Recently, we came across a study by Harvard University researchers that indicated 47.3% of people being treated for substance use disorders (SUDs) have a history of physical or sexual abuse. The correlation is so strong, especially when the abuse happens during childhood, that interventions to reduce child abuse are warranted without any proof of causality.

We have uncovered recent research that points the finger at traumatic stress in the development of eating disorders. The driving motivation for these studies is the common co-occurrence of eating disorders (EDs) and post-traumatic stress disorder (PTSD). The so-called “comorbidity” of the two conditions has led to new research and treatment recommendations.

Researchers at George Mason University conducted a network analysis of EDs and PTSD and got some dramatic results:

• Both dietary restriction and binge eating were “strongly related” to PTSD symptoms.

• Binge eating may be an attempt to “regulate one’s emotions” when impacted by PTSD.

• ED symptoms are associated with psychological impairment such as sleep disorders.

“The PTSD symptoms negative emotions and negative beliefs were the strongest symptoms in the network,” write the researchers [emphasis added]. They say that “PTSD symptoms related to negative alterations in cognitions and mood may be highly influential” in the development of EDs.

A systematic review of the scientific literature on EDs and PTSD was conducted by researchers in the clinical psychology department at the University of California San Diego and published in the International Journal of Eating Disorders in March of 2023. The unusual finding in this longitudinal study is that “traumatic event exposure was associated with greater ED treatment dropout.”

The treatment dropout rate was significantly higher for ED patients suffering from PTSD. The reason, speculate researchers, is that “traumatic events may be associated with greater symptom relapse posttreatment.” They suggest that “the timing of traumatic events, self-perceived impact of trauma, and cumulative trauma exposure may be associated with differential ED treatment outcomes.”

Physical and sexual trauma appear to be the wellspring of addiction. The stress of these traumatic events is channeled through displacement into stress-relieving activities. Unfortunately, many of these activities are unhealthy and habit-forming, such as EDs.

These studies show evidence that the impacts of stress are cumulative and can lead to a resistance to treatment — all the more reason that early intervention is so important. As for interventions that work, the science has also been advanced by the recognition of the comorbidity of EDs and PTSD.

Dr. Kathryn Trottier, associate professor of psychiatry at the University of Toronto, is a specialist in the psychology of eating disorders. She edited the new book, Trauma, PTSD, and Eating Disorders, contributing a chapter on “Integrating cognitive processing therapy for posttraumatic stress disorder with cognitive behavioral therapy for eating disorders in Project Recover.”

Basically, Project Recover is a program to treat people suffering from EDs with a therapy designed for people suffering from PTSD, and vice versa, to treat people suffering from PTSD with therapy designed for EDs. Initial research was published in 2017 in the Journal of Traumatic Stress, showing that the eating disorder therapy resulted in statistically significant improvement for people suffering from PTSD. However, the PTSD therapy resulted in no measurable improvement for ED sufferers.

A follow-up on Project Recover published in the journal Eating Disorders four years later found that, “Interventions from both [cognitive behavioral therapy] for ED, and [cognitive process therapy] for PTSD can be utilized and adapted to address the functional relationship between ED and PTSD, and promote full recovery from both disorders.” Among the integrations recommended by Dr. Trottier:

• Integrating PTSD symptoms into individualized plans for EDs
• Integrating ED information into PTSD maintenance
• Identifying maladaptive beliefs connecting ED with PTSD

In summary, it appears that traumatic stress precedes substance use disorders, eating disorders, and behavioral disorders. The stress, and the need to displace the stress, have a cumulative impact over time, deepening both the likelihood of developing a disorder and resistance to treatment. These studies point out the obvious need for screening for comorbidities and for teaching stress management techniques early and often in life.

Written by Steve O’Keefe. First published April 27, 2026.

Sources:

“Eating Disorders and Posttraumatic Stress Disorder: A Network Analysis of the Comorbidity,” Behavior Therapy, March 2022.

“Posttraumatic stress disorder, traumatic events, and longitudinal eating disorder treatment outcomes: A systematic review,” International Journal of Eating Disorders, March 14, 2023.

“Initial Findings From Project Recover: Overcoming Co-Occurring Eating Disorders and Posttraumatic Stress Disorder Through Integrated Treatment,” Journal of Traumatic Stress, April 11, 2017.

“Integrating cognitive processing therapy for posttraumatic stress disorder with cognitive behavioral therapy for eating disorders in PROJECT RECOVER,” Eating Disorders, March 3, 2021.

Image Copyright: yacobchuk.