Mothering and Recovery Two
Entanglement of Stress Management and Eating Disorders
If the brain’s function is impaired, through restriction of energy intake or through creating overall energy deficits or hormone rhythm disruptions with compromised intake, then that impedes the cognitive recognition of stress. It removes the potential for responding to the stress by changing the external environment and circumstances. In this section we are going to unpack how to prioritize addressing the hidden stressor of trauma that complicates a person’s ability to fully identify and assess external stressors before determining what stress alleviation techniques might be warranted.
Trauma
The March of Dimes quotes NIH statistics to state that 45% of new mothers experience birth trauma.[1]
“Trauma is defined, typically, as involving an intense emotional and biological stress response to a non-ordinary event that is experienced as threatening or aversive”
Not all experiences of trauma inevitably lead to any lasting physical or emotional effects, but when they do, that is categorized as post-traumatic stress disorder (PTSD).
Somewhere between a quarter to half of those with eating disorders are found to have comorbid PTSD.[3]
“A recent systematic review on comorbid PTSD in individuals with eating disorders noted that maladaptive emotion regulation may act as the mediating mechanism (Rijkers et al., 2019). As such, eating disorder behaviors are theorized to enable the avoidance of trauma-related thoughts/feelings and reduce hyperarousal, which are common symptoms of PTSD (Trottier & MacDonald, 2017).”
If there is an active eating disorder present with pregnancy, the risk of hyperemesis doubles and there is a 60% increased risk of antepartum hemorrhage (a bleed after birth). Hyperemesis is a deadly level of morning sickness that often requires emergent hospitalization stays throughout the pregnancy. Such medical risks will often involve trauma associated with the experience of the condition and the treatment used to alleviate it. Beyond the risks to the mother with an eating disorder, there is the risk of complications for the baby. There’s a 60% increased risk of a preterm birth. There’s an almost 2-fold risk for mothers with anorexia having a baby with microcephaly (60% increase for bulimia, 40% for EDNOS). Microcephaly means the baby’s head is much smaller than the range expected at birth.[5]
Far more details on the topic of reproductive health and eating disorders are available in Reproductive Health Part One.
Given that nearly half of all new mothers experience trauma associated with the birth of their child, and mothers with an active eating disorder have significantly increased risk of medical interventions for themselves and their baby during pregnancy and birth, unintegrated trauma is a significant factor in the persistence of eating disorder behaviours while raising children.
Integrated Trauma and Consolidated Memory
As mentioned in the post Rebounding to Calm One 94% of those who experience a traumatic event meet the criteria for having PTSD in the first week following the incident. This drops to 65% after one month and down to 47% by month three.[6]
What is happening for just under half of the population that have persistent PTSD symptoms beyond three months after a traumatic event?
There are experts in the field of PTSD treatment who posit that PTSD is a disorder of memory. The usual process of developing a lasting memory is that the initial fragile and immediate recording of an event is transferred to long-term memory over time. Physically, it is the capturing via hippocampal-cortical links of the event (short-term memory) and the movement of that capture into cortico-cortical connections (long-term memory) in the brain. Much of that transfer occurs while asleep.[7]
“In case of emotional memory, current theories suggest that memory consolidation additionally serves to preserve and solidify the declarative, factual aspect of an emotional memory trace, while at the same time depotentiating its affective charge (Walker & Van der Helm, 2009). This progressive decoupling of emotion and memory is thought to be facilitated by stress-related hormones and neurotransmitters (like cortisol and norepinephrine) that act at the level of the amygdala, thereby modulating the hippocampal-cortical transfer (Van Marle, Hermans, Qin, Overeem, & Fernandez, 2013).”
The shift to long term memory, along with the depotentiation of the emotional charge (making it less intense and fearful) seems to fail for those with PTSD. The memory stays tightly coupled to hippocampal responses (perceptual and autonomic) and the emotional impact is not fully parsed and pruned.
While the treatment addressing PTSD as a memory disorder is called reconsolidation treatment, that seems a bit of a misnomer as the traumatic memory has specifically not previously completed the usual consolidation process and is stuck in hippocampal responses. In any case, the traumatic memory is retrieved in a treatment setting and this opens it up to integration and a complete consolidation. This is preferrable to treatments and drugs that block the fear reactions and intrusive nightmares and thoughts that a patient experiences with PTSD.[9],[10]
The treatment used in reconsolidation is most commonly neuro-linguistic programming (NLP) within the eye movement desensitization and reprocessing (EMDR) method. It works well.[11], [12]
Attending to unintegrated and unconsolidated trauma before trying to manage stress overall is a wise first step. Why? Because there are many structural changes to the brain that occur for those with untreated PTSD and that will necessarily mean that using any of the tools commonly used to knock down/alter brain function will work differently than for a brain unchanged by, or recovered from, PTSD. [13]
I will explain what I mean by “knocking down brain function” in Part Three.
https://www.marchofdimes.org/find-support/topics/postpartum/toll-birth-trauma-your-health
Day S, Hay P, Tannous WK, Fatt SJ, Mitchison D. A systematic review of the effect of PTSD and trauma on treatment outcomes for eating disorders. Trauma, Violence, & Abuse. 2024 Apr;25(2):947-64.
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Mantel Ä, Hirschberg AL, Stephansson O. Association of maternal eating disorders with pregnancy and neonatal outcomes. JAMA psychiatry. 2020 Mar 1;77(3):285-93.
Rothbaum, Barbara Olasov, Edna B. Foa, David S. Riggs, Tamera Murdock, and William Walsh. "A prospective examination of post-traumatic stress disorder in rape victims." Journal of Traumatic stress 5, no. 3 (1992): 455-475.
van Marle H. PTSD as a memory disorder. European Journal of Psychotraumatology. 2015 Dec 1;6(1):27633.
ibid.
Gray R, Budden-Potts D, Bourke F. Reconsolidation of traumatic memories for PTSD: A randomized controlled trial of 74 male veterans. Psychotherapy Research. 2019 Sep 3;29(5):621-39.
Raut SB, Canales JJ, Ravindran M, Eri R, Benedek DM, Ursano RJ, Johnson LR. Effects of propranolol on the modification of trauma memory reconsolidation in PTSD patients: A systematic review and meta-analysis. Journal of Psychiatric Research. 2022 Jun 1;150:246-56.
Gray R, Budden-Potts D, Bourke F. Reconsolidation of traumatic memories for PTSD: A randomized controlled trial of 74 male veterans. Psychotherapy Research. 2019 Sep 3;29(5):621-39.
Astill Wright L, Horstmann L, Holmes EA, Bisson JI. Consolidation/reconsolidation therapies for the prevention and treatment of PTSD and re-experiencing: a systematic review and meta-analysis. Translational psychiatry. 2021 Sep 3;11(1):453.
Kunimatsu A, Yasaka K, Akai H, Kunimatsu N, Abe O. MRI findings in posttraumatic stress disorder. Journal of Magnetic Resonance Imaging. 2020 Aug;52(2):380-96.
Image in synopsis: Flickr.com: Michelle MacPhearson.
