Trauma-Informed Care for Bulimia Nervosa

It’s an unfortunate reality that bulimia nervosa (BN), anorexia nervosa (AN), and many other eating disorders are often connected to a history of trauma, with post-traumatic stress disorder (PTSD) being a common co-occurring condition with these illnesses.


But for those who are struggling with these additional sources of stress on top of their disordered eating behaviors, trauma-informed care can help.

The approach employs empathy at its core, working to help someone feel physical and emotional safety during treatment, which can hopefully help them achieve better physical and mental health.

What Is Trauma-Informed Care?

Trauma-informed care (TIC) is a type of treatment improvement protocol used in a number of mental health services. If a patient has a history of trauma, TIC tactics may be used in their course of care, no matter which type of treatment they’re receiving.

The practice encourages healthcare providers to recognize the presence of any trauma symptoms and consider how this history may impact a patient’s course of treatment. At the same time, it advises medical professionals not to harp on the source of someone’s trauma but rather to accept that it is part of their history and to move forward accordingly.

There are also a number of core principles trauma-informed practices work to establish throughout a patient’s care.1

While all behavioral health services work to create a feeling of safety for patients, a trauma-informed approach employs additional considerations in order to avoid potentially re-traumatizing someone who may already feel uncomfortable being at a hospital, medical clinic, or even out around strangers.

Everything from the amount of personal space an individual has in a waiting room to the way a nurse speaks to a patient can help promote safety. Patients may be allowed to attend treatment sessions with family members or loved ones. And even the facility itself can work to increase a sense of safety by ensuring parking lots and walkways are well-lit, among other strategies.

One of the most powerful ways to heal and grow beyond trauma is by developing a sense of autonomy and exerting personal control over personal decisions in a healthy way.

In a trauma-informed environment, nurses, doctors, and other medical professionals treat patients as the master of their own health. They will make the rights and responsibilities of a patient clear, encourage a patient to share their thoughts and questions, and allow them to make decisions about their care when possible.

Piggybacking off the idea of greater patient choice is the concept of greater collaboration between a patient and their treatment team.

Often when visiting a doctor, there can be a sense of a power differential, with patients naturally deferring to medical staff or feeling dictated to. People who have experienced trauma may be particularly sensitive to these types of feelings.

But a trauma-informed organization will listen to a patient’s input and opinions and work together to create a treatment plan that feels helpful for everyone in the end.

Trustworthiness is one of the most important aspects of successful care, especially when treating complex and sensitive conditions like eating disorders. A patient must trust that a doctor, nurse, or therapist has their best interest at heart in order to fully commit themself to the program.

But a history of trauma often leads to difficulty trusting others.

To help address this issue, TIC recommends establishing clear interpersonal boundaries that are never crossed. They may change, but that evolution should be clear, slow, consensual, and always professional. 

A sense of transparency, honesty, and clarity is also important. And a care provider should also aim to remain consistent, never shifting rules or expectations suddenly.

Important cultural or social differences or preferences that are not adequately addressed in a patient’s care could lead to further stress, mistrust, or re-traumatization.

Presenting treatment and treatment options in a way that recognizes and caters to a patient’s needs is one way to help alleviate this scenario. And health care providers are also implored to recognize and eliminate any biases around a patient’s culture, race, sexual orientation, gender identity, or other potentially sensitive factors.

What Does Trauma-Informed Care Look Like?

One way trauma-informed care is often described is as an overall perspective shift. It switches the focus of someone’s care from “What’s wrong with you?” to “What happened to you?”3

The shift is subtle, but it implies a slightly more considered approach, working to acknowledge the patient as a whole rather than as a set of symptoms. Greater acknowledgment and understanding of a patient’s life experiences are taken into account in order to deliver the most effective care for that patient.

To be sure, TIC shares many similarities with traditional mental health care and other treatment approaches. In all situations, medical care providers should work to establish a sense of trust, safety, and collaboration with their patients. But with a patient who has experienced trauma, these considerations can make an especially big difference in how care is received.

Eating disorder therapist

Trauma-Informed Training

The biggest difference between more traditional healthcare and TIC is the additional training and preparation taken on by hospital and clinical staff.

There is a focus on working to avoid actions that may unintentionally re-traumatize or re-victimize a person. Employees also learn to understand what can be potentially triggering to someone who has experienced trauma and what to do if a patient experiences secondary traumatic stress.3

Much of the tenets and core principles of TIC are established or guided by the way nurses, doctors, and other staff approach and interact with their patients, and these principles should be upheld by staff from the moment they first step into the room to the last day of treatment.

Why Is Trauma-Informed Care Important?

Patients with a history of trauma or abuse may be dealing with additional stress, or other challenges that serve to both exacerbate their condition and make them less receptive to treatment.

Providing trauma-informed care helps a treatment provider address these often unspoken needs and challenges and can help work to make a patient feel as open and comfortable with receiving care as possible.

Trauma-Informed Care and Bulimia Nervosa

TIC may be particularly important for treating patients with bulimia nervosa or other eating disorders, as these conditions are often closely associated with post-traumatic stress disorder (PTSD) or the experience of abuse.

One study found that up to 25% of patients with BN had a co-occurring PTSD diagnosis and that people who exhibit purging behaviors, in general, were more likely to have experienced a history of trauma.2

More than half of all eating disorder patients may have experience trauma at some point in their lives.

Further, previous studies have estimated that anywhere from 37%-100% of all eating disorder patients have experienced a traumatic event, though more refined calculations adjusted that range from 4%-52%.2

Regardless, the high prevalence of trauma within the eating disorder community in general and the bulimia nervosa community, in particular, make the tenets of TIC that much more important when treating these patients.

Is Trauma-Informed Care Always Necessary?

As a general practice, approaching eating disorder treatment from the trauma-informed care perspective is unlikely to have a negative effect, even if it may not be strictly necessary. On a basic level, it is a caring approach that promotes empathy and understanding, which are beneficial even when a person doesn’t have a history of trauma.

The high co-occurrence of eating disorders and PTSD or previous trauma also makes TIC a particularly desirable treatment model, as a general rule. If someone is receiving help for BN or another eating disorder but still doesn’t feel completely comfortable or feels like their needs are not being met, incorporating a trauma-informed approach may help them open up more to treatment.

Regardless, the most important thing for someone struggling with an eating disorder—especially someone with a previous history of trauma—is to find help. There is an entire network of professionals dedicated to helping alleviate the stress and pain that often accompany these conditions and helping people get on the road to recovery.


  1. What Are the 6 Principles of Trauma-Informed Care? (2020, October 26). Duquesne University. Accessed March 2023.
  2. Tagay S, Schlottbohm E, Reyes-Rodriguez ML, Repic N, & Senf W. (2014). Eating disorders, trauma, PTSD, and psychosocial resources. Eating disorders; 22(1):33–49.
  3. Menschner, C., Maul, A. (2016, April). Key Ingredients for Successful Trauma-Informed Care Implementation. Center for Health Care Strategies. Accessed March 2023.

Last Update | 03 - 24 - 2023

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