Eating disorders often driven by trauma and a quest for safety
February 20, 2026
When we feel safe, our bodies and minds are at ease. We can relax, and we can focus on growth and forward progress. But when we experience physical or psychological trauma, our brain searches for something we can control to regain predictability.
For some people, that desire for safety manifests as an eating disorder, such as anorexia nervosa or bulimia nervosa.
I recently served as the scientific editor for a book titled “Slip” that merged investigative journalism about eating disorders with personal experience. As a young girl, the author developed an eating disorder after losing her mother. She describes how focusing on controlling eating helped manage her intense emotions, mitigating the grief of growing up without her mom.
Despite mounting evidence that eating disorders frequently emerge following losses or trauma, myths persist that they are caused by internal personal character features such as vanity or gluttony. These myths suggest eating disorder patients both cause and control their eating, yet most do not feel in control, being unable to eat more, stop eating, or disrupt compensatory patterns like over-exercise or vomiting. This contrast between myths and the patient’s experiences can delay and impede care for these serious multifactorial disorders.
At the same time, eating disorders are becoming more common. A 2019 study found they more than doubled between 2000-2006 and 2013-2018.
Research clearly shows these complex disorders involve both the brain and the body. Severe calorie restriction, purging, and binge eating disrupt the gut-brain connection – a whole-body health network that connects your central nervous system with your digestive tract. Patients with eating disorders often report low energy, depression, anxiety, and gastrointestinal (GI) problems. Left untreated, eating disorders can cause serious health complications and can be fatal.
My colleagues and I in UT Southwestern’s Peter O’Donnell Jr. Brain Institute are shifting the conversation about eating disorders away from shame and toward a biological understanding of the internal quest for stability. By connecting these dots – and with personalized treatment and a supportive personal network – patients with eating disorders can restore their health and quality of life.
Feb. 23-March 1 is National Eating Disorders Awareness Week, designated by the National Eating Disorders Association to educate the public, challenge stereotypes, and promote early detection and treatment.
Energy, routine, gut-brain connection
Food is a primary driver of metabolism. Eating sets off a chain of chemical processes that allows the body to generate energy, regulate hormones, and maintain vital functions. When the fuel source becomes erratic, the brain adapts in ways that enable the body to continue to function despite experiencing what is interpreted as a dangerous environment. Signals are sent throughout the brain and body reflecting that the organism is threatened by a food shortage, which is perceived as a safety crisis.
The gut and brain are in constant communication. Through neural, hormonal, and immune pathways, the gut-brain connection helps regulate appetite, digestion, mood, sleep, and energy levels. Disordered eating breaks down that essential dialogue. Hunger cues may disappear, fullness signals may become distorted, and fatigue and low mood often follow.
Disorders of gut-brain interaction (DGBI) further illustrate how closely these systems are connected. Conditions such as irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and gastroparesis frequently co-occur with eating disorders. Most individuals with eating disorders have at least one DGBI, with IBS being the most common.
Circadian rhythms power the body's internal clock. These patterns govern our sleep-wake cycles and are tightly linked to nutrition and mental health. Eating meals at regular times supports healthy circadian rhythms, while disrupted sleep and irregular eating can amplify stress, anxiety, and depressive symptoms.
Modern lifestyles, such as shift work, late-night screen time, and the isolation that was prominent during the COVID-19 pandemic, disrupt these rhythms and have contributed to the rise in eating disorders. When sleep is dysregulated, appetite signals often fail, leading to erratic eating or bingeing as the brain struggles to regain its footing.
Related reading: Inside the brain of someone with an eating disorder
Trauma and the brain’s search for safety
Experiencing trauma also plays a significant role in many eating disorder cases, particularly in younger patients. Our team found that most children treated in the Children’s Medical Center Eating Disorder Program had experienced traumatic events. Further, though multiple trauma exposures were associated with more severe symptoms at admission, symptoms at discharge were comparable to those without trauma, showing that healing is possible.
Trauma can be impersonal, such as a crime, accident, or natural disaster, or it can be personal, such as bullying, emotional neglect, or the death of a loved one. In our recent study, we found that patients connected personal traumas to their eating disorder symptoms more than impersonal traumas. This suggests that a lack of social safety may also trigger a safety crisis for the body, dysregulating eating and sleeping.
Health anxiety is also common, with intense focus on food quality, ingredients, and perceived health risks. Over time, these patterns can become a persistent disorder that dominates daily life.
Many individuals do not recognize the severity of the problem until they try to change their eating pattern. Changing behaviors requires adequate nutrition and physiological function, and those processes are impaired in eating disorders, creating a vicious cycle.
Signs of an eating disorder
Anyone of any gender or age can develop an eating disorder. The average age of onset is around 19-20, and some forms begin earlier or emerge in adulthood. Transitions such as starting college, living in a dormitory, eating in unfamiliar environments, or managing new social pressures can increase vulnerability.
Symptoms of an eating disorder can include:
- Avoiding meals or eating in secret.
- Fixating on food, calories, or exercise.
- Sudden and dramatic weight loss.
- Fatigue, low energy, or frequent illness.
- Social withdrawal or loss of interest in activities.
Left untreated, eating disorders can lead to serious medical complications, including heart rhythm abnormalities, bone loss and fractures, malnutrition, hormonal disruption, and damage to the gastrointestinal system. Binge eating disorder is associated with a nearly fivefold increase in suicide attempts, and the mortality rate in anorexia nervosa is the highest of any psychiatric disorder.
Treatment: Restoring health and stability
Safety is a central concept in treatment. Establishing regular routines for eating and sleeping helps restore circadian rhythms, energy levels, and appetite cues. Rather than focusing on calories or appearance, treatment emphasizes food as a source of energy that enables people to function, think clearly, and engage in life.
Because these conditions affect both the brain and body, care is most successful when delivered by a multidisciplinary team, all of whom provide support and accountability with eating challenges:
- Psychiatrists: Manage eating disorders and their common comorbidities such as depression, anxiety, substance-use disorders, or obsessive-compulsive disorder (OCD), all of which can exacerbate eating disorder symptoms.
- Therapists: Build insight about stressors, develop new coping mechanisms, and provide consistent support to help patients achieve long-term health and life goals.
- Dietitians: Support appropriate nutrition, rebuild a healthy relationship with eating, and help patients develop eating strategies to minimize GI symptoms.
- Support systems: Recovery is more likely when patients are surrounded by people who understand the goals of treatment and can reinforce healthy routines. Community, connection, and belonging play powerful roles in restoring a sense of safety and well-being.
Goals are individualized and flexible. For one person, progress may mean increasing portion sizes gradually; for another, it may involve eating at consistent times or reducing cycles of restriction and bingeing. Small, concrete changes – sustained over time – are often more meaningful than dramatic short-term efforts. At the same time, treatment encourages balance. Learning when to let go of control is often as important as applying structure.
Medications can be helpful in some cases with two U.S. Food and Drug Administration-approved medications: fluoxetine for bulimia nervosa and lisdexamfetamine for binge eating disorder. Other medications can generally be selected to manage comorbidities, such as anxiety or mood symptoms.
"The treatment for GI disorders is similar to the treatment for eating disorders. It’s a multidisciplinary approach where the brain has to change, the behaviors have to change, and the food that enters the GI tract has to change. When we discuss the gut-brain interaction and circadian rhythms with patients, it helps them normalize and destigmatize their eating disorder."
Carrie McAdams, M.D., Ph.D., Associate Professor of Psychiatry
Rediscovering joy in food and life
Eating disorders are not about self-esteem or willpower or vanity. These are complex conditions that can touch nearly every aspect of life – from physical health and energy to relationships and emotional resilience.
The journey to recovery is rarely a straight line, but the destination is the same: feeling well enough to live a full life. When patients have the right support and the right biological framework, they can find safety and stability through healthy connections rather than calorie restriction or bingeing.
With compassionate, personalized care and the right support, people with eating disorders can reclaim their health and rediscover joy in food, relationships, and daily life.
To talk with an expert about an eating disorder, make an appointment by calling 214-645-8500 or request an appointment online.
