Histories of childhood trauma and complex posttraumatic sequelae in women with eating disorders

The tenacity of eating disorders found among women abused and neglected in childhood becomes comprehensible when they are understood as desperate attempts to regulate overwhelming affective states, and to construct a coherent sense of self and system of meaning when internal structures are lacking. In this article we use conceptualizations of complex posttraumatic stress disorder to make sense of the troubling and sometimes paradoxic facets of disturbed eating behaviors in the traumatized patients: their symbolic and metaphoric meanings; their intensity, repetitiveness, and tenacity; their dissociative qualities; their use as agents of self-soothing as well as self-harm; their resistance to traditional treatments; and the particular nature of accompanying symptoms and syndromes, including self-mutilation, borderline pathology, suicidality, depression, substance abuse, and sexual acting out or avoidance. Treatment of the traumatized eating disorder patient is multifaceted, complicated, and often demanding. It may involve individual treatment, group therapy, family interventions, and/or pharmacotherapy. As survivors connect past traumas with current symptoms and reenactment phenomena within a safe interpersonal context, they gain an increased capacity to relinquish their symptoms of eating disorder and to modulate disruptive internal states in a manner that soothes rather than intensifies past wounds.