Note: this transcript has been edited for clarity, grammar, and flow.

Steph: Some of the journey is about seeing. But do you want to spend your whole life trying to look like an ideal, or do you want to get on with life and do some really amazing, exciting things? Because we know this world needs the amazing, exciting things that you're going to do.

Hello and welcome to the Inside Out Institute Podcast. Thanks for joining us. I'm Steph Boulet, the host of the podcast.

For this episode, we're talking about trauma and eating disorders. Our guest is Dr Sophie Reid. She's a clinical psychologist, researcher, and co-director of The Birch Tree Centre, a specialist centre for trauma, addiction, and eating disorders in Sydney.

As we know, trauma often underlies an eating disorder, but it can also lead to a range of other mental health challenges. In this episode, we explore why that is. We also discuss:

• What trauma actually is
• The impacts of trauma
• How it can be treated
• The goals of treatment

But first, as always, we're starting this episode with the voice of lived experience.

Sabeena Manalis has been a professional actor since she was 18. You may have seen her in shows like Underbelly, Neighbours, and the Logie-winning comedy series Housos. She’s also appeared in numerous commercials and online content.

On top of that, she’s a mum to a seven-year-old boy, works for Australia’s largest digital platform for young people, Year 13, and is a registered psychotherapist.

Here’s Sabeena’s story.

Sabeena: I developed, well, I would say, binge eating disorder when I was 13, after a home invasion. I was almost kidnapped.

I started experiencing PTSD symptoms, like flashbacks. I turned to binge eating to cope with the anxiety and pain I was feeling. Every time I had a flashback or intense anxiety, I would binge and binge and binge.

Even though my binge eating started as a response to trauma and PTSD, body image became a huge shame trigger for me, especially as a young woman in this society. I fixated on my body and how I looked. I already had low self-worth, and when I looked in the mirror, I just saw ‘ugly’.

I also felt so much shame for binging and purging in secret. I remember walking around like a zombie. I was alive, but I wasn’t really living. My anxiety was so bad that I had to stop working because I would shake at work.

I lost a lot of friendships, too. I was engaging in behaviours that weren’t me. I think binge eating can be like an addiction, you’ll do anything to get what you need. Unfortunately, that meant I lost some really close friends.

It was a deep, dark time - about ten years of my life.

Part of the problem was that my family wasn’t really around. I left my mum’s when I was 15 to study performing arts and moved in with my dad, but he wasn’t around much either. I felt like I was dealing with everything on my own. Then, when I was 17, I moved to Sydney again on my own.

If I wasn’t always striving to be an actor, I would have had nothing. My training helped me in some ways. It gave me purpose but acting also comes with a lot of rejection. You walk into an audition feeling good, and then you see 20 or 30 other actors in the room (beautiful, talented people) and you can’t help but compare yourself.

I got into a very toxic relationship, and that’s when I was introduced to crack cocaine. I was 19. By then, I wasn’t binging and purging anymore, I had just stopped. But it was like my pain had found another way to express itself.

I was addicted to crack cocaine for about six months. I remember this one moment when I realised I was fully addicted. I came home, searching frantically for the pipe. I found it smashed, and I was desperately trying to put it back together so I could smoke. It was like something out of a movie.

When I realised what was happening, I stopped cold turkey. Because these behaviours weren’t me. Deep down, I knew this wasn’t who I was.

Then, at 20 weeks pregnant, I auditioned for an acting school in Melbourne. I had already stopped using drugs months before falling pregnant, but getting out of that toxic situation gave me the space to figure out who I really was.

There were people in my life who helped me. One person in particular, a dance partner, had experienced severe trauma as a child. When he met me, he asked, What happened to you?

I didn’t know what he meant. At that point, I had no idea my behaviours were abnormal. But then, there was this moment of realisation: I hate myself. I’m sabotaging my life because I don’t believe I deserve a good one.

Once I saw that, I could rebuild myself. But I think you really have to want to change.

For me, I did. I let myself feel all the emotions I had been suppressing with food. I asked myself, Why am I crying? and I started making sense of my past. Every time I wanted to turn to food or something else for comfort, I just said no and sat with my emotions.

Over time, I realised I was capable of feeling everything and that was powerful.

Now, my only addiction is coffee but I think that’s pretty normal, right?

I’m so much more aware now. Back then, I was just reacting. I had no idea why I was doing the things I was doing. Now, if I wake up feeling anxious, I notice it, and I do the things I need to do.

I have self-care rituals: I light incense, I go outside, I study at the beach because I need the ocean. I feel capable. I feel empowered. I have a strong sense of self.

And I truly believe that anyone suffering from an eating disorder can fully recover.

Steph: You’re listening to the Inside Out Institute Podcast: rethinking eating disorders from the Inside Out.

Our guest today is Dr Sophie Reid. Sophie has years of experience researching and working with people who have trauma and eating disorders. As she explains, her understanding of and passion for mental health and social justice started early in life.

Dr Sophie Reid: I think my whole life has been psychology.

My family actually fostered children. I shared a bedroom with foster siblings from the age of six onwards, so I was a kid who understood enormous social injustice in the world. My passion has always been working with children and adolescents. Having shared a bedroom, spent time with, and lived alongside people who couldn't live with their family of origin, mostly due to trauma, abuse, or severe mental health challenges, I developed an early awareness of these issues.

One of my foster siblings had a birth mother with severe OCD. She lived with us because life wasn’t regular for her.

When you witness childhood being not good enough for so many people, you start to understand how that leads to adult mental health difficulties later on.

I’ve worked with many families, always with the aim of helping them move towards healthier functioning. When I worked in eating disorders at the Children’s Hospital, and later in drug and alcohol services, I saw time and time again that the underlying causes were childhood experiences of trauma.

Steph: What interventions have you seen work best for families in those kinds of environments?

Dr Sophie Reid: Honestly, a lot of it comes down to social justice, issues like poverty, employment, housing, and access to equitable schooling.

Schooling, for example, should be a place where all kids are welcome, not just the ‘good’ ones. If you look at Aboriginal and Torres Strait Islander people or Indigenous populations worldwide, there’s intergenerational trauma stemming from colonialism. It’s a very broad issue.

When it comes to family interventions, one of the things we often say is that parenting is the great call to clean up your own mental health. If you don’t work through your own mental health challenges, you will pass them on to your kids. You have to sort through your stuff so you don’t transmit it to the next generation. Otherwise, you raise children with your own unresolved wounds.

Steph: That’s a really scary thought for parents.

Dr Sophie Reid: Oh my god, yeah. It’s terrifying.

Steph: Where does trauma come into this? What exactly is trauma?

Dr Sophie Reid: We think about trauma in terms of commission and omission. Commission is when things are done to a child that should never happen like childhood sexual abuse, physical abuse, or emotional abuse. This includes excessive yelling and psychological abuse, such as terrorising or intimidating a child. Every parent loses their temper sometimes, but chronic emotional abuse is different.

Omission is when things that should be done for a child aren’t done. This includes neglect, lack of emotional attunement, or failure to respond to a child's despair or hopelessness. Neglect often happens in families struggling with poverty or living in unsafe neighbourhoods, where parents are more focused on survival than on providing secure attachment and care. It can also occur when parents work long hours, have a mental illness, or are dealing with substance dependence - anything that leads them to prioritise other things over creating a safe and secure environment for their kids.

Research, particularly from trauma expert Martin Teicher, has shown that neglect can have just as strong an impact on a child's developing brain as trauma by commission (like physical or sexual abuse).

One of the big challenges with neglect is that it's difficult to put into words what you haven’t had. It’s easier, though still incredibly painful, to say, These things were done to me that shouldn’t have been done. But it’s much harder to recognise that things that should have happened for me never did.

Children are wired to maintain attachment with their primary caregivers because in evolutionary terms, if you didn’t have a good enough parent at five years old, you wouldn’t survive. Because of that, children often blame themselves for their trauma.

A classic example is a child thinking, I was just a really bad kid instead of recognising that my mum or dad had a major alcohol problem.

Steph: And therapy is about unpicking those beliefs?

Dr Sophie Reid: Exactly. A client might say, I wouldn’t go to bed when I was told, I stayed up late. And I’ll say, That sounds really normal. That sounds like a typical kid pushing boundaries.

When we start unpicking those beliefs, people can begin to see their experiences for what they really were. Instead of blaming themselves, they can acknowledge that they did experience trauma, even if they hadn’t recognised it as such before.

Steph: Can you explain the relationship between trauma and eating disorders?

Dr Sophie Reid: Absolutely. I tend to approach eating disorders through an addiction model.

At its core, addiction is about trying to escape pain. I believe every human has something they turn to for comfort - a weak spot, so to speak.

Think about the worst possible day at work. When you get home, you’re probably not going to do the healthiest thing imaginable. You’re going to reach for something that soothes you, whether that’s food, alcohol, TV, or scrolling mindlessly on your phone.

So when we talk about addiction, we’re not just talking about drugs and alcohol. It can be food, sugar, work ... it can be Facebook or Instagram. It can even be an addiction to telling the story over and over again. There are lots of different things we do to try and soothe ourselves.

Food is absolutely a soother in that moment. We know that sweet food releases endorphins. It reinstates that sense of reconnection to self in lots of ways. But if it gets out of control, that’s where it becomes an eating disorder.

Steph: How does that relate to, say, restrictive eating disorders?

Dr Sophie Reid: If you've had the worst day ever and you feel totally out of control (like you're the shittiest person in the world) because that’s what a terrible, terrible day can feel like… Our society, particularly for women, tells us, Well, just let somebody be better than you.

It often starts in that space, but it can also become an obsessive preoccupation with calorie counting, meal planning, recipe screening, all of which can become a distraction. It means you don’t actually have to think about the thing that’s upsetting you.

Every human has an addiction. We all know what we need to keep an eye on for ourselves - it’s the thing. It only becomes a problem when it gets out of control, when we stop exercising the muscle of Maybe I need to self-soothe and be kind and compassionate with myself.

And that’s a really hard muscle to exercise because we’re always being told to do more, be more.

Steph: I guess a lot of people think of PTSD or the term ‘Big T Trauma’ when they think of trauma. But a lot of the things you’ve mentioned wouldn’t necessarily register as trauma for some people. What does that mean for them?

Dr Sophie Reid: I tend to have a slight discomfort with terms like Big T and Little T trauma. From a clinical perspective, I find they can be quite invalidating for my clients. People already tend to minimise their own trauma. They’ll say, Oh yeah, but other people had it much worse than me. That just invalidates and minimises their own experience.

Essentially, everybody’s experience is valid. Everyone’s experience deserves attention. Sometimes, a single big traumatic event isn’t as damaging as lots of moments of not having good enough parenting.

Another example of childhood misattunement is having a parent who is entirely narcissistic; one who only gives love when the child does well, looks good, or reflects positively on the parent. If the child doesn’t meet those expectations, the parent withholds love or criticises them.

That kind of parenting can be incredibly devastating for a child. The number one thing children need is social connection and love. They need safety, attachment, and love before anything else, before food, before shelter. If a child learns that safety, attachment, and love are dependent on behaving well, they will experience deep disconnection from their parent.

Steph: For people who minimise their own experiences, who think, Oh, what I went through wasn’t a big deal, it wasn’t a major trauma - What would your message be to them?

Dr Sophie Reid: I think we have to take it case by case.

We don’t need to compare trauma. We don’t have to work out who had it worse. I often say, It’s all crap - it’s just different shades of crap.

Trauma is trauma. I wouldn’t wish it on anyone. So why compare? Every traumatic childhood is distinct. No two are the same.

Even between siblings, parenting experiences can be completely different. A parent might have a strong connection with one child because of a personality match, but struggle to connect with another.

Siblings are often only two or three years apart, but within that time, major life changes like financial stress, job loss, or relationship breakdowns can happen, changing the way a parent interacts with their children.

One of the groups that can be most invalidating about trauma is siblings. A sibling might say to the ‘black sheep’ of the family. Mum and Dad weren’t that bad. You were just difficult. The rest of us turned out fine.

But that doesn’t hold any validity.

The experience of the person who was targeted or simply didn’t have the same connection with a parent as their siblings did is still real. It still matters.

Steph: So what about the impacts of trauma? What does the research say about its effects on the brain?

Dr Sophie Reid: I think the best way to understand trauma is to think about it in terms of how someone’s experiences have led them to be sitting in front of me today. When I’m working with someone, I ask: What’s gone on in their life that has led to this?

For example, maybe they’re hypervigilant and always on the lookout for danger. Maybe they’re jumpy and startle easily, or loud noises make them anxious. Maybe they constantly feel on edge or carry a knot in their chest.

I think: Right, what’s happened in your childhood that has made your body believe life is always dangerous? Because that’s what those body signals are telling us.

From there, we start exploring: Where did this come from? How long have you been feeling this way? What’s been going on?

As a clinician, what I’m listening for is stories of healthy development, those patterns of regular childhood experiences you’d expect for any child, like your own, or your nieces, nephews, or children you love.

I listen for those, and then I listen for diversions from that pathway. Was there a major life event like a divorce? Divorce is often recoverable, but not always, especially if there was a lot of conflict.

Were there moments or many moments in childhood where there was a lot of stress, conflict, criticism, or mental health challenges in the home? Were high expectations placed on the child to fulfil something the parent needed?

This is often multigenerational. I’ve worked with many parents, including in the juvenile justice system, and I’ve never met a parent who doesn’t love their child. No parent wants to harm their child.

But we bring our own wounds into the way we raise our kids. Sometimes, that means we do harm them unintentionally.

Steph: What does trauma actually do to the brain?

Dr Sophie Reid: If you grew up in an unsafe home or neighbourhood, your nervous system learns to feel more at home in fight-or-flight mode than in relaxation.

Your body’s expectation becomes: Be ready. Be ready. Something could go wrong. The old-fashioned phrase is waiting for the other shoe to drop. That’s essentially what’s happening. Your body is always bracing for the next bad thing.

This process is driven by the amygdala, a small, almond-shaped structure in the brain that sits behind your temple. The amygdala is the control centre for fight-or-flight. When it detects a threat, it sends signals that make your heart pound, your breathing speed up, and your hands shake.

If you grew up in an unsafe environment, your amygdala becomes wired to be constantly on high alert. It starts seeing danger where there may not be any.

Steph: Can this be rewired through therapy?

Dr Sophie Reid: Absolutely.

Your amygdala is connected to the rest of your brain, so therapy helps by engaging the parts of the brain that can override that fear response.

In therapy, we might say: It makes complete sense that you learned to survive your childhood like this. But is that response needed right now, here, with me?

If it is - if I’m presenting as a threat - then we need to work through that together and create safety in this space.

If it’s not - if the fear is based on the past - then we start working to let it go. We breathe into it, we place it in context, and we try to move those memories back into the past, where they belong, rather than keeping them fresh and present.

Steph: That brings us to trauma and memory. What happens to memories in fight-or-flight mode?

Dr Sophie Reid: When we go into fight-or-flight, survival is prioritised over laying down memories. The part of the brain that usually records time and context (the hippocampus) shuts down and starts producing stress hormones like cortisol instead.

This means trauma memories often lose their time and date stamp. They don’t get processed like regular memories, where they gradually fade into the past. Instead, they stay fresh - alive - as though they’re happening in the present.

Dan Siegel suggests that these trauma memories get trapped in a short-term memory loop, never fully processing into long-term memory where they can fade. What we want to do in trauma therapy is bring those memories into the present and engage the hippocampus so we can time and date stamp them properly.

We ask: Is this happening here and now? Is this needed right now?

By doing this, the brain can finally move those memories into long-term storage, where they stop feeling so overwhelming.

That’s the goal of all trauma therapy.

• EMDR (Eye Movement Desensitisation and Reprocessing) does this.
• Cognitive Exposure Therapy does this.
• Narrative Therapy does this.

Each of these therapies helps shift trauma memories from active to processed, so they no longer feel like they’re happening right now.

Steph: Do you think people can do this on their own, or do they really need the guidance of an expert?

Dr Sophie Reid: It depends on how overwhelming the memory is.

If a memory comes in as a flashback (where you feel like you’re right there, reliving it), it’s really hard to regulate yourself out of that alone.

Humans are co-regulators, we rely on others to help us regulate our nervous system. We co-regulate with people, but also with animals.

If I suddenly became afraid while sitting here, you would likely start feeling uneasy too. That’s a mammalian response. It’s like how if one sheep starts running, the whole flock follows. No one knows why, but they all start running.

Whether someone needs professional help depends on whether the trauma memory exceeds their own ability to regulate.

If it does, they may need a therapist. But they may also find support in other ways, through relationships, community, or even animals, which can be incredible for co-regulation.

I had one client with anorexia whose dog would jump on her bed whenever she had a nightmare and snuggle up to help keep her calm. He wasn’t trying to do it; he just had a sense, like, I better go make her feel better.

Which, you know, dogs are just dogs. They’re heaven on earth, really - in my world, anyway. But yeah, whether someone needs professional support depends on how overwhelming the memories are when they resurface.

Steph: When we're talking about treatment options, we've mentioned EMDR and CBT. Can you talk a little more about the evidence base? What’s got the strongest research behind it?

Dr Sophie Reid: It’s an interesting one.

I’ve personally run four large randomised controlled trials (RCTs) on the effectiveness of different mental health treatments. One of the things to remember about RCTs and evidence-based treatments is that they show a pool of people for whom a therapy works but they also leave out the pool of people for whom it doesn’t work.

That part often gets overlooked. For example, there was a really large study in the drug and alcohol field that compared 12-step programs, CBT, and interpersonal therapy. Participants were randomly allocated to one of the three groups, so it was a strong trial, with thousands of people involved.

The results showed that all three therapies worked equally well for a certain number of people. But the thing is, when you randomly allocate people to a therapy, you get a mix of people it works for and people it doesn’t. So, what you’re really measuring is how well a therapy works for those it naturally suits.

In terms of eating disorders, we have strong evidence for:

• The Maudsley Model (particularly for adolescents)
• CBT-E (Cognitive Behavioural Therapy for Eating Disorders)
• Schema Therapy (which has growing evidence in this space)

For trauma, we have strong evidence for:

• EMDR (Eye Movement Desensitisation and Reprocessing)
• Narrative Therapy
• Cognitive Exposure Therapy

As a clinician, my responsibility is to be trained in all of these approaches. That way, I can listen to what has and hasn’t worked for a client before and tailor the next treatment accordingly.

Steph: That’s a really great take on RCTs.

Dr Sophie Reid: Yeah! I mean, RCTs are hugely important, but they don’t mean that one approach works for everyone. For anyone looking for a psychologist or therapist, I always say: It’s usually the third person you talk to who ends up being the right fit.

So, do your homework. Be a really discerning consumer of the therapy you’re going to receive. Ask yourself: Do I actually feel like I can work with this person? Do I trust them with the real treasures of my childhood, my experiences, my difficulties?

If the answer isn’t a clear yes, then keep looking.

I always tell my clients: We don’t like everyone we meet, and we don’t have to. If you don’t like me, that’s totally okay. Find the right person for you. Because you are the most important person in that moment.

Steph: 100%. When you're working with someone who has an eating disorder and past trauma, how do you approach that? Do you address the trauma first, or do you focus on the eating disorder symptoms?

Dr Sophie Reid: I love that question! It’s one that a lot of clinicians ask me too. The first thing is: safety and wellbeing come first.

If someone in front of me is really unwell, like they have a dangerously low BMI, or their heart rate is too low, then I have to address that first. If someone is binging five times a day, I have to address that before we do anything else. So, we stabilise the symptoms first.

That process is also important for building trust. No one is going to open up about their trauma if they think I don’t care, or if they don’t trust me, or if they assume I’m just in it for the money or my own ego.

By working on the symptoms first, we establish a relationship. They can see that I show up for them consistently. Once that foundation is there, we can start exploring:

Why is this eating disorder here? Why do you think it showed up in your life? What’s the job your eating disorder is trying to do in your world?

Because a person’s own understanding of why they do what they do is far more valuable than my idea of what’s happening.

I trust that my clients know themselves better than I do. They usually have the insight to pinpoint the traumas behind their struggles.

For the most part, clinicians tend to ask, What’s wrong with you? But a trauma-informed approach asks, What happened to you?

What’s happened in your life that has led your whole being to believe that having an eating disorder is the best way to stay alive?

That’s the question I like to ask.

Together, we can sometimes see the top layer of that, but we have to work through all the layers underneath. If we can uncover those deeper layers, we can introduce other coping strategies so that a client doesn’t feel like I’m just taking the eating disorder away and leaving them in freefall, unable to cope.

Steph: And do you find that once the trauma is addressed, the eating disorder symptoms start to resolve on their own?

Dr Sophie Reid: It’s an interesting one.

What I often see is a seesaw effect with people who have both an eating disorder and significant underlying trauma. Sometimes, we start trauma work, but that can make the eating disorder worse because the eating disorder is a coping strategy. That’s why it’s there.

So when that happens, we pause the trauma work and shift our focus back to the eating disorder, bringing those behaviours back under control again. Once things feel more stable, we dip back into the trauma work.

That means the process often takes longer than if we were just working on one issue alone. But that’s completely normal, and there’s no rush.

Steph: So how do you know when you’re healed? Does it ever fully resolve?

Dr Sophie Reid: That’s such a great question. When I first meet someone with an eating disorder, I’ll often draw a pie chart. I ask them to:

• Draw the percentage of time they don’t think about food or their eating disorder.
• Draw the percentage of time they do think about it.

So often, it’s 80% eating disorder thoughts, 20% not.

Our goal is to flip that so they spend 80% of their time not thinking about their eating disorder, and only 20% thinking about it.

I’ll out myself here - I’m a staunch feminist. We live in a society that pressures women to look a certain way, and those ideals have changed over time. But the message has always been there: You’re supposed to be tall, blonde, pretty, young. You’re supposed to always look a certain way.

There’s a lot of shaming when someone doesn’t fit the ‘ideal’.

So part of the healing journey is seeing that for what it is.

Do you want to spend your whole life trying to fit an ideal? Or do you want to get on with life and do some really amazing, exciting things?

Because this world doesn’t need you to look a certain way. It needs you to be you. So the idea of being ‘healed’ is an interesting one. It’s hard to fully escape the pressures of socialisation.

There’s healing from the eating disorder, and then there’s healing from trauma. When we talk about trauma, my focus is on how much it pushes you around.

• Are you reacting from a place of trauma?
• Or are you reacting from a place of who you want to be - your own values?

We all stumble. We all make mistakes. But if you can spend more time liking who you are and feeling at peace with the injustices that happened to you, then that’s a huge sign of healing.

On the other hand, if you’re still spending a lot of time in trauma reactivity, feeling hypervigilant, afraid, having flashbacks, feeling unsettled, then we have more work to do.

Steph: And what about trauma leading to growth and positive change?

Dr Sophie Reid: I would never advocate for trauma as a way of becoming a deep, thoughtful person.

But sometimes, one of the gifts of trauma is that it gives people a profound understanding of the world. It can create a philosophical approach to life, deep empathy for others, and a real connection to people who have been through difficult times.

Steph: Finally, what would you say to someone who feels ambivalent or scared about addressing their past trauma?

Dr Sophie Reid: It is so normal to not want to see a psychologist, to hope it just goes away. I think every person has felt that at some point.

But when trauma is pushing us around and making us do things we don’t want to do - things that don’t align with who we are - that’s when we need to stop and say, Maybe I need to sort this out with someone.

If you’ve made the decision to see a therapist, the most important thing is to look after yourself.

Make sure the person you choose to sit down with is the right person for you. If they’re not, move on to someone else. And if that person isn’t right, move on again until you find the right fit. You are the most important person in that room.

And don’t worry about hurting the therapist’s feelings. We’re robust people! You are very welcome to reject us and move on. Please do that. Look after yourself first.

Steph: Thanks for listening.

If you’d like to learn more about The Birch Tree Centre, visit birchtreecentre.com.au.

For more information about Inside Out, visit insideoutinstitute.org.au.

Catch you next time.

If you or a loved one needs support, visit www.insideout.org.au or call the National Eating Disorders Helpline at Butterfly on 1800 ED HOPE (1800 334 673).