If you’ve experienced trauma – you could be at risk for an eating disorder

Lucia Osborne-Crowley 00:09
I suffered very severely with anorexia and bulimia for many years. And that comes from the neurological wiring. That happens in PTSD. When when someone renders you powerless through violence, especially as a child, your brain is always then looking for ways to be in control.

Mandy Goldstein 00:31
The study on maltreatment said we’ve got three times the chance of developing an eating disorder if we have a history of childhood maltreatment. One

Archana Waller 00:39
possibility for disconnection between an eating disorder and trauma could develop as a way of say someone self medicating or coping with an unmanageable feelings associated with the trauma event.

Rachel Soderstrom 00:55
I remember I’d go to the doctor, one time they checked my appendix in my stomach and something else. And I would be in there knowing there was something wrong with me and they weren’t going to find it because it wasn’t physical.

Sam Ikin 01:07
This episode discusses sexual abuse, not in great detail, but it still comes with a trigger warning. Trauma is a person’s emotional and psychological response to an event or series of events that can have a dramatic impact on their well being. It can also potentially lead to disordered eating. And as a result, eating disorders, which is where our investigation leads us in this episode of Butterfly, Let’s Talk. I’m Sam Ikin. And thank you for being here.

Mandy Goldstein 01:36
The word trauma comes from the Greek word which actually means physical injury, a wound, a hurt, or a defeat. And I really love the origin of that word. And I think it’s important for us to think about that because when we think about clients who’ve experienced trauma, certainly they carry injury wound and a sense of defeat sadness in the face of horror and overwhelm.

Sam Ikin 01:59
Thius is Dr. Mandy Goldstein. She’s a practising clinical psychologist and the president elect for the Australia and New Zealand Academy for eating disorders, or an Zed the psychological definition of trauma is a little bit broader. There are three elements that need to be met the first to the event itself. And then there’s the experience of the event. But not everybody who experiences a particular event, we’ll find it traumatic. If that sounds a little bit confusing, let’s go back to Maddie.

Mandy Goldstein 02:29
The genuine definition says that we need to have experienced that event as physically or emotionally harmful or life threatening. There’s the event, the experience of the event, and there has to have a lasting and negative effect. And those effects are across an individual’s functioning, mental, physical, social, emotional, spiritual well being. That’s the sort of definition that’s most broadly used. But I would add to that, that I think relational well being is really impacted when we experienced trauma as well. Specifically, if we experienced trauma over the longer term in a chronic and ongoing way, often in the context of family, or family relationships, that really skews our capacity or impact our capacity to trust in close relationships to build and maintain good relationships. As an example, we might send a cohort of military people off to war and we know that some people may come back with a diagnosis of PTSD, but some will may not, and may not find it a traumatic experience.

Lucia Osborne-Crowley 03:33
I suffer from what we call complex Post Traumatic Stress Disorder. C PTSD. My name is Lucia Osbourne Crowley, I am an investigative journalist and a writer. I’ve spent most of my journalistic career looking at sexual violence and gender based violence. I’ve written three books. The first is a memoir about my own experience of child sexual abuse, organised child sexual abuse to be specific, and sexual assault. I’ve then written a second book, which is a continuation of that memoir, my writing and my reporting focuses on those issues because I care very much about trying to improve the justice system for survivors, people who have lived lives like mine

Sam Ikin 04:22
will go back to leukaemia in just a moment. But first, I thought we’d better define Post Traumatic Stress Disorder or the acronym that we’ve already heard PTSD. Let’s check in with Dr. Goldstein. Can you experience trauma without experiencing PTSD? Hmm,

Mandy Goldstein 04:43
I think he can. I think there are lots of things that would be experienced as trauma. So there recent, really significant weather events up in Queensland, depending on the amount of damage that you might have experienced that might have been experienced as traumatic by some people but not every person. who went through that hurricane is going to come out with PTSD? Absolutely. So PTSD is a diagnosis that we use when we have lasting difficulties that spring from that experience of trauma. I

Lucia Osborne-Crowley 05:13
was groomed and abused by an older mentor. In a semi professional athletics setting. There were a group of us who were similarly groomed and abused by this same perpetrator. That began when I was recruited by him when I was about nine years old, and continued until I was 16. In the midst of that, when I was 15 years old, I went on a night out with some friends, I was a teenager in Sydney, I went out with a few friends to karaoke and a group of men approached us and one of them grabbed my hand at your mutual bathroom and very violently sexually assaulted me, and he was armed, he had, he had a knife, and I escaped from that situation, and ran away from him, and got myself home. But he didn’t tell anyone that it happened, including the three friends who were there. And who knew they saw me, they saw me running away. And they knew afterwards that I was very distressed. But But I wouldn’t tell them what had happened because I was so convinced that it was my fault. And I was so ashamed. So I didn’t tell anyone about either the ongoing abuse in in my athletic career or the rape until I was 25. That’s a big

Sam Ikin 06:36
thing to carry. That’s more than most people go through, I think, you know, a lot of people experienced trauma in their life, but it seems like you certainly have had the lion’s share.

Lucia Osborne-Crowley 06:47
PTSD is is a really interesting condition, because the comorbidities it has with other illnesses are extremely high, because the symptomatology of PTSD is so wide ranging and it can cause so many other problems. So, eating disorders is a is a huge example. So I suffered very severely from with anorexia and bulimia for many years. And and that comes from the neurological wiring that happens in PTSD. When when someone renders you powerless through violence, especially as a child, your brain is always then looking for ways to be in control of your own life because you’ve lived through experiences where you had absolutely no control, and no power and no agency.

Archana Waller 07:43
There is evidence that there is a strong correlation between trauma and eating disorders. I guess where it becomes a little bit complicated is and it becomes a slightly unclear is how these issues relate to one another. This

Sam Ikin 07:56
is Archana Waller, she’s a psychotherapist who works in a specialist eating disorder clinic. And she’s also managed butterfly foundations recovering support services. On a daily basis she experiences how the two disorders co occur, and where they intersect in the real world.

Archana Waller 08:14
One possibility for disconnection between an eating disorder and trauma could develop as a way of say someone self medicating or coping with, you know, and manageable feelings associated with the trauma event. Studies also show that traumatic events often occur before someone shows signs of an eating disorder. Right so so that that might that hypothesis that trauma might be a significant risk factor for the development of eating disorders.

Sam Ikin 08:49
There are lots of different types of trauma it can be rooted in events caused by domestic violence, natural disasters, terrorism, life threatening illnesses or neglect to name just a few and all can be risk factors for eating disorders. But Archana Wallace says certain types of traumas have shown higher correlations with eating disorders, there

Archana Waller 09:12
is a lot of research that is being done and has shown that individuals who have experienced sexual abuse commonly experience feelings of body dissatisfaction which can then lead to that you know, disordered eating behaviours, any abuse, whether it is physical, emotional, psychological, either starting from childhood, like childhood maltreatment leads to a lot of feelings of low self esteem, body dissatisfaction again, it goes back to a lot of those places, which can then lead to disordered eating. Like there are studies which have shown that low self esteem caused by abuse was found to be a contributing factor in the development of binge eating disorder, and even night eating syndrome.

Sam Ikin 10:03
It is pretty clear that a lot of people who suffer a traumatic event may end up feeling like they’re not good enough. And often that can manifest yet in in body dissatisfaction, which can

Archana Waller 10:16
lead to the disordered eating behaviours, which can then later turn into more clinical like a clinical diagnosis of eating disorders. Yeah, I’d be binge eating disorder, whether it’s being there, nervosa or anorexia.

Sam Ikin 10:29
So the eating disorder kind of functions as a subconscious survival mechanism. And it may have or seem to have a protective function for the emotional confrontation with that trauma experience, which people relive over and over in their heads. They

Rachel Soderstrom 10:46
had been told I was bad, and dirty and done something very, very wrong. So I was manipulated into doing it, and then told how bad I was doing. Hi, I’m Rachel, I am a mom of two adult kids.

Sam Ikin 11:01
This is one of the first times that Rachel has opened up about her childhood abuse. And I could tell that it was difficult for her to talk about, even though decades had passed, there

Rachel Soderstrom 11:12
was about seven or eight there was an individual who’d visit our house regularly, who I trusted know the person and the incidences that occurred, there were multiple incidents happened with that person. And still very clear in my memory. This is 40 years later, actually, so that when that act did occur, so I’ve done a lot of processing of this over the time, but when I look back, there’s a few years. So these incidents were kept secret, there was no one else that knew about them for about seven years. And when I look back and see how that that those incidents at that time affected me, there was a whole lot of also ongoing threats and mental manipulation from this person, especially in those first couple of years afterwards, after, after the incidents occurred. Rachel

Sam Ikin 12:02
experienced traumatic events really early in her life. But it wasn’t until her mid to late teens that she said she developed an eating disorder, in response to that trauma that happened years before.

Rachel Soderstrom 12:14
By the time I’m around 17. I know, I am dealing with bulimia at that time. There’s some other eating disorders, that kind of, and behaviours that pop up later on. But at that time, it’s bulimia. And I know, there’s something very wrong with me. And I am doing my best to try and overcome it and stop my behaviours. But I could, I knew there was something wrong with me. And at that time, I was already able to link it to the abuse and what had happened to me when I was younger. And I also want to add that when I was in primary school, so when I’m keeping this secret, I can I feel like there’s something wrong with me, I remember I’d go to the doctor, one time they checked my appendix and my stomach and something else. And I would be in there knowing there was something wrong with me. And they weren’t going to find it because it wasn’t physical. But it was obviously very young. And I didn’t understand what that meant. But I knew in primary school, there was something wrong with this took me until I was recovered later in life. But looking back, when I was young, I felt like my body was bad and dirty. And not good because it had done things I wasn’t happy with when I was seven or eight in the during the abuse. And I was I was someone who was quite obsessed with the media and pop stars and celebrities and things like that, and reading dolly every single week from when I was a kid and clear I love these magazines. And so yeah, I did identify with the appearance ideals in those so it didn’t take me long to start to identify fat, a body, you know, the fat in body shapes that we’ve seen these magazines, that one body being not good. So now I’m seeing these images of women pointing to fat thighs or things like that. I’m going through puberty at this stage 1415 Looking at my thighs scenes that I already think I’m bad. Now, I’m bad, my body’s bad fats bad somehow that whole soup of ideas going on. When I did actually get some professional help. It was an older friend who was studying counselling or something that noticed in me my behaviours. So she noticed my behaviours, which I find unusual that back in the 90s Someone picked that in me. So she took me to find a counsellor that’s, you know, specifically for eating disorders. And that was really helpful. That was the first person that really started to help help me identify when I may be in Jate what my triggers might have been, and that was my first steps towards healing that I can’t remember how long I went for, but really began to get some self awareness around my behaviours still didn’t recover. I fully for quite a few years. And from then on, even though I did occasionally see counsellors or other professionals, it was I would say mostly self help sometimes alternative therapies. And I have done deep to heal myself over the years. And even I’m currently through doing a psychology degree. Because I mean my original degrees in in creative arts, film and TV, but I wanted to heal. And even though I recovered from my eating disorder 24 years ago, a long time ago now, I can absolutely say that that recovering from the trauma and the effects of that had taken a lot longer.

Mandy Goldstein 15:41
When trauma was first, incorporated into the DSM, it was seen as a really unusual experience that only war veterans came back from war with. And what we know is that trauma impacts two out of every three adults. So when we acknowledge that we can no longer say that trauma is unusual. Trauma is a really common experience. And when we look at the research, we know that in those patients who kind of present with trauma, around 16 to 25% of those sort of quarter of those people experiencing trauma, also have had difficulties with eating or eating disorders. And vice versa. In our eating disorder clients, around 20 to 24% of those have experienced PTSD or endorse symptoms of PTSD or trauma. And that number gets higher when we look at treatment seeking samples and people who have bulimia nervosa or binge eating disorders. So, you know, when we look at kind of the experience of maltreatment, it really does increase the likelihood that you’re going to develop an eating disorder. In fact, a study on maltreatment said we’ve got three times the chance of developing an eating disorder if we have a history of childhood maltreatment.

Sam Ikin 16:59
Archana Waller says that when she’s treating someone that she knows has a traumatic past, she has to be constantly looking for signs that that trauma is taking over.

Archana Waller 17:08
I’m continuously assessing for, you know, trauma injuries, and then to see how it’s manifesting in the session how it is a lot outside.

Sam Ikin 17:20
So am I hearing this right that if you’re looking at a chicken in the egg, kind of a situation which came first, the trauma or the eating disorder, usually it’s a trauma and so naturally, you’d have to treat the symptoms of the eating disorder, but you’re probably going to need to look at a more holistic approach. When you rather than just treating the eating disorder or yes,

Archana Waller 17:40
it’s sometimes you have to work with the trauma centres as it’s happening in the session, get them into hyper arousal space, or hypo, which is where you’re basically dissociating, you know, it is important for me to recognise that and to say, Okay, let’s do some grounding instead, you know, when they have lost that capacity in that moment, to to manage their internal struggle, you know, whether it’s the emotions or the thoughts, and you can see that they’re, they’re out of that window of tolerance, and they’re moving into that hyper aroused space or hypo, like going down. It is to, you know, I have to pause and see, okay, what just happened here, I can provide information about the eating disorder, you know, saying no to this with the eating disorder symptoms, where they don’t have the capacity to take in what I’m saying.

Sam Ikin 18:37
We know a lot more about the underlying causes of eating disorders today than we did say 10 years ago. And we’ve discussed this phenomenon a few times in previous podcasts. That said, we still have a long, long way to go. There’s still heaps that we don’t know, when when Rachel was reaching out for help more than 20 years ago, a co occurring conditions were barely acknowledged. Were you treated first for the trauma? Or was it the eating disorder symptoms? Never,

Rachel Soderstrom 19:03
in any of those therapies did those two worlds come together, the early stuff was specifically about the sexual assault, and that was what was looked at there. And then later, when I had some therapy around the eating disorder, the trauma didn’t come up at all, where I was more about addressing, again, my behaviours and the feelings behind them, but not going way deep.

Mandy Goldstein 19:27
I do always incorporate a question, a very broad question on whether people have experienced something they they would describe as traumatic in their life. And if it’s in an initial interview, I would always say that I don’t need them to go into detail about that. I would really have them rest assured that that’s a broad question. I would ask anybody. I give some examples around whether it’s, you know, an extreme weather event or a car accident or a sexual experience that was unwanted, but it’s only really the reason I’m kind of emphasising this If I’m working with someone who’s had long standing prolonged trauma, it’s really only in the context of a safe established treatment relationship that I would start to get into the details of that, and kind of come back to, you know, what was challenging for them.

Sam Ikin 20:14
And that relationship though with your, your therapist, that that’s just I don’t think many people understand how long that can take or how important it is to get that relationship. I mean, I was seeing my shrink for almost two years, I think before I just, I just kind of went in when I was almost like at a really low point, I guess. And then it took that for me to actually open up to pull, take the mask off and actually talk to him in a way that was going to get us somewhere.

Mandy Goldstein 20:46
It’s so important that you’ve shared that same because it really normalises for people and it is, you know, from my experience that it really does take a long time to establish that good relationship. Because, again, if we think about what complex trauma really means, it means trauma early in life, it means being hurt, when you should have been able to trust people and be protected. And so if that’s happened to us, it makes it much harder for us to trust in relationships as adults to open up to believe that people are going to be there for us. And so the it does take a length of time to develop that trusting sense of relationship with with a psychologist or somebody else that you’re working with. Lucia

Sam Ikin 21:24
experienced so much shame when it came to what had happened to her that she said she didn’t want to ask for help. And it wasn’t until she was 25, roughly 10 years after her violent sexual assault, that she finally told someone about it. I

Lucia Osborne-Crowley 21:39
was I was incredibly weak, I was very, very unwell. And I was I was having a mental breakdown. And I just thought, you know, I’ll do anything to get better. At this point. Even the one thing I promised myself I’d never do, which is tell people what happened to me. So once I did tell people, all these treatment options opened up. So that included mental health treatment for trauma, which over many years included treatment for my disordered eating. So that obviously came up through my trauma treatment, they asked a lot about my relationship with food. And I was able to then disclose how bad that had been. And then I was able to get proper help through trauma specialists who specialise in in eating disorders, I was able to get proper help from dietitians, and nutritionists and, and things. And I was also able to get, you know, the best physios for victims of sexual violence, which I didn’t even know was a thing before I made my disclosures. So I started all I wanted to see a sex and intimacy therapist for the first time to kind of heal the relational aspects of of what had happened to me. So, I started all of this treatment at the same time, this was in 2017. And I’ve been on that journey since since then, really so So I still see all of those specialists fairly regularly. And then as I said, that this all culminated in residential treatment at the beginning of 2023, at the at the trauma rehab centre that I’m at now, and that has really just brought everything together

Sam Ikin 23:22
with serious trauma affecting so many of us, how can we even begin to deal with the fallout, not just the eating disorders that come from it?

Lucia Osborne-Crowley 23:31
I’m a huge believer in talking about it as much as we possibly can. This is something I get asked at events every, every single time I do a book event, someone will say, you know, how can we change this? There’s so much trauma in the world, there are so many people who are willing to take advantage of others willing to traumatise others. How do we you know, and I always say, Well, you know, we can’t change the world overnight. But what we can do is wake up every day and decide to be someone who is willing to hear other people’s stories as hard as they are to hear and wake up every day and being willing to be brave enough to share our own stories if we feel able to, and have those conversations and be the friend who makes someone feel safe enough to actually talk about what they’ve been through, or how they’re dealing with symptoms of what they’ve been through. So I’m a huge advocate of that I still find it incredibly helpful to talk.

Sam Ikin 24:25
And that’s what we do here. It’s even in the name of this podcast. Let’s talk while Lucia and Rachel’s stories are hard to listen to, there’s real benefit in sharing those stories, particularly for people who could be in the same situation, afraid to speak about it isolated, just trying to survive. So I’m going to ask you to share this episode with someone, anyone, particularly someone who you think needs to hear it. If you’re concerned about an eating disorder, it could be yourself or someone that you care that the best first step to take is to reach out to the butterfly helpline on 1 800 33 4673 That’s 1800, E D, H O P E. There are heaps of online resources as well. If you just like to read up a little bit on eating disorders, go to butterfly.org.au. That’s also the place to go. If you’re looking for a clinician, they have a referral database of plenty of well trained clinicians who know exactly how to help you. Butterfly: Let’s Talk is produced by Ikin Media for Butterfly Foundation with the support of Waratah Education Foundation. We really appreciate their support. Our executive producer is Camilla Becket. We have lived experience support from Kate Mulray. Hosting, editing and general production is done by me. I’m Sam Ikin. And as always, if you’d like to support us in any way, the best thing you can do is share this podcast or write us a review in the app that you’re listening to right now. I’m Sam Ikin and thank you so much for your company.