While links between eating disorders and post-traumatic stress disorder are well established, dominant frameworks have tended to locate trauma primarily outside healthcare, offering limited tools for understanding how neglect, exclusion, coercive practices, and epistemic misrecognition within care may contribute to ongoing distress. Drawing on empirical research, ethical scholarship, and reflexive lived experience analysis, this Comment paper examines how trauma-related symptoms in eating disorders may arise not only from early life adversity, but also through harmful relationships with healthcare, including eating disorder services themselves. Three interrelated domains of iatrogenic trauma are examined: exclusion and neglect within care pathways; traumagenic dynamics within clinical encounters; and epistemic injury, where individuals are undermined as credible interpreters of their own experience. Together, the author suggests that these processes may contribute to disturbances in self-organisation, dissociation, mistrust, and increased reliance on disordered eating behaviours as coping strategies. The paper argues that failure to recognise trauma arising within healthcare risks misattributing system-generated distress to individual psychopathology, reinforcing disengagement and treatment impasse. Recognising iatrogenic trauma has important implications for assessment, formulation, and treatment planning, and requires greater attention to acknowledgement, epistemic justice, and collaborative, formulation-driven models of care. Efforts to refine the links between eating disorders and trauma therefore require explicit attention to healthcare-related harm if they are to support more ethical, effective, and humane practice. Many people with eating disorders experience trauma-related difficulties such as fear, dissociation, and problems trusting others. Most research explains this by focusing on traumatic experiences earlier in life, such as abuse or neglect in childhood. While these experiences are important, trauma can also develop or worsen through people’s experiences within healthcare, including eating disorder services. The author looks at research, ethics, and their own lived experiences to show how harm can arise through ongoing contact with services. This includes long delays in care, repeated exclusion from treatment, coercive or unsafe clinical encounters, and situations where people are not believed or taken seriously when they try to explain their distress. Experiences like these may lead to ongoing feelings of threat, mistrust, and disconnection, and can increase reliance on eating disorder behaviours themselves. Over time, this pattern can look very similar to complex forms of post-traumatic stress, even when trauma is assumed to lie only in the past. When harm arising within healthcare is not recognised, distress may be wrongly understood as part of the individual’s illness, making engagement and recovery more difficult. Recognising trauma linked to healthcare experiences is important for understanding people’s difficulties more accurately and responding more safely. This includes acknowledging past harms, taking people’s accounts seriously, and working collaboratively to develop shared understandings of distress. Paying attention to healthcare-related harm is essential if eating disorder care is to become more ethical, effective, and humane.
James Downs (Thu,) studied this question.