves as overweight, even when they weigh dangerously less than they should weigh to be considered healthy and fit. According to information on the National Institute of Mental Health’s website, Anorexia nervosa causes the highest number of deaths associated with mental disorders. It mostly affects young men and women, who die from complications arising from starvation while others commit suicide (Eating Disorders, 2016). Symptoms include, extremely reduced eating and emaciation, unwillingness to maintain a normal and healthy body weight, vivid fear of weight gain, deformed body image, and low self-esteem. The more deadly symptoms that develop with time include, among others, dry and yellowish skin, anemia and muscle wasting, brain and heart damage and severe constipation.

Bulimia Nervosa 

People with this conditions sporadically eat large amounts of food and have an insatiable appetite during these times. They then feel the need to compensate for the overeating and do so by inducing vomiting, using laxatives, and fasting and excessive physical exercises. The symptoms include, among others, inflamed and sore throats, swollen salivary glands, gastrointestinal problems, dehydration, and electrolyte imbalance. Peoples suffering from this conditions usually maintain relatively healthy body weights as compared to those suffering from anorexia.

Binge-Eating Disorder 

People with this condition lose control over their eating, but unlike people with Bulimia, they do try to compensate for the overeating. People with binge-eating disorder eat even when they are not hungry and eat incredibly fast during these binge episodes. They are often distressed and guilty of their eating behavior and will often eat alone to avoid embarrassment. Binge-eaters are usually obese and at a high risk of developing obesity-related disorders such as coronary heart disease, diabetes, and stroke.

Treatment and Therapies for Eating Disorders 

The most basic forms of prevention from and treatment of eating disorders are adequate, healthy and balanced nutrition and the right amount of physical exercise. Psychotherapies are also used to treat eating disorders. For instance, family-based therapies are used to handle cases of anorexia where family members of people with this condition take up the responsibility of feeding them. Cognitive Behavior Therapy (CBT) is used to assist people with binge-eating disorder (Eating Disorders, 2016). Medications such as antidepressants, antipsychotics, and mood stabilizers are also administered by medical practitioners to treat these diseases.

Understanding Trauma 

Trauma is the response a person has when they go through an incredibly horrendous and harmful situation. Reactions to traumatic events can have profound effects on the way people live their lives after these experiences. Trauma causes stress and the impairment of a person’s physical and emotional functionalities (Salovey et al. 2000). Trauma is caused by physical and psychological factors. These factors are informed by negative situations such as rape, natural and human-made disasters, illness and injury, domestic violence and child abuse or witnessing the suffering and death of a loved one.

People suffering from trauma are disoriented, nonresponsive during conversations and distant when engaging with other people. Even when they are physically present, they appear to be very far away in thought. Trauma victims are almost always anxious about something and often experience nightmares, irritability, and inquietude. Their moods change all the time, and they have a hard time concentrating. Emotional symptoms of trauma include misplaced anger, denial, and emotional outbursts. Physically, trauma victims appear pale, lethargic and fatigued. They also experience irregular heartbeats and panic attacks. Trauma can manifest itself immediately after a person goes through a traumatic event or it can take a long period to do so.

Literature review 

In the article, Eating Disturbance and Sexual Trauma in Childhood and Adulthood , the authors aimed to establish the link between sexual trauma and eating disorders, considering factors such as the victims’ ages and the effects of multiple sexual attacks. The subjects who were used in the survey were children and adults who had been victims of sexual abuse or rape during their childhood or in adulthood or both. The results of the study showed that childhood sexual abuse victims were at a higher risk of developing eating disorders, but there was insufficient evidence to support the assertion that these disorders came about squarely as a result of the sexual abuse encounters (Wonderlich et al. 2001). This is because people who had been raped as adults did not exhibit the increased likelihood of developing eating disorders. The study also established that victims of childhood sexual abuse and rape were significantly diet and body weight. The study established that what such abuses visibly resulted in, was the victims’ responses and reactions to later sexual trauma (Wonderlich et al. 2001).

The journal, Childhood Trauma as a Predictor of Eating Psychopathology and its Mediating Variables in Patients with Eating Disorders , is a resultant publication of a study carried out to ascertain whether particular types of childhood trauma predict eating abnormalities and to investigate the interceding effects of psychological signs of depression and obsessional coercion between childhood trauma and eating abnormalities in people suffering from the disorders. The study showed that emotional maltreatment, physical neglect, and sexual abuse were all concrete and conclusive predictors of eating abnormalities or psychopathologies (Kong & Bernstein, 2009). The study established that depression fully contributed to the association between some types of a childhood trauma and eating disorders but obsessional coercion, which also known as obsessive-compulsion, did not. The study concluded that physicians should evaluate the possibility of childhood trauma when handling patients with eating disorders, especially those that exhibit some level of resistance to the treatment. It also concludes that depression resulting from a traumatic experience is a more reliable predictor of eating disorders than the traumatic experience itself (Kong & Bernstein, 2009).

In the article, The Relationship between Eating Disorders and Sexual Trauma , the authors delineate the outcomes of a study aimed at verifying the assertion that sexual trauma is one of the most significant risk factors associated with the development of eating disorders. The results of the study showed that sexual trauma was affiliated with several signs and symptoms of eating disorders (Madowitz et al. 2015). According to the research, people suffering from sexual trauma may have difficulties when relating with their bodies, and this discontentment with their bodies, the shame and sexual dysfunction that arises from the traumatic experiences leads to the development of eating disorders (Madowitz et al. 2015). Victims of sexual abuse are psychologically unstable, and while trying to cope with these difficulties, the victims are highly likely to develop eating disorders. From the study, the researchers established that conditions such as depression and Post-Traumatic Stress Disorder set victims of sexual abuse on a pathway that usually leads to eating psychopathologies (Madowitz et al. 2015).

The paper by the Academy for Eating Disorders (Klump et al. 2009), amplifies the position of the academy, that anorexia nervosa, bulimia nervosa, and binge eating disorder are all life-threatening Biologically-Based Mental Illness(BBMI). The paper accentuates that these conditions should be taken with the same seriousness and enough health care resources and services should be directed towards their treatment, as is the case with mental illnesses such as schizophrenia and depression. The position of the Academy is informed by the scientific considerations that have been made on the relationships between eating disorders and aspects such as the genetic and neurobiological setup and the mental and emotional functionality of the human body. The paper explains that eating disorders (ED) are hereditary conditions, just like bipolar disorders. This means that if a person suffers from ED, another member of their family, an elder most likely, suffered from the same condition before. The paper also asserts that EDs are connected to shortfalls in a person’s mental and emotional functionality, just like in Biologically-Based Medical Illnesses such as obsessive-compulsive disorder (Klump et al. 2009).

The empirical article, Childhood Trauma and Cortisol Awakening Response in Symptomatic Patients with Anorexia Nervosa and Bulimia Nervosa , is based on research that was conducted to determine whether going through traumatic experiences during one’s childhood can lead to the development of eating disorder in their adulthood (Monteleone et al. 2015). Being subjected mistreatment, neglect, abuse and experiencing the loss during childhood is known to heighten the risk of the victims developing psychological and behavioral trouble later in their adult lives. Some of these troubles are affiliated with anorexia and bulimia, and the intent of this study was to establish to what degree that happens. Results showed that a significant count of the study subjects who were suffering from anorexia and bulimia had at some point in the early stages of their lives been physically abused and emotionally neglected. According to Monteleone et al (2015), being exposed to traumatic situations during childhood causes the dysregulation of the hypoactivity axis in adults suffering from these eating disorders.

The article, History of Childhood Sexual or Physical Abuse in Japanese Patients with Eating Disorders; Relationship with Dissociation and Impulsive Behaviours , is grounded in a study in which the researchers looked into the prevalence of traumatic situations in patients suffering from eating disorders and the association between these situations and the clinical characteristics of these disorders (Nagata et al. 1999). The results of these study informed the researchers’ conclusion that sexual abuse does not necessarily lead to the development of eating disorders such as anorexia and bulimia.

The basis of the article, early trauma, dissociation, and late onset on the eating disorders , is a study that explored the connection between trauma experienced during childhood and the eating that develop later on in life. Tobin et al. 1995 aimed to demonstrate that a pattern exists between these two phenomena. The authors of the document explore and analyze two cases to define these connections. The first case involved a 43-year old married Caucasian woman who was being assessed for anorexia. She was acutely apprehensive of food and exercises strenuously for over three hours every day. Apart from the eating disorder, the patient was suicidal and dissociated from her husband whenever they had sexual relations. The patient described that the reason she dissociated was that sexual activity reminded her of the sexual and physical abuse she suffered as a child in the hands of her father and brother (Tobin et al. 1995). The second case involved a 46-year old Caucasian woman who was under assessment for depression and eating troubles. She exhibited symptoms affiliated to both trauma and eating disorders. When her condition deteriorated, she was admitted to a psychiatric facility where she revealed that she had been raped 25 years before, her father had sexually abused her from when she was five years old all the way to when she was in her twenty’s and that she had even procured an abortion.

The article, variants of potentially traumatizing life events in eating disorder patients , is informed by a study conducted to determine to what degree non-interpersonal and interpersonal traumas, and negative childhood situations were accounted in a study sample of patients suffering from eating disorders with the comparison to the non-clinical group (Lejonclou et al. 2014). During the study, an assessment of variations in trauma experiences among groups of people who were diagnosed with different types of eating disorders was carried out. The researchers analyzed the associations between the traumatic experiences and the level of severity of the eating disorders that patients in this study group were suffering from. The study found that patients in the eating disorder group accounted a higher oftenness of recurrent traumatic experiences than the women in the non-clinical group. On some particular aspects, the patients with eating disorders experienced more interpersonal traumatizing situations as compared to members of the non-clinical group. Interpersonal trauma events include, among others, rape, violent robberies, and emotional neglect (Lejonclou et al. 2014).

Research critique 

The development of eating disorders such as anorexia nervosa, bulimia nervosa, binge eating atypical eating disorders is associated with a huge variety of sophisticated risk factors and direct and indirect causes. Though this research studies and the resultant publications articulately espouse the causes of the eating disorders, they do not offer concrete evidence to support their biological, psychological and socio-cultural effects on the development of these disorders. Minimal information can be drawn from these studies and their documentation to facilitate the understanding, learning, and teaching of the fundamental interactions between the different types of eating disorders (Levine & Smolak, 2006). The fact that most of the conspicuous symptoms of some eating disorders are occur hand in hand with other eating disorders appears to escape most researchers and authors.

The conclusions from some researches have suggested that eating disorders are ways of dealing with stressful situations. This assertion is misleading in the sense that even though people suffering from eating disorders may initially overfeed or eat less to cope with stress, there is no proof whatsoever that they can be determinant and efficacious coping strategies. Experts have referred to this assertion as merely a casual illustration of the symptoms of eating disorders.

It warrants considerable concern that in most of the literature reviewed here, the authors have not documented the possible difficulties that researchers might have gone through when undertaking their studies. It is very unlikely that a research project would undergo its full life cycle without encountering some interruptions and difficulties along the way. Research projects are extensive and costly regarding the human and non-human resources that go into their execution from initiation to completion. Study subjects might not always be cooperative, and changes may need to be made in the course of the studies. These modifications to the study samples and research structures should be elaborated to augment the credibility and usability of the research findings.

From the research articles used in this paper, it is impossible to generalize the findings beyond the study population samples. This is because the sample count is often too low to give credible findings that would be used to make accurate assumptions about the general population regarding the study topics under investigation. In most of the studies, symptoms such as dissociation, anxiety, and alexithymia have been excluded. The exclusion of these symptoms leads to questions on whether have sufficient comprehension of the full scope the attributes, causes and the treatment measures of eating disorders, which compromises the integrity of the research studies.

From the evaluation and critique of the literature it is prudent to recommend that during execution of further research programs on eating disorders and trauma, bigger study samples be used to heighten the level of accuracy of the resultant findings. Future studies should also accommodate additional psychological factors as connections between traumatic experiences and eating disorders. The studies should also acknowledge that these conditions can affect any person despite their age; old people are at risk of suffering from eating disorders, just as much as the children and young adults are.

References

Eating disorders. (2016, February). Retrieved March 27, 2017, from https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml 

Klump, K. L., Bulik, C. M., Kaye, W. H., Treasure, J., & Tyson, E. (2009). Academy for eating disorders position paper: eating disorders are serious mental illnesses. International Journal of Eating Disorders, 42 (2), 97-103.

Kong, S., & Bernstein, K. (2009). Childhood trauma as a predictor of eating psychopathology and its mediating variables in patients with eating disorders. Journal of Clinical Nursing, 18 (13), 1897-1907.

Lejonclou, A., Nilsson, D., & Holmqvist, R. (2014). Variants of potentially traumatizing life events in eating disorder patients. Psychological Trauma: Theory, Research, Practice, and Policy , 6(6), 661.

Levine, M. P., & Smolak, L. (2006). The prevention of eating problems and eating disorders: Theory, research, and practice. Psychology Press.

Madowitz, J., Matheson, B. E., & Liang, J. (2015). The relationship between eating disorders and sexual trauma. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 20(3), 281-293.

Monteleone, A. M., Monteleone, P., Serino, I., Scognamiglio, P., Genio, M., & Maj, M. (2015). Childhood trauma and cortisol awakening response in symptomatic patients with anorexia nervosa and bulimia nervosa. International Journal of Eating Disorders, 48 (6), 615-621.

Nagata, T., Kiriike, N., Iketani, T., Kawarada, Y., & Tanaka, H. (1999). History of childhood sexual or physical abuse in Japanese patients with eating disorders: relationship with dissociation and impulsive behaviours. Psychological Medicine, 29 (04), 935-942.

Salovey, P., Rothman, A. J., Detweiler, J. B., & Steward, W. T. (2000). Emotional states and physical health. American psychologist, 55 (1), 110.

Tobin, D. L., Molteni, A. L., & Elin, M. R. (1995). Early trauma, dissociation, and late onset in the eating disorders. International Journal of Eating Disorders, 17 (3), 305-308.

Wonderlich, S. A., Crosby, R. D., Mitchell, J. E., Thompson, K. M., Redlin, J., Demuth, G., ... & Haseltine, B. (2001). Eating disturbance and sexual trauma in childhood and adulthood. International Journal of Eating Disorders, 30 (4), 401-412.