Abstract
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.