The Impact of Intergenerational or Historical Trauma on Eating Disorders in African Americans
By Carolyn Coker Ross, MD, MPH, CEDS
What happens when we lose an essential part of ourselves – a sense of safety, of trust or security? This describes the essential impact of trauma – whether it be from abuse, neglect, loss or violence. A history of trauma is particularly important to ascertain in African Americans who present for treatment of eating disorders. Across all racial groups, black and Hispanic children have been exposed to more adversities than white children. Nine percent of African Americans have been diagnosed with PTSD (vs. 6.8% of whites) (Feliti and Anda, 2010). Lifetime prevalence of PTSD after trauma was 51% in a study of African-American patients in primary care offices with trauma and it was higher in females than males (Alim et al., 2006). Trauma has been shown to impact risk for eating disorders (Trottier K, MacDonald DE. 2017)
The Adverse Childhood Experiences (ACE) Study has catalogued the impact of trauma that occurs before age 18 and found that a history of more than one ACE is associated with a higher risk for eating disorders, substance use disorders, depression and over 40 other disorders, including heart disease, stroke and diabetes.
In his 1952 semi-autobiographical novel Go Tell it on the Mountain, the esteemed African American author James Baldwin asked the question “Could a curse come down so many ages? Did it live in time, or in the moment?” Historical trauma was initially studied in children and grandchildren of Holocaust survivors in the 1960’s. Offspring of Holocaust survivors showed a variety of trauma response pathology and experienced themselves as “different or damaged” by their parents’ experiences (Sotero, 2006). Studies on families of Holocaust survivors shows an association between eating disorders and Holocaust exposure (Zohar et al., 2007) and also the transmission of trauma down through the third generation (Bar-On et al., 1998).
More recent studies involving historical trauma research have focused on American Indian/Alaska Native (AIAN) populations. Dr. Maria Yellow Horse Brave Heart describes historical trauma as “…the cumulative emotional and psychological wounding over one’s lifetime and from generation to generation following loss of lives, land and vital aspects of culture” (Brave Heart and DeBruyn, 1998).
In African-Americans, a condition called Post-traumatic Slave Syndrome (PTSS) was articulated by Dr. Joy DeGruy Leary (2005) to reflect a condition that exists as a consequence of centuries of chattel slavery followed by institutionalized racism and oppression that became part of the collective identity of African-Americans. Generations after slavery, children were witness to their parent’s or grandparent’s daily degradation at the hands of the broader culture.
J.D. Leary described three outcomes of the trauma of slavery: low self-esteem, ever-present anger (or sensitivity to disrespect, what may be also called shame-proneness) and racist socialization. PTSS, then begins with multigenerational adaptive behavior, some of which is positive, such as resilience and other behaviors which are more harmful and destructive. One researcher states that exposure to trauma causes a rupture in one’s life routine, that demands coping and adaptation. The trauma can also become a family legacy, whether or not survivors talked about it or kept it silent, even to children who were born after the trauma (Danieli, 2016).
In a landmark analysis of four studies on the impact of childhood maltreatment and intergenerational violence, the Center for Disease Control and Prevention (CDC), it was found that having a history of childhood maltreatment increased the odds of maltreating offspring by 1.3 to 5.3 times depending on the severity of the parent’s abuse history. (editorial 2013, J of Adolesc Hlth) Danieli (1998) suggested that the trauma will be passed down as the family legacy, whether or not survivors talked or kept silent, even to children born after the trauma
Though slavery was abolished, its intergenerational effects still persist. While African-American clients who present with eating disorders are the same in many ways, as other patients we treat, they are also different. Being open to learning about these differences is important in healing current and past trauma and ensuring a more stable recovery from an eating disorder. The CDC has identified the promotion of safe, stable, nurturing relationships (SSNRs) as a key strategy for the public health approach to child maltreatment prevention. Establishing therapeutic relationships and helping patients improve other relationships in their lives that model the CDC guidelines can also go a long way towards healing intergenerational trauma.
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Carolyn Coker Ross, MD, MPH, CEDS is a physician, Certified Eating Disorders Specialist, internationally recognized speaker, expert in the use of integrative medicine to treat eating disorders and addictions as well as being the Co-Chair of iaedp’s African American Eating Disorders Professionals (AAEDP) Committee. She is board certified in both Preventive Medicine and Addiction Medicine. She is the author of four books, the most recent of which is “The Food Addiction Recovery Workbook.” Earlier books include “The Overcoming Binge Eating Disorder and Compulsive Overeating Workbook” and “The Emotional Eating Workbook.” She is also the co-presenter on an audio with Dr. Andrew Weil, “The Joy of Eating Well.”