Unraveling the intersection of stigma and trauma in eating disorders: What clinicians need to know
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Eating disorders are complex conditions that go far beyond food and weight. While we’re all familiar with the clinical aspects—restrictive eating, binging, purging, and more—the underlying factors driving these behaviors can be equally intricate. Stigma and trauma are two of the most important—but often overlooked—influences of these behaviors.
As clinicians working with those affected by eating disorders, it’s important to understand how stigma and trauma intersect. By recognizing the role these factors play, we can provide more sensitive and holistic care to patients.
The impact of stigma on eating disorders
Stigma around eating disorders creates a major barrier for those seeking treatment and sustaining recovery. For many, societal norms can make them feel ashamed and guilty about their disorder, causing them to refrain from seeking treatment or acknowledging their mental illness at all.
Stigma can show up in various ways—people with eating disorders may be labeled as vain, selfish, or lacking willpower. These stereotypes fail to capture the deep-rooted psychological, emotional, and often traumatic origins of the disorder, making it hard for patients to feel understood or validated.
In addition, this stigma can be internalized, causing those with eating disorders to hide their struggles, feel isolated, or even avoid seeking help altogether. As clinicians, it’s our job to create a safe space where patients can feel seen without judgment—and we must recognize that these feelings of shame are real and powerful.
The societal pressure around body image can also intensify this stigma. Unfortunately, our culture glorifies thinness, especially for women, and anyone falling outside of these narrow ideals can face discrimination. This is particularly true for individuals who may already feel marginalized because of their size, race, gender, or socioeconomic status. For many, this external stigma deepens their internal struggle, making it harder to break free from the eating disorder.
Examples of stigma in eating disorders
Judgment of character and the assumption that those with eating disorders are just being stubborn, difficult, or trying to get attention rather than acknowledging the deeper psychological and emotional factors at play.
Stereotypes that eating disorders don’t affect men or that those with an eating disorder are just vain or obsessed with their looks.
Judgments based on someone’s body size that make someone who is not classified as extremely thin or underweight feel invalidated about their eating disorder.
Perceptions of choice that suggest individuals have chosen to have their condition, reinforcing the idea that it’s a personal failing rather than a mental health issue.
Cultural and racial stigma that suggests eating disorders are an issue for White individuals only, alienating people of color and those from diverse cultural backgrounds.
Mental health stigma that implies that eating disorders are a sign of mental weakness.
Trauma: A key driver of eating disorders
Trauma, in any form, is a critical piece of an individual’s history when it comes to eating disorders. Research has consistently shown that those with a history of trauma are at a higher risk of developing disordered eating behaviors as a way to cope with overwhelming emotions.* In some cases, food becomes a means of control, especially when the body feels unsafe or out of control due to past trauma.
Eating disorders may also offer a false sense of safety—restricting food intake, binging, or purging may help to numb the pain or take attention away from traumatic memories. However, this coping mechanism ultimately creates its own set of problems, and many patients end up stuck in a cycle that’s hard to break.
Sensitivities of treating patients with trauma
Patients who have had a history of trauma, especially PTSD or depression, may find it difficult to trust therapists, fight to be vulnerable in treatment, or even refuse to engage in recovery because of the emotional intensity tied to past experiences. As a clinician, understanding that trauma and eating disorders are often intertwined—and that one cannot be treated without considering the other—is essential to helping patients heal.
The double burden: When stigma and trauma collide
A bigger issue occurs for eating disorder patients who experience the intersection of stigma and trauma. As you can imagine, this is like a double whammy of psychological burden to overcome.
Take, for instance, someone from a marginalized community—whether that’s a person of color, someone in the LGBTQ+ community, or an individual with a lower socioeconomic status. These patients are often dealing with the compounded effects of trauma and stigma, not just from their eating disorder but from the ways society views them because of their identity. These extra layers of discrimination can make accessing care more difficult and further reinforce feelings of shame and hopelessness.
These patients may need more than just standard treatment—they may need to feel heard and supported in ways that acknowledge both the trauma they’ve experienced and the stigma they face in their day-to-day lives. Providing culturally-sensitive care and creating a nonjudgmental space can go a long way in breaking down these barriers.
What does this mean for treatment?
Eating disorder professionals need to be aware of the deep and often complicated relationship between trauma and stigma in eating disorders. It’s not enough to just treat the eating disorder behaviors—we need to address the emotional and psychological factors that drive these behaviors.
Trauma-informed care
Trauma-informed care means understanding that the individual’s behaviors may be rooted in past experiences of harm and that treatment needs to create a safe, supportive environment. Acknowledge the trauma—don’t push it—and give patients the space they need to process their feelings without fear of judgment or re-traumatization.
Addressing stigma
During therapy, it’s important to uncover any internalized stigma surrounding one’s eating disorder and to reduce the shame they may feel. It’s also important to challenge societal stigma, whether through body-acceptance work, advocacy, or encouraging patients to engage in communities where they feel supported and seen for who they truly are.
Collaborative care
More often than not, eating disorders don’t exist in isolation. Trauma-related symptoms, mental health struggles, and eating disorders all interact. To treat an eating disorder for long-term recovery, a comprehensive team approach is required that includes trauma specialists, mental health professionals, dietitians, and medical providers.
Our responsibility as eating disorder clinicians
Eating disorders aren’t just about food or weight—they’re deeply influenced by the intersection of stigma and trauma. As clinicians, it’s important to acknowledge the emotional, psychological, and social factors that affect the person in front of us, not just the behaviors.
By taking a trauma-informed approach and challenging the stigma that surrounds eating disorders, we can provide more compassionate, effective care that addresses the whole person. When we understand and address the complex ways stigma and trauma intertwine with eating disorders, we can help patients take the first steps toward recovery, free from shame and supported in their healing.
Watch the full webinar
Want to dive deeper into these important topics? Watch the replay of our webinar, “Unraveling the Intersectionality of Stigma and Trauma on Eating Disorders in Marginalized Communities,” now available on our YouTube channel. Gain insights from our conversation and explore how we can collectively advance equity in eating disorder treatment.
Let’s continue the conversation
How are you fostering inclusivity and equity in your practice? What steps are you taking to challenge stigma and support marginalized communities?
Share your thoughts in the comments or reach out directly—we’d love to hear from you.
References
Convertino, A. D., Morland, L. A., Blashill, A. J. (2022). Trauma exposure and eating disorders: Results from a United States nationally representative sample. International Journal of Eating Disorders; 55(8):1079-1089.
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