The Dietitian’s Role in Treating Trauma in Eating Disorders

Contributor: Kourtney Vandenburgh, RD at Montecatini Eating Disorder Treatment Center

Trauma has been linked to numerous negative health behaviors, including disordered eating and eating disorders. Trauma can include interpersonal violence such as bullying, domestic violence, social violence (wars and terrorism), natural disasters (earthquakes, fires), and chronic social stressors (poverty, racism, sexism, homophobia) [1].

In this way, marginalized identities, such as racial and ethnic minorities, women, LGBT clients, and so forth, are vulnerable to a layered experience with trauma. It is important to note that trauma work inherently requires multicultural competency because it is necessary to understand the role that systemic and institutional systems have on a client’s lived experience.

Trauma and Eating Disorders

The eating disorder community understands that eating disorders can also serve as a coping mechanism, typically as a means for emotion regulation, such as reducing anxiety or “numbing out” emotions. Trauma survivors often rely on coping skills that help them regain control or autonomy, and disordered eating and eating disorders are examples of unhealthy coping mechanisms.

Eating disorder clients who have experienced trauma may connect to food as a way to regulate their emotions or gain a sense of control. Marginalized identities such as women or people of color/women of color have historically been asked to “shrink themselves,” and eating disorders embody both a physical and symbolic image of that social stressor [2].

Trauma Food

Eating disorder clients who have experienced trauma often struggle with “trauma foods” or food aversions that, when exposed to the food, may trigger a trauma response in the client. This can be a texture-based/sensory-related trigger, or these foods may serve as a tangible reminder of a traumatic event(s). Registered dietitians work with the client to develop a safer relationship with these food items and facilitate a path to desensitize food-related trauma.

Dietitians often utilize prolonged exposure therapy to work on reintroducing these trauma foods. “The term prolonged exposure (PE) reflects the fact that the treatment program emerged from the long tradition of exposure therapy for anxiety disorders in which patients are helped to confront safe but anxiety-evoking situations to overcome their unrealistic, excessive fear and anxiety” [3].

It can be emotionally overwhelming to start to reintroduce these trauma foods into the diet. It is important that the dietitian works closely with the therapist so that the client can create a thoughtful and methodical plan and be provided the space to safely process these exposure responses.

Food exposures may start with the dietitian and the client sitting in the same room as the food or having the food on the plate without eating it. As time goes on, the dietitian will support the client in eating the trauma food and promoting a new experience with it.

Trauma foods and food aversions are just one of many opportunities for dietitians and therapists to really utilize a treatment team model and apply these two scopes of practice (dietary and clinical) to best serve our clients.

Addressing Trauma

Cognitive behavioral therapy, also known as CBT, is also an evidence-based practice in addressing trauma in eating disorder clients. CBT is a form of psychotherapy that focuses on modifying dysfunctional emotions, behaviors, and thoughts by interrogating and uprooting negative or irrational beliefs [4].

Initially, dietitians utilize CBT to establish short-term goals to address and decrease eating disorder behaviors. Clients must be able to use CBT skills to decrease maladaptive behaviors related to the eating disorder before starting food-based trauma work.

Working through trauma is a necessary part of eating disorder recovery, and dietitians serve a vital role in collaborating with the client to heal the relationship with food and restore connection to the body. It is imperative that dietitians understand the impact that trauma has on the client and use trauma-informed practices.

There is a need for more training and education about trauma-informed care for dietitians as well as a need for research targeted at benefits of trauma-informed care with a trauma-informed registered dietitian as a part of the multidisciplinary team.

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References:

1. Herron, K. (2016, December 27). How Trauma Can Affect Nutrition. MSU Extension. https://www.canr.msu.edu/news/how_trauma_can_affect_nutrition

2. Small, C. (2016). African-American Women on Predominantly White College Campuses: In the Shadows of Eating Disorders. iaedp Foundation Membership Spotlight, 1

3. Rothbaum, B. O., & Schwartz, A. C. (2002). Exposure therapy for posttraumatic stress disorder. American journal of psychotherapy, 56(1), 59-75.

4. Taibi, R. (2019, March 5). Quick Guide to Cognitive Behavioral Therapy (CBT). Psychology Today. https://www.psychologytoday.com/us/blog/fixing-families/201903/quick-guide-cognitive-behavioral-therapy-cbt

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About the Author:

Kourtney Vandenburgh, RD completed her undergraduate degree in nutrition and dietetics at California State University, Long Beach. She then completed her dietetic internship at Western Carolina University in North Carolina. Kourtney is a member of the Academy of Nutrition and Dietetics and the National Eating Disorder Association. One of Kourtney’s great passions is to help people embrace the wonderful benefits of mental and physical wellbeing. She achieves this by working with clients to restore healthy thoughts and perceptions about food. Kourtney prides herself on providing tailored nutrition education to individuals and groups.

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About Our Sponsor:

At Montecatini Eating Disorder Treatment Center in Carlsbad, California, we provide comprehensive care for adolescent girls and adult women who are struggling with eating disorders.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Reviewed & Approved on June 25, 2020, by Jacquelyn Ekern, MS, LPC
Published June 25, 2020, on EatingDisorderHope.com