Eating disorders impact an estimated 30 million people in the United States and that number does not include those who experience disordered eating symptoms but may not have been formally diagnosed with an eating disorder (National Association of Anorexia Nervosa and Associated Disorders, 2022). However, many still don’t know the signs of disordered eating or may feel deep shame surrounding disordered eating and therefore don’t reach out for help. Let’s take a closer look at disordered eating, particularly as it relates to trauma.

Disordered eating could include chronic dieting, preoccupation with food, restrained or inflexible eating patterns, and compulsive eating that may progress to an eating disorder over time. Signs you or someone you love may be struggling with an eating disorder include:

  • obsessively counting calories
  • skipping meals
  • disappearing after meals
  • avoiding eating in public
  • exercising excessively
  • experiencing negative thoughts about your body
  • socially isolating

While there is a component of body dissatisfaction, disordered eating is typically a symptom of other additional underlying concerns which can be addressed through counseling. In other words, disordered eating is not just about thinness. Often, disordered eating is an attempt to regulate overwhelming emotions or to gain control when other aspects of life feel out of control.

There could be many reasons why disordered eating impacts so many people in the United States including Eurocentric standards of beauty and society’s preoccupation with thinness, the diet industry’s profit off of people hating their bodies, and the moralization of food as “good” or “bad”. One additional reason that mainstream language around disordered eating often overlooks is trauma, including racism, gender violence, poverty, abuse, and more (Strings, 2019; Trottier et al., 2016). For marginalized groups, disordered eating may function as a way to manage distressing emotions surrounding systemic racism, microaggressions, anti-queer bias, violence, food insecurity, unstable housing, and more.

Research suggests that trauma is not simply psychological but is also physiological.

Trauma symptoms and memories can deeply impact the brain and body, often leaving survivors disconnected from their bodies’ cues. This disconnection can be described as numbness or dissociation. Trauma survivors may try to cope with this overwhelming feeling of numbness or regain control in their lives using disordered eating. The intention here is positive and brave – survivors are searching for a way to heal and find tools that they have access to. Their bodies are attempting to protect them from the harm they have experienced and the memories that may be associated with it. Yet, this method of survival ends up further disconnecting them from their bodies and perpetuates the cycle of emotional distress.

The good news is that healing from both disordered eating and trauma symptoms is possible. Healing can include support from a clinical mental health provider, community support, creating new brain pathways through corrective experiences, and ultimately, compassionate reconnection with your body (Kahn & Suejung, 2017; Mitchell et al., 2012, Van der Kolk, 2015).

Through treatment a person may learn to identify hunger and fullness cues, meet physical and emotional needs, and challenge thought patterns that aren’t working anymore. The first step, however, is reaching out for support. Many people hesitate to ask for help based on the myth that they “aren’t sick enough” but the truth about disordered eating and trauma is that they do not have a face, a body type, or a one size fits all presentation.

 

OSFED and ARFID

Avoidant Restrictive Food Intake Disorder (ARFID) is a new diagnosis that first appeared in the Diagnosis and Statistical Manual- 5th edition (DSM-5, 2013). Like anorexia nervosa, ARFID involves limitations in the amount and/or types of food consumed. However, ARFID does not involve distress about body image, body shape, or body size.

Characteristics of ARFID include an apparent lack of interest in eating food or food avoidance based on sensory characteristics of food and/or concern about adverse consequences of eating. These maladaptive patterns must also be associated with significant weight loss or failure to achieve expected weight, significant nutrition deficiency, dependence on nutrition supplements, and impairment in functioning.

Risk Factors:

Like all eating disorder, there are a range of biological, psychological, social, and cultural factors that may increase the likelihood of developing ARFID. Because it is a newer diagnosis, research on ARFID is limited. However, some consistent findings indicate that individuals who have neurodevelopmental disorders (such as autism spectrum disorder, attention-deficit/hyperactivity disorder, and intellectual disabilities) are more likely to develop ARFID. This may be due to sensory difficulties (food textures, smells, etc.,) that are often experienced by individuals with neurodevelopmental disorders. Additionally, many individuals with ARFID tend to have co-existing anxiety related disorders that may exacerbate fear of adverse consequence of eating (i.e., choking, allergic reactions, pain, upset stomach, etc.,)

Health Consequences:

Health consequences of ARFID are similar to other eating and feeding disorders. ARFID is associated with malnutrition which can result in declined cognitive energy and can result in serious medical consequences, such as electrolyte imbalance, impaired immune functioning, menstrual irregularity, and cardiac arrest.

Treatment:

Treatment for ARFID is often multifaceted and involves coordinating with a medical doctor, nutritionist, and therapist. Treatment goals often include achieving and maintaining a healthy weight and more adaptive eating patterns, increasing variety of foods eaten, learning ways to eat while decreasing strong negative emotions (i.e., fear and worry). Additionally, medication can assist to increase appetite and to help anxiety management.

Other Specified Feeding and Eating Disorder (OSFED) is a category of eating disorder that was developed to include individuals who did not meet diagnostic criteria for anorexia or bulimia nervosa, but still experienced a clinically significant eating disorder. It should be noted that OSFED is associated with similar severity levels as other eating disorders and can be life threatening.

OSFED presentations include:

  • Atypical anorexia nervosa
  • Bulimia nervosa (of low frequency and/or limited duration)
  • Binge eating disorder (of low frequency and/or limited duration)
  • Purging disorder
  • Night eating syndrome

These symptom presentations typically include features of restricting calories, binging, and/or purging. However, they do not meet the diagnostic criteria for other eating disorders such as anorexia nervosa, bulimia nervosa, or binge eating disorder due to insufficient time criteria or number of symptoms required for diagnosis.

 

If you need immediate assistance for yourself or a loved one you can contact the National Eating Disorders Association below for support, treatment options, and other helpful resources.  We also hope that you will contact the professionals at Matone Counseling & Testing.  704-503-8196  We want to help.

 

South Charlotte: 704-503-8196
Cotswold: 704-264-2973
Asheville: 828-333-9320

 

Alex Washburn is a current masters-level student that is pursuing her degree in Clinical Mental Health Counseling at the University of North Carolina at Charlotte.

Written by: Terran Sutphin and Alex Washburn

Alex Washburn is a clinical intern and support team member at Matone Counseling and Testing. Alex received her Bachelor’s in Public Relations from the University of Georgia and is currently pursuing her Master’s in Clinical Mental Health Counseling from the University of North Carolina at Charlotte. 

 

References

Eating disorder statistics: General & Diversity stats: Anad. National Association of Anorexia Nervosa and Associated Disorders. (2022, June 8). Retrieved September 25, 2022, from https://anad.org/eating-disorders-statistics/

Kahn, J. H., & Suejung Han. (2017). Attachment, Emotion Regulation Difficulties, and Disordered Eating Among College Women and Men. The Counseling Psychologist, 45(8), 1066–1090. https://doi.org/10.1177/0011000017744884

Mitchell, K. S., Wells, S. Y., Mendes, A., & Resick, P. A. (2012). Treatment Improves Symptoms Shared by PTSD and Disordered Eating. Journal of Traumatic Stress, 25(5), 535–542. https://doi.org/10.1002/jts.21737

Strings, S. (2019). Fearing the Black Body: The Racial Origins of Fat Phobia. New York University Press.

Trottier, K., Wonderlich, S. A., Monson, C. M., Crosby, R. D., & Olmsted, M. P. (2016). Investigating posttraumatic stress disorder as a psychological maintaining factor of eating disorders. The International Journal of Eating Disorders, 49(5), 455–457. https://doi.org/10.1002/eat.22516

Van der Kolk, B. A. (2015). The body keeps the score: brain, mind, and body in the healing of trauma. New York, New York, Penguin Books.

“People who feel safe in their bodies can begin to translate the memories that previously overwhelmed them into language” (Van der Kolk, 2015, p. 277).