Eating disorders (EDs) are common chronic illnesses that most clinicians, regardless of specialty, will encounter at some point, and trauma is universal in those who have EDs. Trauma from physical and/or psychological injuries overwhelms the mind and body’s capacity to adapt, and can set off or perpetuate an already present ED. The nutritional support of an individual who struggles with an ED and is a trauma survivor can be one of the most challenging tasks a dietitian encounters. One of the most accurate ways to assess the nutritional status of the body is to do two types of tests: metabolic testing and body composition analysis. Physicians, dietitians, and nutritionists who treat EDs will be treating trauma. Physicians, specifically, have a critical role in diagnosing and treating EDs. Medical caregivers need to let the patients know that they will stay the course and support them for as long as it takes.

This chapter briefly discusses the interaction of trauma, attachment injury, and dissociation in treating eating disorders (EDs). What is it that causes some people to develop an ED, and others to manage eating behaviors in a relatively normal manner? The answer is anything but simple. EDs are a biopsychosocial illness. They are the result of a complex interplay of factors including genes, temperament, social interactions, early attachment, culture, and of course life experiences. These variables come together and affect each other in a perfect storm fashion and may result in ED psychopathology. The cycle of being flooded with early, unprocessed trauma upon remittance of ED symptoms, followed by relapse, reduces the foundation of treatment to shifting sand. Unless the trauma and the ED are treated simultaneously, treatment becomes futile at best: fraught with multiple relapses, behavioral substitutions, feelings of hopelessness, and premature termination.