Eating Expectancies, Trauma, & Disordered Eating: Current Research

· by · in Awareness, trauma. ·

by Alexis Dumain, Gil Intern

Eating expectancies are the collection of one’s learned expectations about eating, which are formed and reinforced through experiences.2,3,5 Stated another way, they are what you think about the meaning and function of food in your life. Expectancies can be positive, such as “Eating is Pleasurable and Useful as a Reward” (i.e., food is enjoyable and can be used as a reward), or negative, such as “Eating Leads to Feeling Out of Control” (i.e., the eating behavior leads to feeling out of control of the behavior and/or of one’s life).5 Other examples include “Eating Helps Manage Negative Feelings” (i.e., eating helps “block out” or “bury” uncomfortable feelings, such as loneliness), “Eating Improves Concentration”(i.e., eating helps one to study or work better), and “Eating Alleviates Boredom” (i.e., eating is something to do when bored to fill time). Previous studies have found that certain eating expectancies are related to different features of disordered eating. For example, Eating Helps Manage Negative Feelings connects a trait called negative urgency (the tendency to act rashly when distressed) with binge eating and compensatory behaviors, such as purging or compulsive exercise.7, 8, 9

An interesting little personal experiment is to ask people you know what eating means to them. I tried this with some friends and family members and got a range of responses, from the very practical “Eating Is Just Ingestion of Food” to the very positive “Eating is an Expression of Love.” For many people with eating disorders, the eating expectancies are quite negative, and it is important to ask how they get established.

Experiencing trauma or bullying is one avenue that can contribute to the development of your food expectancies. For example, someone who was teased or bullied about being fat in grade school might develop an expectancy like “Eating Makes Me a Target” and lead to a life of eating in secret and a link between eating and shame.

It is well-established that trauma exposure and adverse life experiences are associated with disordered eating, particularly binge eating.1,4,9,10 In one study, the prevalence of post-traumatic stress disorder (PTSD) was significantly higher among men and women with bulimia nervosa and binge-eating disorder than in the general population.6 Brewerton et al. (2007)1 reported that trauma was more common in individuals with an eating disorder who reported binge eating and/or compensatory behaviors (like purging) than those with an eating disorder who did not report these behaviors.

Currently, there isn’t a lot of information about whether traumatic experiences increase someone’s likelihood of developing certain eating expectancies. However, it is possible that trauma might be one important experience that shapes someone’s eating expectancies. For instance, traumatic events are by definition, negative, and can lead to a lot of negative feelings (like stress, anxiety, anger). If a person is unable or doesn’t have the tools to deal with uncomfortable emotions, they may turn to food to help manage those feelings. This is where eating expectancies come in: if someone expects food or eating will make them feel better, they are more likely to turn to it to help them deal with challenging or upsetting emotions.

More research into this association is needed so that psychologists can develop more effective treatments for disordered eating. Therapeutic strategies that view trauma as part of how an eating expectancy is formed could help transform negative eating expectancies (and the associated disordered eating behaviors) by directly targeting the driving beliefs and experiences that led someone to develop an eating disorder in the first place.

One therapy that might be effective at addressing eating expectancies is Cognitive Behavioral Therapy (or CBT). CBT is based on the idea that by changing irrational thoughts or beliefs, we can change the way we feel and act. So, even if you develop one or several negative eating expectancies, you’re not stuck with them forever! In CBT, a therapist would help you challenge the beliefs of the eating expectancies (like, “Eating Alleviates Boredom”) and replace them with a more helpful expectancy, like “Talking to a Friend Alleviates Boredom” or “Eating is a Way to Connect with Loved Ones.” Creating new eating expectancies sets the stage for developing more healthful eating behaviors.

References

  1. Brewerton, T. D. (2007). Eating disorders, trauma, and comorbidity: Focus on PTSD. Eating Disorders, 15(4), 285–304. https://doi.org/10.1080/10640260701454311
  2. Brosof, L. C., Munn-Chernoff, M. A., Bulik, C. M., & Baker, J. H. (2019). Associations between eating expectancies and eating disorder symptoms in men and women. Appetite, 141, 104309. https://doi.org/10.1016/j.appet.2019.06.001
  3. Combs, J. L., Smith, G. T., & Simmons, J. R. (2011). Distinctions between two expectancies in the prediction of maladaptive eating behavior. Personality and Individual Differences, 50(1), 25–30. https://doi.org/10.1016/j.paid.2010.08.015
  4. Harrington, E. F., Crowther, J. H., Henrickson, H. C. P., & Mickelson, K. D. (2006). The relationships among trauma, stress, ethnicity, and binge eating. Cultural Diversity & Ethnic Minority Psychology, 12(2), 212–229. https://doi.org/10.1037/1099-9809.12.2.212
  5. Hohlstein, L. A., Smith, G. T., & Atlas, J. G. (1998). An application of expectancy theory to eating disorders: Development and validation of measures of eating and dieting expectancies. Psychological Assessment, 10(1), 49–58. https://doi.org/10.1037/1040-3590.10.1.49
  6. Mitchell, K. S., Mazzeo, S. E., Schlesinger, M. R., Brewerton, T. D., & Smith, B. N. (2012). Comorbidity of partial and subthreshold ptsd among men and women with eating disorders in the national comorbidity survey-replication study. International Journal of Eating Disorders, 45(3), 307–315. https://doi.org/10.1002/eat.20965
  7. Rijkers, C., Schoorl, M., van Hoeken, D., & Hoek, H. W. (2019). Eating disorders and posttraumatic stress disorder. Current Opinion in Psychiatry, 32(6), 510–517. https://doi.org/10.1097/YCO.0000000000000545
  8. Schaumberg, K., & Earleywine, M. (2013). Evaluating the acquired preparedness model for bulimic symptoms and problem drinking in male and female college students. Eating Behaviors, 14(1), 47–52. https://doi.org/10.1016/j.eatbeh.2012.10.012
  9. Tagay, S., Schlottbohm, E., Reyes-Rodriguez, M. L., Repic, N., & Senf, W. (2014). Eating disorders, trauma, PTSD, and psychosocial resources. Eating Disorders, 22(1), 33–49. https://doi.org/10.1080/10640266.2014.857517
  10. Trottier, K., & MacDonald, D. E. (2017). Update on psychological trauma, other severe adverse experiences and eating disorders: State of the research and future research directions. Current Psychiatry Reports, 19(8), 45. https://doi.org/10.1007/s11920-017-0806-6