The Relationship Between Bulimia and Trauma

For nearly as long as they’ve been identified, eating disorders were thought to be primarily social diseases, with sufferers developing unhealthy thoughts and behaviors under the pressures to look or present a certain way in society.

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But the more these conditions are studied, the more researchers are learning how complex they truly are.

In fact, eating disorders like bulimia nervosa (BN), binge eating disorder (BED), anorexia nervosa (AN), and others are nearly always developed and driven by a combination of genetic and environmental factors. And one of the biggest environmental predictors of BN and other eating disorders is experiencing trauma.

What Is Trauma?

Trauma is a broad term that refers to an event or series of connected events that are particularly distressing. This can include natural events, such as hurricanes; pure accidents, such as car crashes; or human-driven events, such as assaults. 

Most people will experience at least some type of trauma over the course of their life, though most of these experiences will not have long-term consequences on their mental health. [1]

But if an experience elicits feelings of intense fear, helplessness, or horror, or poses a real threat to someone’s life or the life of others, it’s more likely to leave a physical impression on someone’s central nervous system, forming a powerful permanent memory which may continue to trigger these intense emotions over time. [2]

The recall of these events, and the emotional experiences that accompany it, can work to develop or drive many additional mental health complications, including eating disorders, a range of anxiety disorders, and post-traumatic stress disorder (PTSD), which occurs when someone consistently re-experiences these memories and emotions.

Different Types of Trauma

While the concept of trauma may feel blunt, obvious, and powerful, the experience of trauma is actually very personal and nuanced.

There are many different types of trauma and potentially traumatizing events, and everyone may experience and react to these situations differently.

Childhood trauma is generally defined as trauma of any kind that occurs during someone’s early life. These experiences can be especially powerful—and potentially problematic—as the early years of someone’s life encompass key periods of their mental growth and development. A person also typically feels the most powerless during this time, and the most dependent upon caregivers and other adults. 

The most common types of childhood trauma frequently involve those same caregivers, including cases of neglect and physical and emotional abuse. Unfortunately, child sexual abuse is also a fairly common example of childhood trauma, generally thought of as experiences of unwanted bodily contact with someone at least 5 years older than the child in question. [3]

Physical trauma is a fairly straightforward concept, involving cases of serious physical injury or harm to the body. Some of the most common examples are blunt force trauma, which involves being forcefully hit with an object, and penetrative trauma, when an object pierces the skin or causes open wounds in the body. In some cases, surgical procedures, and their resulting effects on the body, can also be considered a type of physical trauma. [4]

These types of traumatic events nearly always have an accompanying emotional component, as humans naturally fear pain and injury. Someone may form a mental connection between the event or similar scenarios and the expectation of pain. And physical trauma has also been shown to change people on a physiological level, through the body’s instinctive survival mechanisms and the way it works to heal serious injuries. [4]

Emotional trauma is one of the most common types of trauma. It is also one of the most subtle, and subjective. What one person finds to be emotionally traumatic very frequently will not be the same as what another person experiences this way.

Unlike physical or sexual abuse, these scenarios don’t involve a physical interaction with the person experiencing trauma. Instead, emotionally traumatic events are those that bring about overwhelming or powerful emotional reactions.

The loss of a loved one, even if the death was natural and expected, is often emotionally traumatic. If this loss occurred at a young age, its effect may be magnified. Emotional abuse or neglect can also be considered emotionally traumatic, such as when one spouse belittles the other or intentionally withholds affection to get something they want. 

Sexual trauma is one of the most sensitive and potentially powerful types of traumatic event, often caused by the experience of sexual assault or harassment. Definitions of these situations vary widely and can be very personal, though it’s generally agreed that sexual assault or harassment involves unwanted sexual activity or advancement through force or threat, or in any case when consent was not given, or initially given but then withdrawn. [5]

It’s important to note that a sexual incident doesn’t have to be non-consensual or even physical to cause sexual trauma. Exposure to body parts, images, or videos one doesn’t wish to see can also be traumatic, as well as agreeing to participate in an act that may later cause shame or regret. At its core, sexual trauma is frequently tied to the intense feelings of helplessness and fear that so often work to form permanent, upsetting memories and emotional reactions.

Trauma’s Connection to Bulimia

While the exact connection between experiencing trauma and developing bulimia nervosa isn’t fully understood, studies have linked the two again and again.

One analysis found that as many as 33% of women who struggle with BN had a history of trauma. [6]

Sadly, it seems the experience of sexual trauma is a particularly strong indicator of developing bulimia nervosa and other eating disorder behaviors.

Those who’ve experience childhood sexual abuse are 2.5x more likely to develop bulimia.

One study noted that 26.6% of female participants had experienced an incident of sexual assault in their past. [7] And another found that childhood sexual abuse correlated even more strongly with the development of disordered eating, with those experiencing one incident 2.5 times more likely to develop BN, and those who experienced two or more incidents 4.9 times more likely to struggle with the condition. [6]

Why Trauma Leads to Bulimia Nervosa

There are many theories about why a history of trauma may make someone more likely to develop BN or another eating disorder.

The deeply-embedded sensation of helplessness brought on by these experiences can spark undue anxiety, and make it difficult for someone to feel in control of their own life. In these cases, people may turn to patterns of disordered eating as maladaptive coping mechanisms, to help them manage their feelings or regain a sense of control. 

Many incidents of sexual trauma can also lead someone to become fixated on their body or body image. The objectification that often accompanies an experience of sexual harassment or assault may cause someone to focus on their appearance and fixate on concepts like diet and exercise to deal with these hurtful thoughts, or ideas associated with body shame. [8]

Bullying, particularly over someone’s weight or physical appearance, has also been tied to not only eating disorders, but the low self-esteem, social isolation, and poor body image that often work to develop or maintain these conditions. [9]

Bulimia Nervosa and PTSD

Bulimia nervosa in particular has also been found to co-occur at high rates with post-traumatic stress disorder. Aside from most likely stemming from the same traumatic event in someone’s past, BN and PTSD also share a number of traits that may make them more likely to occur together.

Both BN and PTSD have high rates of dissociation—or, a mental disconnect from certain thoughts, memories, or experiences. It’s possible that the disordered patterns associated with BN are used to help someone distract or distance themselves from disturbing memories. [10]

Other researchers have suggested that the purging aspect of BN could be a subconscious attempt to rid oneself of unwanted memories and emotions, while the binging aspect could be an attempt to fill an emotional void left by the experience of trauma. [10]

And some research is beginning to explore the genetic and biological similarities of bulimia nervosa and PTSD, with early studies finding some overlapping factors that may explain the high rate of co-morbidity. [10]

Why It’s Important to Treat Trauma & Bulimia Together

As a general rule, it’s important to seek treatment for all co-occurring mental health disorders at the same time. These issues are complex and often deeply intertwined, making it especially difficult—if not impossible—for someone to overcome one mental health condition without addressing any others.

This is especially true for bulimia nervosa and past instances of trauma, as the two are nearly always directly related.

Aside from eating disorders, trauma frequently manifests as a number of anxiety disorders, which are known drivers of disordered eating behaviors and poor self-esteem. And when trauma manifests as PTSD, the continued experience of these intense and upsetting emotions may continually reinforce the types of feelings that drive people to utilize maladaptive coping mechanisms.

Getting Treatment for Trauma & Bulimia

If you or a loved one are struggling with bulimia nervosa, experiencing PTSD symptoms, or have a history of trauma, it’s important to seek out help. These issues may feel overwhelming or too big to change, but treatment is possible, and generally widely available.

If you feel scared or intimidated by the idea of seeking help or going to a facility, you’re not alone. Many people who struggle with trauma or PTSD feel triggered by aspects of the experience.

But many hospitals and treatment facilities today practice something called trauma-informed care. This method takes into account the sensitivities of those who have experienced trauma, and tweaks some of the more triggering aspects of going to the doctor, in order to make the experience more comforting and helpful.

And there are many therapies with a history of effectiveness for both bulimia nervosa and trauma-related disorders, including cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), and narrative exposure therapy (NET).

Regardless of the type of help you seek out, the act of looking for it is the most important step you can take. Bulimia nervosa and a history of trauma can be devastating, but they don’t have to be destiny. With the right kind of treatment, it’s possible to start on a path toward a healthier and happier future.


  1. Trauma-Informed Care in Behavioral Health Services. (2014). Substance Abuse and Mental Health Services Administration. Accessed January 2023.
  2. Sandburg S. (2007). Childhood Stress. Encyclopedia of Stress (Second Edition). Accessed May 2023. 
  3. What Are Major Types of Trauma? (2023). TeachTrauma. Accessed January 2023.
  4. Physical Trauma. National Institute of General Medicine Sciences. Accessed May 2023.
  5. Sexual Assault and Harassment. American Psychological Association. Accessed May 2023. 
  6. Sanci L, Coffey C, Olsson C, Reid S, Carlin JB, Patton G. (2008). Childhood Sexual Abuse and Eating Disorders in Females: Findings From the Victorian Adolescent Health Cohort Study. The Archives of Pediatric and Adolescent Medicine, 162(3):261–267.
  7. Danksy B, Brewerton T, Kilpatrick DG, O’Neil P. (1997). The National Women’s Study: Relationship of victimization and posttraumatic stress disorder to bulimia nervosa. Eating Disorders, 21(3):213-228.
  8. McLaughlin A. (2022). Sexual Assault and Body Image: Hope, Healing and 3 Common Myths. National Eating Disorders Association. Accessed January 2023. 
  9. Bullying and Eating Disorders. National Eating Disorders Association. Accessed January 2023.
  10. Eating Disorders, Trauma, and PTSD. National Eating Disorders Association. Accessed January 2023.

Last Update | 06 - 6 - 2023

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