Eating Disorders and Psychotrauma: From Genesis to Reconstruction

Introduction: When Trauma Inscribes Itself in the Relationship with Food

Psychotraumas - these invisible wounds of the soul - maintain a complex and bidirectional relationship with eating disorders. While 70% of people suffering from EDs have experienced at least one significant trauma, the care journey itself can become a source of new wounds, creating a vicious cycle of vulnerabilization and marginalization.

This reality, still too unknown to the general public and sometimes even to professionals, nevertheless illuminates the deep mechanisms of EDs. The body becomes the theater where traumas replay, where unspeakable suffering expresses itself, where questions of control, safety, and identity negotiate. Food then becomes much more than a simple biological function: it becomes language, refuge, and sometimes battlefield.

In my Paris clinical experience, I observe how recognition and integration of these traumatic dimensions radically transform the therapeutic approach. It's no longer just about "fixing" a dysfunctional relationship with food, but understanding how this relationship was built as a survival strategy facing the unbearable.

The Traumatic Genesis of EDs: When the Body Becomes Refuge

Early Traumas and the Architecture of Survival

Childhood traumas - whether acute (assaults, accidents) or chronic (neglect, emotional abuse) - profoundly modify neurological and psychological development. The nervous system, in permanent alert state, develops adaptive strategies that can include food control as a means of emotional regulation.

Incest and sexual abuse, present in the history of 30-50% of people suffering from severe EDs, create a particular dissociation with the body. This "betrayed", "soiled" body becomes the enemy to control, punish, or make disappear. Anorexia can then represent an attempt at desexualization, a return to a pre-pubescent "innocent" child's body. Bulimia can express self-disgust, the need to "vomit" the unbearable, to fill an abyssal void.

Attachment traumas - abandonment, emotional neglect, chaotic parenting - create a fundamental insecurity that food will attempt to fill or control. Binge eating becomes self-consolation, restriction proof of autonomy, food rituals an attempt to create the predictability that was lacking.

Complex Traumas and Global Dysregulation

Complex trauma, resulting from repeated and prolonged exposure to traumatic situations, particularly in a relational context from which one cannot escape, produces global dysregulation. This dysregulation affects:

The autonomic nervous system: Alternation between hyperactivation (anxiety, hypervigilance) and hypoactivation (dissociation, numbness). Eating behaviors become ways to modulate these states: restriction to control hyperactivation, bulimia to exit numbness.

Emotional regulation: Inability to identify, tolerate, and regulate emotions. Food becomes the emotional mediator: eating not to feel, not eating to feel something, vomiting to evacuate the intolerable.

Self-image: Construction of a fragmented identity, based on shame and unworthiness. The ED becomes a substitute identity, something one "masters" in a world where everything else escapes control.

Vulnerabilization: Fragile Ground

Developmental Windows of Vulnerability

Certain developmental periods create particular vulnerability windows where trauma and ED can intertwine:

Puberty: Body changes can reactivate sexual traumas, trigger identity anxieties, create a feeling of loss of control. The ED becomes an attempt to stop or control these transformations.

Adolescence: Period of identity construction where unresolved traumas resurface. The ED offers an identity, belonging (pro-ana communities), a sense of control facing inner chaos.

Life transitions: Leaving home, starting studies, entering professional life. These moments of vulnerability can trigger or worsen an ED in traumatized people, the disorder becoming a way to manage separation anxiety and uncertainty.

Social Vulnerabilization Factors

Trauma is not limited to individual events but includes social and systemic traumas:

Discrimination: Racism, homophobia, transphobia, fatphobia create chronic minority stress. EDs can become an attempt at conformity, disappearance, or conversely identity affirmation.

Precarity: Food insecurity in childhood multiplies by 3 the risk of developing an ED. The relationship with food remains marked by fear of lack, forced restriction/compensation alternation.

Structural violence: Gender inequalities, institutional violence, social marginalization create vulnerability ground where the ED sometimes becomes the only accessible form of control.

Hospital Violence: When Care Traumatizes

Iatrogenic Traumas in ED Management

Hospitalization for EDs, particularly when forced, can become a source of new traumas. Coercive practices - force-feeding, isolation, constant surveillance, autonomy deprivation - can reactivate previous traumas and create new wounds.

Testimonies are damning: "I experienced hospitalization as rape", "I was treated like a criminal", "I lost all trust in the care system". These traumatic experiences create lasting mistrust toward caregivers, sometimes delaying help-seeking by several years.

Violence can also be more subtle: invalidation of experience ("it's in your head"), minimization of suffering ("others have experienced worse"), exclusive focus on weight without consideration for psychological distress. This "soft" violence is no less destructive.

The Paradox of Care That Hurts

The paradox is cruel: the most traumatized people, requiring the most gentleness and safety, often find themselves in the most coercive care settings. Vital urgency justifies practices that, without malicious intent, reproduce traumatic dynamics: loss of control, violation of bodily boundaries, powerlessness.

This re-traumatization has lasting consequences:

• Worsening of dissociative symptoms

• Reinforcement of pathological defense mechanisms

• Development of a compliant "false self"

• Disorder chronification through care avoidance

The Feeling of Margin: Living on the Periphery

Marginal Identity as Consequence and Protection

The accumulation of trauma + ED often creates a deep feeling of marginality. "I'm not like others", "No one can understand", "I live in a parallel world". This marginality is both endured and sought: endured because it isolates, sought because it protects from a world perceived as dangerous.

The ED then becomes an alternative citizenship, with its codes, rituals, communities. Pro-ana forums, despite their danger, offer a sense of belonging to those who feel excluded from the "normal" world. This marginality becomes identity, and leaving the ED would mean losing this belonging, however painful it may be.

The Double Penalty of Misunderstanding

Traumatized people suffering from EDs experience double misunderstanding: misunderstanding of trauma ("it was long ago", "you need to move on") and misunderstanding of the ED ("just eat, it's simple", "it's a whim"). This double invalidation reinforces feelings of loneliness and otherness.

The feeling of margin strengthens when care spaces themselves become excluding: therapy groups where one cannot speak about trauma "not to trigger others", therapists not trained in psychotrauma who focus only on eating symptoms, care structures that exclude "too complex" cases.

Toward a Trauma-Informed Approach: Gentle Reconstruction

Principles of Respectful Care

A trauma-informed approach to EDs rests on fundamental principles:

Safety first: Create a physically and emotionally safe environment. This means respecting pace, predictability, transparency, absence of coercion.

Collaboration and choice: Restore agency, offer options, respect refusals. After traumatic powerlessness, regaining sense of agency is crucial.

Experience validation: Recognize the reality and legitimacy of trauma, understand the ED as survival strategy, honor the strength it took to survive.

Holistic approach: Not artificially separating trauma and ED but understanding their interweaving. Treat the whole person, not just symptoms.

Tools for Reconstruction

In my practice, I use gentle and progressive approaches:

Stabilization: Before any trauma work, establish basic safety. Nervous system regulation techniques, creation of soothing routines, development of internal resources.

Progressive integration: No brutal confrontation with trauma but a titration approach. Integrate little by little, at the person's tolerable pace.

Somatic work: Gently reconnect to the body, without forcing. Adapted mindfulness practices, gentle movements, massage, creative expression.

Narrative reconstruction: Help build a coherent story where the ED has its place as survival strategy, but where other chapters can be written.

This approach requires patience, humility, and deep respect for each person's rhythm. Healing is not linear, relapses are part of the process, and it's in this acceptance that true transformation can occur.

Living and eating are two sides of the same coin. Lighten your relationship with food and free yourself from what doesn't serve you!