The Connection Between Trauma and Eating Disorders with Heather Ferguson, LCSW
Trauma is a word that’s thrown around a lot. And the idea that trauma and eating disorders are connected is pretty known… but WHY are they connected, and what connects them?
Heather is a clinical social worker and psychoanalyst with a private practice in NYC. She’s also an eating disorder and trauma expert. She is faculty and a supervisor at The Institute for Psychoanalytic Study of Subjectivity; The National Institute for Psychotherapies; and The Manhattan Institute for Psychoanalysis and the Certificate Program in Trauma Studies.
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She’s also a review editor for Psychoanalysis, Self and Context and she’s written about eating disorders from a self psychological, relational, and neurobiological perspective (if those words mean anything to you).
A lot of her work has inspired and informed the talks and webinars I’ve given. She’s written academic papers for decades and I love her work. To be honest, her works are some of my favorites when it comes to eating disorders and psychoanalysis. So consider us real lucky to have her join us here.
What Do We Mean by “Trauma”?
Trauma is in the eye of the beholder. What might be seemingly not so traumatic to one person might actually be very traumatic to another. And the other way around.
Heather cites a client she had who had a sexual experience online with a male cousin when she was a teenager. While this might not seem very traumatic to some, for her, it was; when she went back to her childhood home during the time of COVID and everything was online, the experience came flashing back to her in an overstimulating way. For her, this took on significant meaning and affected her self-esteem, gender identity, and so on.
For others, trauma could mean emotional neglect; chronic misattunement; and of course, bodily trauma. Often, we think of media sensationalized events as trauma, but that’s just a sliver of what trauma is.
Moreover, not everyone responds to these events the same way. Context is everything; someone’s age, who they were surrounded by, and the support response (or lack thereof) they receive affects whether or not it’s traumatic.
For instance, something that happens to an 11-year-old is different from a 17-year-old. And if they go to a parent to share the experience with, does the parent respond positively and supportively? Or does the parent invalidate and dismiss the experience?
If they are dismissed, particularly if they are a younger child, then they may begin to feel that they made up the experience, or it was their fault… and that’s what determines the impact of the trauma.
And readers beware. In today’s day and age, “trauma” has become a word to describe any upsetting experience. That is not at all what we’re endorsing.
Relational Trauma
Cumulative relational trauma is a less-talked about type of trauma. This might mean a family member, often a parent, is always or often enough misattuned. They would be the one to respond to a child’s experience if something is off, and if the child does not get what they need from the parent at that moment, its cumulative effect can be dramatic.
Having a safe place to go and having your words and experiences welcomed and encouraged is so important. Not having this place really affects the developing child, and can cause them to grow up feeling very alone, leading to an experience that is secret and solitary.
The Connection Between Trauma and Eating Disorders
Now, of course not everyone who has an eating disorder has a history of trauma. But a significant number do. Heather has seen eating disorders as a very viable solution to trauma.
What does this mean? She cites a patient – a middle-aged married woman she names “Allison” – who had early childhood trauma at the hands of a family member. It was a secret she did not feel safe to share with her family, and disordered eating became an outlet for her to self-soothe and self-regulate.
She had states of hyperarousal and agitation that she had no way to manage, and she used not eating as a tool for self-management. The eating disorder became a solution and a strategy to manage her states of hyperarousal and anxiety.
Eating disorders can have multiple functions. They can soothe the nervous system, but it can also be self-harming and self-punishing. Sometimes, her client will say she doesn’t eat because she enjoys the pain of being hungry. And she’s not the only one.
Heather says she sees eating disorders sometimes acting as a self-attack because that’s what the brain tells itself surrounding trauma: “I’m bad. I deserve punishment. I caused [the trauma] to happen.” It’s illogical, but it’s how the psyche makes sense of the trauma.
It’s really complex. In a way, the eating disorder can be a window into the trauma. We need to start asking questions like: How has their eating disorder saved them? How does their eating disorder serve them? At the same time, how does their eating disorder get in the way, hurt them, and punish them?
More Understanding of Self-Harm
Everyone is so unique, and eating disorders are unique to individuals. There’s not a one-size-fits-all way of thinking.
But in a general way, how does it work when someone unconsciously tells themself their trauma is their fault, and punishes themself for it? What’s the purpose of this self-harm? Like how is that helpful?
Heather continues to use Allison as an example. For Allison, she might feel like she deserves punishment. After being sexually abused at 6 years old, she imprinted the belief that she was bad. She absorbed this sense of violation that became part of her; it was so early in development and she didn’t have any other ways of processing it.
One idea Heather mentions is an analytic one called identificatory processes. Meaning, there’s often a feeling of being linked to the aggressor, because they maybe need the attachment – but they’re also bad by proxy for what happened.
Allison felt like she was bad by proxy, because she went along with her abuser at age 6. Logically, we know that a 6-year-old wouldn’t have the self-efficacy to refuse a grown adult. Heather has been working with her to help her see she was in a state of freeze and fright. She could not move, and that idea of being frozen in fright is a body state she lives out today as an adult.
People who study body work know that this is a mammalian brain survival method – there’s fright, flight, and freeze, and when you’re in shock, you freeze. And so, sometimes the healing work, Heather says, is to help the patient feel efficacious in their body – almost reviving a sense of protest in their body.
Eating disorders can be self-soothing and self-regulating, but also a form of protest; a way of saying, “this is my body. Bug off; I’ll do with my body what I want.” There’s a semblance of self-assertion and control in eating disorders.
But, as Heather notes, this is paradoxical, because the thing that makes you feel like you’re in control sometimes becomes habituated. It sometimes feels like the eating disorder has hijacked your life, mind, and body, and it takes on a life of its own.
A simple way to understand self harm is to think about a kid processing what’s been going on in the scary world. “It’s way too dangerous to think about the world being an unsafe place. It’s far more organizing to think I’m the one who’s bad, I’m the one who needs to be harmed. This way, my environment and the adults around me can remain a safe place to exist.”
Eating Disorders as Way of Processing Trauma
Traumatic life events often do not make sense to the brain and are difficult to process. To go back to the aforementioned examples, it doesn’t make sense why an adult someone trusts would abuse them and hijack their sense of autonomy and safety. It especially wouldn’t make sense to a 6 year old.
Using eating disorder behaviors may act as a way to negotiate a seemingly unprocessable experience. I can have control over my food even if I don’t have control over my situation. I can soothe myself with food even if I can’t find any other way to soothe. I can make sense of these horrific experiences by blaming and harming myself and not the adults who were supposed to take care of me.
So What Now?
So maybe someone understands they have a history of trauma, and they begin to understand a little more conceptually about how their eating disorder is connected. What does the process of healing look like here?
Not to sound like a broken record, but of course, everyone is an individual and it’s important to get individualized help. With that said, here are some major ideas for healing?
Heather begins by saying it’s hard to find healing alone. It could be an eating disorder self-help group, a therapy group, talking to a friend or family member, or professional help through a nutritionist or therapist… but whatever method you choose, it’s important to start the process with others.
The frustrating part of practical advice is that it’s not usually about learning more information. It’s not just about putting pieces together logically (read more about this in last week’s blog post) – there HAS to be a piece of this where we’re slowing the body down, digesting this information, and actually experiencing it.
Otherwise, it’s just the body on its own agenda.
That can happen by starting with eating disorder behaviors or starting with telling the trauma story. Either way, it’s all about taking the narrative and slowing down. To identify the feelings attached.
And when someone can begin to identify behaviors with feelings and sensations, it’s possible they can come up with an alternate coping strategy (that’s where a therapist can point out the behaviors, and propose grounding techniques).
In this, the person is creating a new narrative – one where they have autonomy over their body.
Heather says there has to be someone – whether it’s a friend or therapist – who is, in compassion, digesting and feeling the story with the person. Trauma, invariably, happens in isolation – so reinvigorating the sense that someone cares about that person as they share these traumatic events is so important.
Emotional Disconnect from Your Story
And if someone is able to share their story, but they’re emotionally disconnected from it?
Heather says it’s important for a therapist to respect someone’s need to distance themselves from their story.
But she says if there’s already some safety and rapport in a relationship, she might either ask: “What are you feeling right now in your body? Do you notice a sensation? It seems like you’re really in your head right now,” in order to bring them back to an emotional connection to their body.
Or, she might let them stay in a “self-protective cocoon.” She says it’s important to respect where the patient is at, and not force them to go further than their body or mind is capable of at the moment.
Dissociating from Trauma through Numbing
Eating disorders can be soothing, a way to control, or they can be numbing and dissociative.
We know about the neurobiology of restriction; there is a neurochemical process in which restricting makes you light-headed. There’s an endorphin rush when you’re starving, and it can feel good. And think about a binge, it’s so easy to get lost in that trance. It’s dissociative.
In that way, the purpose of the eating disorder is to create a dissociative, numbing feeling.
Neglectful or Narcissistic Parent
When we talk about relational trauma or cumulative trauma, repeated misattunement or neglect, or a child’s need to constantly adjust to a narcissistic parent, it may seem like the path toward healing would be wildly different. It’s not like there’s a “traumatic event” that needs to be processed. It’s more like over time this has had an astounding negative impact.
Well, maybe you wouldn’t look at hyper and hypoarousal in the same way (or maybe you will), and you’re definitely working on self-efficacy, self-assertion, and communicating your needs.
Maybe it’s communicating to family members when you go home to not talk about your body or food habits. Maybe it’s about having more boundaries and taking care of yourself in that way.
Heather also remembers a patient who had relational trauma with her mother, who was emotionally neglectful. Any time this patient needed anything, her mother told her she was too much and she needed too much. The patient internalized this belief, and she learned to restrict and self-manage.
Treatment for her was about getting her to feel entitled to needing other people – including her friends, boyfriend, therapist, and so on. Treatment was getting her to feel like she was allowed to have needs and feelings, and allowed to share them.
It was a lot of unpacking. Understanding how the body responds to overwhelm is very helpful here – and that’s where work with a therapist comes in.
Example
Let’s say you call your boss to ask for extra vacation days, and you freeze. That’s likely reflective of something that happened in your family of origin.
Heather would then ask, “Does this remind you of anything?” or “Does this remind you of the time you asked your mother for something, and she shut you down and humiliated you?”
When you’re able to make the links between your experiences, you’ll be able to start putting the puzzle pieces together and eventually make sense of your eating disorder. All of your experiences are clues.
Intergenerational Trauma
Intergenerational trauma is the idea that somehow, there is a traumatic story of a prior generation and it is passed down through generations.
A number of clinicians worldwide have been talking about this, and research has come out from survivors of the Holocaust that says it takes 3 generations to remember that kind of trauma because the brain shuts down.
So you have people in Israel not talking about the Holocaust because it can’t be spoken. It’s too dangerous and too horrific.
And so those secrets get passed along from mother and father to child, and then to grandchildren. Heather has also seen sexual trauma and eating disorder trauma passed through generations. It might not be spoken, but it’s felt bodily.
Food scarcity within a family could also be passed down and communicated within families without realizing it. People who have a family history of food scarcity might hoard food, or eat super fast, or have a lot of rules around food, for instance.
Trauma and eating disorders are not one-size-fits all, and is dependent upon the unique individual; it’s so vital to work with a therapist to find a plan that works for you.
Tweetable Quotes
“The eating disorder became a self-management tool, a self-regulating tool, a strategy to manage states of hyperarousal and anxiety, to have a sense of efficacy and control.” –Heather Ferguson, LCSW
“Most of us with a psychoanalytic frame of mind think about eating disorders serving both functions, that is, they can both downregulate and soothe the nervous system, but it can also be self-harming and self-punishing.” – Heather Ferguson, LCSW
“That’s part of what gets mapped around trauma – ‘I’m bad, I deserve punishment.’ It’s illogical, it’s sort of how the psyche makes sense of this – that you are the bad one, and you somehow induce the traumatic event.” – Heather Ferguson, LCSW
“The eating disorder in a way can be a window into understanding the trauma.” – Heather Ferguson, LCSW
Resources:
Heather’s email: heatherfergusonlcsw@outlook.com
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Hey there! I’m Rachelle, the host of the Understanding Disordered Eating Podcast. As a Licensed Mental Health Counselor, I work with clients to make sense of life’s messy emotional experiences.
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