When trauma underlies a patient’s binge eating disorder, recovery cannot begin until the binge eating stops — and long-term remission cannot occur until the trauma is addressed and alternate coping mechanisms are developed.
The underlying trauma may not be from an incredibly dramatic event such as witnessing a death, suffering a sexual assault, experiencing a serious car accident or being deployed in combat. It could be having a family pet die, losing a job, being forgotten at school or going through a divorce or difficult breakup. All can have the same effects: an increase in anxiety and frustration and, in some cases, post-traumatic stress disorder with its associated symptoms of nightmares, dissociation and avoidance.
Eating disorders, particularly binge eating disorder, bulimia nervosa and the restrictive form of anorexia nervosa, all serve to alter mood and distract the person with the disorder from their trauma. The planning involved in hiding the purchase and consumption of vast quantities of food, creating excuses for missed meals, disguising purging, if that is a component, and avoiding social outings create a preoccupation that suppresses other thoughts and memories while providing a sense of control shattered by the traumatic event.
Those who purge experience a physiological release and a neurochemical surge that makes them feel good. Bingeing on energy-dense fast foods and desserts triggers a similar chemical response in the brain. For an individual in distress, both can serve to self-soothe.
Bingeing can be understood as a response to trauma in another way as well. It can serve as a protective mechanism. This is most common in cases of sexual assault, where the survivors, often subconsciously, begin to build a wall of flesh to protect themselves. They may become too large to hug or unable to go out in public. Instinctively, they may seek to make themselves appear unattractive so no one will try to attack them. Obscuring their sexual organs in layers of fat may be seen as a way to suppress the inner turmoil caused by their violation.
In time, though, the behaviors that initially provided escape, protection and calm spiral out of control. The individual becomes physically dependent on the release of hormones that come with consuming ever greater quantities of food. With or without purging, the continued assault to the body eventually destroys health and can kill the affected person.
To start on the path to recovery, binge eaters must stop bingeing and stop purging, if that has been a characteristic of their disease. Ideally, they will work with a dietitian to ensure they receive the nutrition they need and establish an appropriate meal and snack regimen. Therapists will help them develop coping skills and change their frame of reference for meal times.
Without the food, the numbing action of excess eating, the release of purging, and the distractions associated with the disorder, the person in recovery begins to experience more emotions. Their intensity and lability can frighten them, particularly as they have anesthetized themselves for so long.
The traumatic events and associated emotions will also resurface. At this point, the affected individual can begin to work on their response to the trauma, with a goal of reducing the intensity and duration of their response to related stimuli. This work can include things such as re-parenting, empty-chair work, and psychodramas.
In other cases, a therapist may virtually inoculate the patient through increased exposure to situations that have become fraught with anxiety, thus building their immunity to overreaction and fear. The exposure can be actual — going out to a restaurant, talking to a stranger, driving again after a severe accident — or they can be created through guided imagery. Either way, these therapeutic interactions require a skilled clinician who can continue to increase the exposure and the depth of healing without overwhelming the patient to the point that they suffer a setback.
The goals of therapy are to defuse the power of the trauma and then help patients learn how to protect and soothe themselves in healthy ways. Much of the protection comes from learning how to establish clear personal boundaries. In the future, patients may not be able to avoid new trauma, but they can avoid becoming victims again by understanding that they have intrinsic worth and value.
All people have the right to protect themselves, but they need to test their protective positions against reality. A rape survivor may think that all men are predators and avoid all contact with them. That is protective, but it is also a disordered way of thinking. They must learn to recognize that individuals they encounter now are not the people who abused them. That does not mean they should trust everyone. They must maintain boundaries and may need vigilance in certain situations, but over time they can observe others’ behavior and come to trust them.
For trauma survivors who have binge-eating disorder, addressing their pain, accepting themselves, establishing boundaries and learning new coping skills are crucial steps in recovery. Skipping any of them puts the binge eater at risk of returning to a path of destruction the next time a stressful situation occurs.
Lifelong recovery depends on working through each of step at the start of treatment and mastering them in the years that follow.