June is Post Traumatic Stress Disorder (PTSD) Awareness Month. This year, PTSD Awareness Month falls on the heels of an incredibly trying time. We’ve all endured a pandemic. As we touched on in a recent blog post, many people are grappling with individual experiences of PTSD or trauma in the wake of COVID-19. We’ve also born witness to a public, painful reckoning with systemic racism and racial justice, sparked by the video footage of George Floyd’s murder, among other highly visible, broadcasted examples of racial inequality.
Trauma is a frequent predecessor to the development of an eating disorder and can also occur as a result of an eating disorder. A variety of eating disorder treatment centers and outpatient eating disorder treatment providers specialize in this intersection. Staff at Reasons are trained in the Trauma Resiliency Model (TRM) and Dialectical Behavior Therapy (DBT), both of which have been shown to be effective for reducing symptoms of PTSD. Modalities such as Eye Movement Desensitization and Reprocessing (EMDR) or Brainspotting can also prove helpful in treating the co-occurrence of trauma and eating disorders. Within the field of eating disorder treatment, the co-occurrence of trauma and eating disorders is well understood. Furthermore, best practices in the field promote the importance of a trauma-informed approach to eating disorder treatment.
However, no two people experience trauma in the same way. Consider the pandemic. Consider the murder of George Floyd. Chances are you can list a wide variety of reactions, thoughts and emotions you felt or bore witness to among those you love. Chances are you would describe your experiences differently than the person beside you. While we have shared a collective experience through these difficult times, we have each experienced these times differently.
As eating disorder treatment providers, we must do more than simply acknowledge and treat co-occurring trauma. An effective, compassionate path toward eating disorder treatment must approach the topic of trauma through the lens of intersectionality.
A term coined by Kimberle Williams Crenshaw, intersectionality is a framework for considering how multiple components of an individual’s identity combine to impact their experience of discrimination and privilege. Intersectionality does not just urge us to explore where the intersection of our identities places us relative to privilege and discrimination. Intersectionality also asks us to explore how the interwoven nature of our identities make it difficult (or impossible) to parse out where one element ends and another begins.
In the context of eating disorder treatment and many other healthcare settings, intersectionality urges us to rethink what constitutes a trauma-informed approach. Historically, bias has shaped every way in which healthcare settings seek to help people – from research to access to quality of care. Our systems have long failed people who fall outside of the established “norms” of white, cis, thin, able-bodied, neuro-typical identities. Righting this bias requires more than a perfunctory education on cultural sensitivity. Instead, we must look with a truthful, critical eye at how our systems operate and how bias impacts care.
When considering how bias impacts a trauma-informed treatment approach, we need to remain humble and curious. Trauma impacts people differently. Not all experiences will be perceived equally by individuals or groups. Furthermore, we must remain alert to the possibility that historically marginalized groups that fall outside of stereotypical identity “norms” can experience trauma in the very settings where they are seeking help and treatment. Medical settings and behavioral health settings have long been sources of trauma for people in larger bodies, neuro-divergent people, BIPOC communities and LGBTQIA communities, to name just a few. Sadly, eating disorder treatment settings have been a historic source of trauma for these folks as well.
Representation matters – in treatment settings and in all contexts of life. Seeing providers and patients who look like us or share similar backgrounds helps ease stigma and lack of awareness of how eating disorders impact everyone. Representation increases our ability to provide culturally responsive care at an individualized level. Representation helps us move beyond a “one-size-fits-all” approach to treatment. But, representation does so much more. For those of us who provide trauma-informed eating disorder treatment, representation and an intersectional approach can fundamentally shift how we see and treat our patients. This shift can deepen our understanding of the myriad of ways in which trauma appears and can evolve our understanding of how to establish safety for a patient.
As treatment providers who specialize in treating trauma, we want nothing more than to create a safe, inclusive environment to nurture our patients’ wellbeing. Intersectionality must be part of the foundation of a healing-centered, culturally rooted approach. In order to truly serve our patients, we must do so with the utmost respect and care for their lived experience. Being seen in this way represents a cornerstone on the path to healing from trauma.