Category: women

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Childhood Trauma and Personality: How Our Complex Lives Influence the Development of Eating Disorders and Alcohol Abuse

by Jasmine Atwal

Trigger Warning: Mentions of Suicide and Childhood Trauma/Abuse

Demi Lovato wearing a blue shirt: Demi Lovato.

Singer and Actress, Demi Lovato at Award Function, Gazette, 2020. Retrieved from Justin Bieber and Jennifer Lopez among E! People’s Choice Awards winners | Basingstoke Gazette

“I’m tired of running myself into the ground with workouts and extreme dieting. I thought the past few years was recovery from an eating disorder when it actually was just completely falling into it,” -Demi Lovato

Demi Lovato. Russel Brand. Elton John. Amanda Bynes.

Aside from being talented artists, these individuals share one more common link- they have all experienced eating disorders and substance abuse.

In 2018, Lovato was hospitalized due to an overdose and has since shared her heart-wrenching experience with alcohol abuse and eating disorders in the 2021 docuseries, Demi Lovato: Dancing with the Devil.In 2018, after mixing multiple substances, Lovato experienced multiple strokes, a heart attack, brain damage, and legal blindness. Regarding her previous experience with eating disorders, Lovato recounted:

  • “I was compulsively overeating when I was 8 years old.”
  • “For the past 10 years I’ve had a really unhealthy relationship with food.”
  • “I was performing concerts on an empty stomach.”

Lovato’s story is one among many that highlights the life-threatening impact that eating disorders and alcohol abuse can have on an individual.  

Eating disorders refer to illnesses in which individuals experience significant disturbances to their eating behaviours and accompanying emotions and thoughts. Often, these individuals are preoccupied with thoughts about food and body weight. There are many types of eating disorders including:  

  • Anorexia nervosa– The individual may have an unusually low body weight and a fear of gaining weight. These individuals will try to control their weight by limiting calories, exercising excessively, or using laxatives.   
  • Bulimia nervosa– These individuals will eat a lot of food and then try to get rid of the calories through unhealthy ways such as vomiting, using laxatives, or exercising too much.   
  • Binge eating– These individuals will likely eat too much and feel that they cannot control their eating. They will continue to eat even if they are full and often feel guilty afterwards. 

See the source image

The Signs of an Eating Disorder, Rehab Medical, 2020. Retrieved from Eating Disorders: Symptoms, Signs, Types and Causes- Rehab Medical (rehab-medical.com)

In Canada, eating disorders impact approximately 1 million individuals and these behaviours are often accompanied by other harmful behaviours, such as abusing alcohol. Abusing a substance refers to using too much, too often, or being unable to control use even though it might be harming other parts of your life. Approximately, 50% of individuals with an eating disorder also abuse alcohol.

Clearly, there is a large percentage of people who are experiencing symptoms related to two separate illnesses at the same time. Thus, these individuals require treatments that are able to target both mental illnesses. Treatments are only effective if the roots of the illness are identified and targeted, thus, it becomes extremely important to understand the specific risk factors (i.e., things that increase the likelihood of engaging in a behaviour) that contribute to the development of both disorders. It must be emphasised that the presence of these factors does not necessarily mean that you will definitely develop both/either disorder, it simply means that there may be an increased risk. Also, the factors that will be discussed can also lead to the development of other illnesses, but due to a limited number of studies that focus only on eating disorders and alcohol abuse, it is difficult to determine risk factors that are only related to these two disorders.

Also, alcohol abuse and eating disorders can be risk factors for the development of each other. For example, some individuals with anorexia may use alcohol to suppress their appetite- they drink to avoid eating. Some individuals may use alcohol to relieve themselves of feelings of guilt and shame when they do not eat or eat too much. Thus, while we will discuss what factors contribute to the development of both disorders, each one can contribute to the other as well.      

Childhood Trauma

It has been well-established that our childhood influences our adult lives by shaping our personalities, opinions, and memories. Childhood trauma refers to an emotionally painful, scary, violent, or threatening experience that occurs in one’s childhood and has a lasting impact on their mental or physical health. This can include neglect, sexual and physical abuse.

Childhood trauma has been found to be a risk factor for eating disorders and alcohol abuse. For example, a study by Corstorphone et al. (2007) found that individuals who had experienced any form of abuse in their childhood were more likely to develop any type of eating disorder in their adult lives. Further, childhood sexual abuse was the most significantly linked to the development of bulimia and binge-eating, alcohol abuse, and self-harming behaviours. Similarly, a study by Guillaume et al. (2016) found that any form of mistreatment in one’s childhood could predict future development of an eating disorder and accompanying alcohol abuse.    

In fact, childhood trauma is fairly common in individuals who are experiencing eating disorders and alcohol abuse. Multiple studies have found that 37% to 100% of individuals with eating disorders have experienced some form of abuse or neglect within their childhoods. While the reasons are likely complex, it is suggested that individuals with traumatic experiences in their childhood may lack proper coping skills and resort to harmful behaviours (such as eating and drinking a lot) as a way to deal with their trauma and emotions. Alongside childhood trauma, one’s personality also influences the development of these illnesses.  

See the source image

Childhood Trauma and Development of Eating Disorder, ESI, 2019. Retrieved from Childhood Feeding Neglect and Trauma in Developing Eating Disorders

Personality

Our personality influences many aspects of our lives. Impulsivity (i.e., acting quickly without thinking), how we respond to our emotions, among other factors can increase or decrease the likelihood of committing certain behaviours and in turn what disorders are developed.

            A study by Lozano-Madrid et al. (2020) focused on personality traits in female participants with diagnosed eating disorders who displayed symptoms of alcohol or drug abuse. The researchers found that impulsive individuals with executive control problems and emotional dysregulation were at a higher risk of abusing alcohol. Executive control problems refer to one’s ability to make decisions and create/work through goals while emotional dysregulation is one’s inability to control their emotional responses. Essentially, the study found that the symptoms of alcohol abuse in individuals with eating disorders were more likely to transform into a disorder in the presence of the previously mentioned risk factors.

            Similarly, a study conducted by Micheeva and Tragesser (2016) focused on multiple personality factors including negative urgency and emotionality. Negative urgency refers to a type of impulsivity in which one reacts rashly when they are in distress, such as using alcohol to cope with a problem in their lives. The researchers found that negative urgency heavily contributed to the development of eating disorders and alcohol abuse. These individuals may turn to food or alcohol as a means to cope with the problems they are currently or have in the past,- experienced and, overtime, these behaviours increase in riskiness and translate to disorders.

Concluding Remarks

            While the studies mentioned above provide important information, there are some things that we must remember. Firstly, the above list is not exhaustive as there were many factors that were not discussed in this post including genetics. Also, we must remember that the simple presence of these factors in your life do not automatically guarantee the development of eating disorders and alcohol abuse- it simply increases the risk.

            Fortunately, there are many treatments that are available for individuals with eating disorders and alcohol abuse, that target specific risk factors (such as those mentioned above). For example, cognitive-behaviour therapy (CBT) targets negative thoughts and behaviours and has been found to be effective in reducing anorexia and binge-eating. Interpersonal psychotherapy which targets interpersonal problems (i.e., family or relationship issues) in the individual’s life that may be contributing to their poor eating/drinking habits. These treatments may seem vague, but each one can be specialized to target the factors that are causing the individual’s problems. In Canada, organizations such as National Eating Disorder Information Centre (NEDIC) and Ontario Community Outreach Program for Eating Disorders can help you gain access to such treatments.

If you or a loved one require support, please refer to the following website which provides information about Canadian organizations that provide resources and support to individuals with eating disorders and other accompanying problems. https://www.eatingdisorderhope.com/treatment-for-eating-disorders/international/canada/canadas-eating-disorder-organizations-charities

References

Cookson, P. (2020, October 5). 23 Celebrities with Eating Disorders: The Recovery Village. The Recovery Village Drug and Alcohol Rehab. https://www.therecoveryvillage.com/mental-health/news/celebrities-with-eating-disorders/.

Corstorphine, E., Waller, G., Lawson, R., & Ganis, C. (2007). Trauma and multi-impulsivity in the eating disorders. Eating Behaviors: An International Journal, 8(1), 23-30. https://doi.org/10.1016/j.eatbeh.2004.08.009

Guillaume, S., Jaussent, I., Maimoun, L., Ryst, A., Seneque, M., Villain, L., Hamroun, D., Lefebvre, P., Renard, E., & Courtet, P. (2016). Associations between adverse childhood experiences and clinical characteristics of eating disorders. Scientific Reports, 6(1), 35761-35761. https://doi.org/10.1038/srep35761

Hibberd, J. (2021, April 14). Demi Lovato’s Eating Disorder Comedy Pilot Gets NBC Order. Billboard. https://www.msn.com/en-us/tv/news/demi-lovato-s-eating-disorder-comedy-pilot-gets-nbc-order/ar-BB1fCPTX?ocid=uxbndlbing.

Hilliard, J. (2021, April 2). Alcohol and Eating Disorders. Alcohol Rehab Guide. https://www.alcoholrehabguide.org/resources/dual-diagnosis/alcohol-eating-disorders/.

Kass, A., Kolkata, R., Wilfley, D. (2014). Psychological Treatments for Eating Disorders. Curr Opin Psychiatry, 26(6), 549–555. https://doi.org/https://dx.doi.org/10.1097%2FYCO.0b013e328365a30e 

Lewaniak, L. (2016, April 1). The Link Between Eating Disorders and Alcohol Abuse. Eating Recovery Center. https://www.eatingrecoverycenter.com/blog/signs-symptoms/The-Link-Between-Eating-Disorders-Alcohol-Abuse. 

Lozano-Madrid, M., Clark Bryan, D., Granero, R., Sánchez, I., Riesco, N., Mallorquí-Bagué, N., Jiménez-Murcia, S., Treasure, J., & Fernández-Aranda, F. (2020). Impulsivity, emotional dysregulation, and executive function deficits could be associated with alcohol and drug abuse in eating disorders. Journal of Clinical Medicine, 9(6), 1936. https://doi.org/10.3390/jcm9061936

Malone More Articles April 6, C. (2021, April 6). ‘Dancing With the Devil’: Demi Lovato Was 5 Minutes From Death After Her 2018 Overdose. Showbiz Cheat Sheet. https://www.cheatsheet.com/entertainment/dancing-devil-demi-lovato-overdose.html/.

Mayo Foundation for Medical Education and Research. (2018, February 20). Anorexia nervosa. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/anorexia-nervosa/symptoms-causes/syc-20353591.

Mayo Foundation for Medical Education and Research. (2018, May 10). Bulimia nervosa. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/bulimia/symptoms-causes/syc-20353615.

Mayo Foundation for Medical Education and Research. (2018, May 5). Binge-eating disorder. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/binge-eating-disorder/symptoms-causes/syc-20353627.

Mikheeva, O. V., & Tragesser, S. L. (2016). Personality features, disordered eating, and alcohol use among college students: A latent profile analysis. Personality and Individual Differences, 94, 360–365. https://doi.org/10.1016/j.paid.2016.02.004 

National Initiative for Eating Disorders. (2020, November 24). Eating Disorders in Canada. NIED. https://nied.ca/about-eating-disorders-in-canada/.

National Institute of Mental Health . (n.d.). Eating Disorders. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml?ftag=YHF4eb9d17.

Tagay, S., Schlottbohm, E., Reyes-Rodriguez, M. L., Repic, N., & Senf, W. (2013). Eating disorders, Trauma, PTSD, and Psychosocial Resources. Eating Disorders, 22(1), 33–49. https://doi.org/10.1080/10640266.2014.857517 

Tavolacci, M. P., Ladner, J., Grigioni, S., Richard, L., Villet, H., & Dechelotte, P. (2013). Prevalence and association of perceived stress, substance use and behavioral addictions: a cross-sectional study among university students in France, 2009–2011. BMC Public Health, 13(1). https://doi.org/10.1186/1471-2458-13-724

U.S. Department of Health and Human Services. (n.d.). Helping Children and Adolescents Cope with Disasters and Other Traumatic Events: What Parents, Rescue Workers, and the Community Can Do. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/helping-children-and-adolescents-cope-with-disasters-and-other-traumatic-events/index.shtml.

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When Society Gets in the Way of Health and Help

How stigma can prevent women from seeking treatment for addiction

Samantha Johnstone

Kathy sat on the floor of her bedroom, looking at the pile of gifts for her and her baby. Her friends and family had been so generous but seeing them stacked in the corner flooded her with an overwhelming sense of guilt. She poured another glass of wine. If anyone knew her secret, surely they would take back the gifts. She didn’t deserve them, she thought to herself.

Canva (March 2021). [Image cartoon girl sitting on floor, expressionless].Figure 1: Woman sitting on ground, slouched and expressionless. Graphic by Samantha Johnstone, template from CANVA is licensed under a Free Media License Agreement

Kathy knew that her drinking had gotten out of control before she found out she was pregnant. She tried really hard to stop once she found out because she knew the risks. But no matter how many promises she made to herself, she just couldn’t get it under control. She had thought about looking for a rehab clinic, but worried if people found out, no one would ever speak to her again. And even if it was possible to hide her therapy from the rest of the world, she would never be able to afford it alone. She would have to ask her parents, and what if they were disappointed in her? 

It was a never ending cycle of feeling guilty about drinking and then drinking to quell the guilt, again and again. If only she knew someone that could help, she thought.

Kathy faced numerous obstacles when trying to get treatment for her addiction. One of the recurrent issues was fear of negative judgement from her peers. She worried that the people around her would shame her for struggling to control her drinking. Kathy’s fear of negative judgement became a barrier in her way to accessing addiction treatment.1

What is a barrier to addiction treatment?


A treatment barrier refers to any element in a person’s life that makes it more difficult to access treatment.2. These are usually considered personal issues like not being able to take time off work, having to take care of children, or not feeling ready to seek help with your addiction.

Figure 2: Woman resting her head on her hand. Graphic by Samantha Johnstone, template from CANVA is licensed under a Free Media License Agreement

For example, if you need to access a treatment facility, but you don’t have anyone to look after your children, it would be helpful if the facility had funding to provide childcare. If the government did not allocate funding to this service because it wasn’t considered important, this would make it more difficult for you to seek treatment.

Are barriers to treatment different for women?


Women with addictions face unique barriers to treatment.2. Looking back at the previous example, we see that childcare is often a major obstacle. Women who need to access addiction treatment are more likely than men to be responsible for children.2. They are also less likely to have a stable partner that can take on the role of being the sole provider.2. As you can imagine, this makes it difficult for them to check into rehabilitative facilities when they need to.

Stigma as a treatment barrier: 

Figure 3: Speech bubble with the following text: “Quick Facts: People who experience high levels of stigma about substance use are less likely to seek treatment. Stigmas can also interact with each other. Negative attitudes about substance use interact with sexism and racism.”. Graphic by Samantha Johnstone, template from CANVA is licensed under a Free Media License Agreement

A key barrier to treatment that women with addictions face is stigma.2. Stigma refers to a set of unfair, negative beliefs about people based on certain characteristics.3 These beliefs are often about factors like sex or gender, sexual orientation, race, religion, or having an addiction. 

Addiction stigma may look like: thinking addiction is a choice, thinking people who use drugs are immoral, or that they deserve to be arrested.

Experiencing addiction stigma can result in people feeling judged, ashamed, or powerless, similar to how Kathy felt.3 They may feel like recovery is pointless. Let’s take a look at a couple of examples that help to illustrate the effects of stigma on women seeking treatment:

  • Stigma from the medical community: In the 20th century, doctors were prescribing stimulants and tranquilizers primarily to White women for weight management, general “housewife malaise”, a little “pick-me-up”, and other minor issues.4 On top of that, they weren’t warning women about the risks of developing an addiction to these drugs.4 At that time, a common negative belief in the medical community was that addictions were a “man’s issue” and doctors would often dismiss women when they asked for help.4 Some even went as far as to say that women were unable to develop an addiction.4

Imagine feeling that your use of a prescribed drug is out of control, but the doctor who gave it to you didn’t warn you that it was dangerous and didn’t take you seriously when you disclosed your concerns. You might convince yourself that nothing is really wrong and not feel motivated to seek out treatment. 

  • Stigma from the public: In the 1980s, the United States government declared a “war on drugs” and these policies were mostly being enforced in Black communities.4 This quickly became a way to reinforce racial power differences through unfair laws. The media contributed to this by promoting negative beliefs and shaming people from these communities. For example, Black women were continuously stereotyped as being sexually promiscuous in exchange for drugs.4 By targeting and shaming Black women specifically, the media was contributing to harmful attitudes about race, sex/gender, and addiction.

Widespread stigma about drug and alcohol use promoted by public entities like the media and government can be a barrier to treatment.4 Women who would otherwise want to seek treatment will see these messages, and may fear being judged if they ask for help. They may also worry about fulfilling racist or sexist stereotypes and being further discriminated against.4 

  • Stigma from friends and family: Similar to Kathy’s story, women can also face negative judgement from the people closest to them. Pregnant and parenting women report worrying about what will happen if people find out that they are using drugs or alcohol, which prevents them from seeking treatment.1 They worry others will perceive them as a “bad mother”.1 They may also be concerned about losing custody, or having child services get involved, and keep their addiction a secret rather than ask for help.2. 

Women are often judged more harshly than men by the people around them for using substances.4 People with negative beliefs about sex/gender and addiction may believe that pregnant women who use substances are undeserving of sympathy.4

The Motherisk Scandal: Taking a closer look at the intersection of sex/gender, race, and addiction stigma.

Figure 4: Six women holding hands in a circle. Graphic by Samantha Johnstone, template from CANVA is licensed under a Free Media License Agreement

We just discussed many examples of addiction stigma and how it may interact with sexism and racism in women. But often these forms of stigma are not distinct experiences.

The Motherisk scandal shows us how these stigmas can interact and act as barriers to treatment.

As recently as 2015, hospital policies in Toronto allowed doctors to administer faulty drug tests to pregnant women.5 The doctors would then involve child services. This punitive approach to addiction resulted in thousands of children being wrongfully removed from families.

  • The doctors involved ignored the fact that the tests were often wrong about the presence of drugs.5 Child services paid little attention to whether or not the mother took care of her children when deciding to remove the child. This shows a stigma against addictions.5
  • This practice was primarily aimed at pregnant and parenting women, although fathers were sometimes drug tested as well.7 This shows a stigma against women who use substances, specifically.
  • The majority of the women who lost custody of their children because of faulty drug tests in the Motherisk scandal were Black or Indigenous.5 This shows a stigma against Black and Indigenous women who use substances, specifically. 

The Motherisk scandal shows us how different forms of stigma can interact. The doctors and child service workers involved had negative beliefs about the women because of their race, the potential for drug use, and their sex/gender. The consequence? Thousands of wrongfully separated families, most of whom were Black and Indigenous.7  It also likely resulted many women avoiding medical care or treatment for addiction while pregnant or parenting out of fear of losing their children or being arrested.6 

Is there any good news?

The cool thing about being part of society is that we can help to influence other people’s negative attitudes and reduce stigma about addiction! 

  • Learn about language: The words we use matter. For example, terms like “junkie”, “addict” or “alcoholic” are considered rude, and diminish people to their illness. Instead, use person-first language like “people with addictions”. Other examples can be found here.
  • Educate others: Consider telling the people you know the facts about addictions, and how stigma and stereotypes can be harmful. You can start by sharing this article! Some other resources about addiction stigma that you can share can be found at the Recovery Village,  from the Government of Canada, and from the Stigma of Addiction Project.
Figure 5: Two women leaning on each other. Graphic by Samantha Johnstone, template from CANVA is licensed under a Free Media License Agreement
  • Break barriers: If you or someone you know is struggling with an addiction, consider looking into treatment options. Some reputable resources for addiction treatment can be found from the Government of Canada, as well as numerous online resources, and at Toronto’s Centre for Addiction and Mental Health (CAMH). There are also resources for family members at CAMH.

If you have questions or concerns about pregnancy and substance use, a fact sheet, along with a list of reputable resources can be found here. Additional resources for women and their families can be found at the Jean Tweed Centre in Etobicoke ON. 

References

1. Center for Substance Abuse Treatment. (2009). Substance Abuse Treatment: Addressing the Specific Needs of Women. Treatment Improvement Protocol (TIP) Series 51. Retrieved from Rockville, MD: http://www.ncbi.nlm.nih.gov/books/NBK83252/

2. Greenfield, S. F., Brooks, A. J., Gordon, S. M., Green, C. A., Kropp, F., Mchugh, R. K., Lincoln, M., Hien, D., & Miele, G. M. (2007). Substance abuse treatment entry, retention, and outcome in women: A review of the literature. Drug and Alcohol Dependence, 86(1), 1-21. doi:10.1016/j.drugalcdep.2006.05.012

3. Kulesza, M., Matsuda, M., Ramirez, J. J., Werntz, A. J., Teachman, B. A., & Lindgren, K. P. (2016). Towards greater understanding of addiction stigma: Intersectionality with race/ethnicity and gender. Drug and Alcohol Dependence , 169, 85–91. https://doi.org/http://dx.doi.org/10.1016/j.drugalcdep.2016.10.020 0376-8716 

4. Becker, J. B., McClellan, M., & Reed, B. G. (2016). Sociocultural context for sex differences in addiction. Addiction Biology, 21, 1052–1059. https://doi.org/10.1111/adb.12383 

5.  Contenta, S., Rankin, J., & Mendleson, R. (2016, October 28). Motherisk tests played role in 10 families where children taken, first phase of review finds. Thestar.Com. https://www.thestar.com/news/insight/2016/10/27/motherisk-tests-played-role-in-10-families-where-children-taken-first-phase-of-review-finds.html

6. Illegal Drug Use While Pregnant is Not Child Abuse. (2019, April 4). American Bar Association. https://www.americanbar.org/groups/public_interest/child_law/resources/child_law_practiceonline/january—december-2019/illegal-drug-use-while-pregnant-is-not-child-abuse/

7.  “I haven’t seen her in almost six years”: Father on pain of losing daughter after Motherisk test. (2018, February 27). CTVNews. https://www.ctvnews.ca/health/i-haven-t-seen-her-in-almost-six-years-father-on-pain-of-losing-daughter-after-motherisk-test-1.3820345

Images

1. Canva (March 2021). [Image cartoon girl sitting on floor, expressionless]. 

2. Canva (March 2021). [Head of women resting her head on her hand]. 

3. Canva (March 2021). [Speech bubble with the following text “Quick Facts: People who experience high levels of stigma about substance use are less likely to seek treatment. Stigmas can also interact with each other. Negative attitudes about substance use interact with sexism and racism.”].

4. Canva (April 2021). [Six women holding hands in a circle].

5. Canva (March 2021). [Two women, leaning on each other].