Integrating Trauma Treatment into Eating Disorder Programs: the Road to Long-Term Recovery

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Research shows that experiences of trauma are common among adolescents with eating disorders. One study found that a majority (75%) of adolescents who entered residential treatment for eating disorders had experienced at least one type of childhood trauma, while 38% met the criteria for PTSD.

Young people who live with trauma symptoms alongside an eating disorder face additional challenges and tend to have more severe symptoms and higher rates of depression and anxiety.

Until recently, the go-to treatments for eating disorders (such as family-based therapy) tended to take a one-disorder-at-a-time approach, only addressing experiences of trauma once a young person had left intensive care settings and entered outpatient treatment.

However, recent research now proves the effectiveness of integrating trauma treatment with evidence-based eating disorder treatment, even in higher-level care. With integrated treatment, people showed meaningful improvements in eating disorder symptoms – and significant relief from trauma symptoms – both when they left their program and at the 6-month follow-up.

This blog outlines the results of this research and explores the link between eating disorders and experiences of trauma. It also looks into the reasons why integrated treatment is so important for recovery from mental health disorders.

Why Is PTSD So Common Among Young People with Eating Disorders?

Many adolescents who enter eating disorder residential programs have post-traumatic stress disorder or have experienced some form of trauma.

Research shows that adolescents with the earliest onset of the disorder (from the age of 5 to 10 years) have the highest rates of PTSD (76%), more than those who experienced onset from 11 to 17 (45%) or as adults (31%). People whose eating disorders began in childhood are more likely to have experienced traumatic events and have a current PTSD diagnosis. 

Research has established that childhood trauma is a risk factor for developing eating disorders (EDs). Scientists still don’t fully understand the pathways between trauma and EDs, but they have some ideas.

Young people may use food to try and cope with distressing emotions that follow traumatic experiences. Childhood emotional abuse may lead to low self-esteem, a trait that can underlie disordered eating behaviours. 

As a result, young people with PTSD are more likely than others to develop eating disorders. Equally, adolescents with eating disorders are more likely to have PTSD than those without.

Young people rarely recover from PTSD or unprocessed trauma without effective support: they deserve and require trauma treatment to recover and heal.

Why Is It Important to Treat Eating Disorders and Trauma at the Same Time?

For young people who have experienced trauma, symptoms of PTSD or unprocessed trauma can underlie eating disorder symptoms, sustaining disordered eating behaviours and, if untreated, acting as barriers to lasting recovery.

Full and meaningful recovery requires a whole-person approach to treatment that is built upon the complex interplay of different symptoms, disorders, and life experiences that make up a young person’s mental health concerns. Underlying causes of eating disorders should be addressed early to pave the way for healing and recovery from the symptoms they sustain or drive.

This means providing trauma therapy to teenagers and adolescents from the start of eating disorder treatment, even in intensive treatment settings and high levels of care.

This might involve one of several types of evidence-based trauma therapies or a combination of different approaches. Treatment should also teach young people tools and coping skills to self-manage symptoms and sustain recovery in the long term.

How Effective is Integrated Eating Disorder and Trauma Treatment?

Earlier this year, an important study explored the effectiveness of integrating trauma therapy (based on the principles of cognitive processing therapy) into residential eating disorder (ED) treatment.

They measured the severity of ED symptoms, PTSD, major depressive disorder (MDD), state-trait anxiety (STA) symptoms, and eating disorder quality of life at three time points: the start of treatment, the end of the program, and six months later. They found that:

  • 81% of individuals with PTSD when they entered the program had significantly fewer PTSD symptoms when they left treatment. 73% had significantly fewer symptoms at the six-month follow-up.
  • Individuals both with and without PTSD showed significant improvements in eating disorder symptoms between the start and the end of treatment, as well as anxiety and depression symptoms and quality of life.
  • Eating disorder symptoms did not significantly worse between the end of treatment and the six-month follow-up. This contrasts with programs without integrated trauma therapy that show a significant worsening of symptoms at this time.
  • Individuals in ED treatment with PTSD reported more severe symptoms of eating disorders, major depressive disorder, and state-trait anxiety at all time points than those without PTSD. They also reported a lower quality of life.

These results show that integrating trauma treatment into residential eating disorder programs can effectively treat both conditions – and have enduring positive effects.

Their findings constitute a move away from the idea that trauma therapy should only be initiated in outpatient settings: a perspective that may be rooted in a lack of expertise in trauma treatment or a fear that addressing trauma could make ED symptoms worse. But in reality, avoiding trauma treatment often results in relapse and a need to re-enter treatment. 

The study also suggests that it’s not necessary to complete a full course of trauma therapy to experience benefits. Even some exposure to trauma therapy and its principles is important, helping individuals to understand the factors that cause or sustain eating disorders and instilling hope that they can recover and heal from the trauma they’ve experienced.

The Wave Clinic: Transformative Recovery Programs for Young People

The Wave Clinic offers transformative recovery programs for adolescents and young people from our residential centre in Malaysia. Our world-leading approach combines exceptional clinical care with social responsibility and an international gap year experience, supporting young people to plan and build better futures.

We consider each young person as a whole, treating their multiple needs to encourage inner healing and lasting growth. We offer young people respect, agency, and support as they rediscover their passions in life and develop the skills they need to follow them.

For the past six years, we’ve provided concurrent ED treatment and trauma treatment to young people living with eating disorders and experiences of trauma, helping them to heal and achieve lasting recovery. 

If you’re interested in finding out more about our programs, get in touch today. We’re here for you.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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