PTSD and Eating Disorders

June 16, 2020 by Jay Tyszka

What is PTSD?
Post-traumatic Stress Disorder (PTSD) occurs when a person experiences or witnesses a traumatic event and is unable to cope or return to functioning levels prior to the event, with symptoms persisting for at least one month. These symptoms include intrusion (i.e. nightmares, flashbacks), avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity.

What are eating disorders?
Eating disorders (EDs) can broadly be defined as psychological illnesses with severe disturbances in eating behaviors that are rooted in the psyche. Restriction, binging, purging, preoccupation with weight or food, negative and/or distorted body image, and fear of weight gain are just some key indicators of eating disorder presentation.


How are PTSD and EDs related?
PTSD and EDs are often co-morbid; research shows that nearly 25% of individuals with an ED also struggle with PTSD (1). One study specifically demonstrated that 74% of women participating in residential eating disorder treatment, one of the most intensive levels of care, reported experiencing a traumatic event and 52% reported trauma-related symptoms consistent with a PTSD diagnosis (2). This overlap exists because eating disorders can develop indirectly as a way to deal with trauma and PTSD. As trauma impacts feelings of safety and control, self-esteem, identity and sense of self, and/or body image, individuals may turn to severely disordered behaviors around food, movement, and body as a means for coping with negative or uncomfortable thoughts and emotions as well as environmental stressors. It may seem illogical, but even though ED behaviors can seem obviously destructive from an outsider’s perspective, someone engaging in them may find a deep sense of comfort, relief, normalcy, and escape, which can be very hard to let go of.

How does one heal from PTSD and an ED?
Healing and recovery are not always easy, but they are always possible. Treatment involving a multidisciplinary team which includes a qualified therapist, dietitian, medical professional, and possibly a psychiatrist is strongly recommended for the most effective and comprehensive treatment. Once an individual can understand the purpose of their ED behaviors, healthier alternative coping skills can be learned and developed, and their trauma can be processed.

The most common evidence-based treatment modalities for PTSD and EDs are Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT). These therapeutic models are used to help the individual uncover underlying emotions and cognitions related to the traumatic event(s) and teach them adaptive coping skills to process their trauma and leave their eating disorder behaviors behind. While CBT and DBT encompass general strategies and specific techniques, treatment should be tailored to meet the needs of each unique individual.

1. Tagay, S., Schlottbohm, E., Reyes-Rodriguez, M. L., Repic, N., & Senf, W. (2014).
Eating disorders, trauma, PTSD and psychosocial resources. National Institute of Mental Health.10.1080/10640266.2014.857517.
2. Gleaves, D.H., Eberenz, K.P., & May, M.C. (1998). Scope and significance of posttraumatic symptomatology among women hospitalized for an eating disorder. International Journal of Eating Disorders. 24(2),147‐156. 10.1002/(sici)1098-108x(199809);2-e

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