What does it mean to provide trauma-informed care?

In the public eye, trauma is often viewed as a major event that poses an immediate sense of danger. In reality, trauma is a very complex experience that can occur on multiple timeframes, in a variety of forms, and of varying degrees. Traumas can be both physical and/or psychological. These include chronic traumas, which are incurred over a prolonged period at multiple instances (e.g. abuse), in addition to the initially exemplified acute situations most commonly considered (e.g. accidents). The similarity in these different experiences is a compromised sense of safety.

Reframing trauma with this perspective allows for a more holistic understanding of how folks may struggle to establish a sense of safety in the present due to a perceived threat from the past. This is especially true for marginalized identities who experience the continuous harms of oppression throughout their life. The compiled effects of all traumas an individual may have experienced/be experiencing is what is to be considered in trauma-informed care approaches.

Neuroception

 

The concept of neuroception can be helpful in understanding how past trauma can show up in real-time. Neuroception is the way our autonomic nervous system scans the environment for cues of safety, danger and threat, without involving the thinking parts of our brain. This occurs without conscious awareness and is largely influenced by an individual’s experiences, particularly traumatic ones. Neuroception explains why a child might coos at a caregiver but cries at a stranger, or may enjoy a parent’s embrace but fears a hug from a stranger.

Do all nervous systems react similarly?

 

Another important aspect of being trauma informed is considering that, while all have nervous systems, our individual systems will react and respond differently, even to the same information. So, if two or three of us were in a room and something traumatic happened, it is possible that all three of us would have very different responses in our nervous systems. For some, this cue moves them into a state of mobilization. These folks will either take confrontational or avoidant action. For others, ‘danger’ cues may move them into a state of collapse.

These automatic responses to one perceiving a threat to their safety are commonly classified in the following;

  • Fight (Hyperarousal): An effort to overcome and regain a sense of control.
  • Flight (Hyperarousal): The tendency to escape into something that hurts less.
  • Freeze (Hypoarousal): A means of shutting down in order to avoid traumatic feelings.

Understanding the unique nature of an individual’s nervous systems may help account for what might occur in recovery spaces. Examples of dysregulation responses presenting in sessions:

What is Trauma-Informed Care?

Trauma informed care relays the practice of support that accompanies someone through their healing. It is understanding how the compiled experiences of one’s past transcend into one’s present existance. Central to this type of support is creating a space in which the person feels valued for who they are rather than judged. This non-pathologizing perspective asks “what is your experience” rather than “what is wrong with you.” At a core, it honors lived experience.

Central to trauma informed care is to understand the relationship between trauma and coping mechanisms. Experiencing trauma can result in a need to cope in order to feel safe/protected. Recognizing how disordered eating behaviors can act as a way to cope clarifies the connection of how a need to cope with trauma can lead to the development and/or reliance on disordered eating as a means of relief/escape (i.e. protection) from the pain/discomfort (i.e. threat).

Observing how eating disorders often develop during significant life changes or transition exemplifies their nature as a trauma response. Therefore, a trauma informed perspective means looking through lenses that are less oriented towards seeing eating disorder symptoms and more towards the source the response may link back too. This insight can help shape a provider’s understanding of an individual’s triggers and response mechanisms. Oftentimes, one’s body is caught in the crossfire of this. One example could be that as a result of diet culture placing great value on body size, we often try to earn love and worth by belonging with our bodies, and find significance/create safety with it. That being said, there are many reasons people don’t want to connect or do not feel safe in their bodies, any and all of which can lead to mechanisms of defense and protection.

Eating disorders as a source of trauma

If we continue with the concept of stress influencing an eating disorder, we begin to see how an eating disorder can become a source of trauma; all eating disorders create stress on the body. Through this lens, we can reframe ED symptoms: starvation, binging, purging, dieting, and excessive exercise are seen as forms of physical abuse, neglect, and assault on the body. An eating disorder’s lack of boundaries can be viewed as emotional abuse. Thought and belief distortions are a form of gaslighting, negative self-body talk is a source of bullying from the inside out, and the intrusive behaviors that the eating disorder suggests are harassment.

Using this trauma informed lens allows one to challenge the validity of eating disorders as a life preserver. This belief comes genuinely and innocently in search for a means of protection, but a trauma informed approach accounts for how EDs may eventually become the source/bully. However, this must be done cautiously and consciously. Challenging someone to give up control of food is asking them to give up one thing that creates safety for them in that fight or flight system or collapse mode. It’s important as care providers to connect and build trust over time. As individuals lose their safety mechanisms (i.e. ED behaviors), they are trusting that we are going to be there to hold the space for them to find a new meaning of safety within their own bodies. The core tenets of trauma informed care provide us a foundation for doing so:

  • Normalize one’s urge to engage in ED behaviors rather than shaming them.
  • Let the client lead the way (i.e. assume a client knows what is best for them).
  • Ask for consent (e.g. would it be okay if we…).

Seeking Help

 

Clients are seeking services because they want to change, however, wanting to change and feeling capable of change are fundamentally different. As providers, understanding the complexity of trauma and its relation to coping provides the opportunity to create a safe space in which those seeking support feel comfortable. Exploration of the nervous system can cast light onto how one can reach a state of safety and connection within their environment. 

Reminder: Safety is not something someone is told. It is something someone feels.

 

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Written by

Liam Fowler

McGill Dietetics Intern

References

  1. Besso, Annyck. ERD Pro Presentation.
  2. Maria Sorbara Mora, MS, RD (2021). Webinar “Somatic Feeding: Trauma Informed Eating Disorder Nutrition” Available at: https://www.youtube.com/watch?v=fFRRsdaOHEg
  3. Nina and Tracy Brown, RD, LD/N (2022). Trauma Treatment Collective’s Podcast (Ep 24): Eating Disorders and Trauma Treatment. Available at: https://podcasts.apple.com/us/podcast/trauma-treatment-collectives-podcast/
  4. Porges S. W. (2009). The polyvagal theory: new insights into adaptive reactions of the autonomic nervous system. Cleveland Clinic journal of medicine, 76 Suppl 2(Suppl 2), S86–S90. https://doi.org/10.3949/ccjm.76.s2.17

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