Trauma and Resilience in Youth With Opioid Use and Eating Disorders

Trauma and Resilience in Youth With Opioid Use and Eating Disorders 1024 575 Abbie Miller and Pam Georgiana
Teen girl with backpack

Health care providers should expect patients to have hidden traumas and reduced resilience.


When treating adolescents and young adults in the Substance Use Treatment and Recovery program at Nationwide Children’s, medical director Erin R. McKnight, MD, MPH, noticed that while most of her young patients had experienced some trauma in their lives, some patients displayed more resilience than others.

“Despite past trauma, certain patients do better in treatment compared to others. They overcome challenges and respond to therapy better,” says Dr. McKnight, who is also an attending in Adolescent Medicine at Nationwide Children’s and an assistant professor of Clinical Pediatrics at The Ohio State University College of Medicine.

“From previous studies, we know that patients who’ve experienced more than four instances of childhood trauma have a greater chance of developing a substance use disorder,” says Andrea E. Bonny, MD, division chief for Adolescent Medicine at Nationwide Children’s and professor of Clinical Pediatrics at The Ohio State University College of Medicine. “We decided to study how much and what kind of trauma our patients have experienced in their young lives and how that corresponded to their resilience factors.” Clinical Pediatrics recently published the results.

The team initially planned to study only patients in the substance use clinic, but doctors in the eating disorders clinic mentioned to Drs. Bonny and McKnight that there are often shared experiences with that patient population. Despite their co-occurrence, little is known about shared risk factors. The team decided to follow the inquiry and compare trauma and resilience indices in both populations.

Ninety adolescents and young adults undergoing outpatient treatment for either opioid use disorder or an eating disorder completed the Modified Adverse Childhood Experience (ACE) Survey and Southern Kennebec Healthy Start Resilience Survey.

The ACE Survey assesses a patient’s exposure to adverse experiences during childhood, including neglect, abuse, and household dysfunction. The Southern Kennebec Healthy Start Resilience Survey assesses a patient’s ability to adapt and bounce back from adversity. The questions focused on social support, coping strategies, self-esteem, and optimism.

“The main takeaway from this study is that patients need a trauma-informed treatment approach. In many clinics, treatment is siloed, with trauma-informed treatment occurring after recovery. That may not be the most optimal approach,” Dr. McKnight says. “Fortunately, our doctors here at Nationwide provide combined care, meaning trauma-informed care is an integral part of treatment.”

More than 50% of the patients in the study reported more than four traumatic experiences. Evidence of emotional neglect, household mental illness, and peer victimization/isolation/rejection was similar between groups. In comparison, Dr. Bonny says that only 17% of adults in the United States have been exposed to four or more traumatic experiences.

“We were profoundly impacted by the significant amount of trauma our patients have experienced, especially in our substance use patients. It’s gut-wrenching,” Dr. Bonny remarks.

“Much of the trauma was hidden, never revealed. Whether known or never reported, our patients live with it daily. When treating these patients, health providers need to be aware that there’s more trauma than they are willing to talk about or their families will admit.”

The study also found that patients with opioid use disorder were less likely to endorse nine or more resilience factors. The Southern Kennebec Healthy Start Resilience Survey asked questions about feeling loved as an infant or having rules at home to measure resilience. These experiences foster emotional well-being, a sense of security, and healthy coping strategies — all of which contribute to resilience.

Dr. McKnight stresses that understanding and addressing a patient’s trauma and corresponding resilience can enhance treatment using an informed approach that speaks to a patient’s specific needs. She offers an example of using incentive tokens like bracelets or certificates that mark patient achievements.

“For some patients, those tokens may be the first time they ever received praise. That small gesture goes a long way to promoting resilience and recovery,” she says.

In a follow-up study, which is currently in review, Drs. McKnight and Bonny compare specific patient treatment outcomes to trauma and resilience scores.



McKnight ER, Gardner SM, Cottrill AC, Levy CB, Bonny AE. Trauma and Resilience in Adolescents and Young Adults With Opioid Use and Eating Disorders. Clinical Pediatrics (Phila). 2023;62(8):856-861.

About the author

Abbie (Roth) Miller, MWC, is a passionate communicator of science. As the manager, medical and science content, at Nationwide Children’s Hospital, she shares stories about innovative research and discovery with audiences ranging from parents to preeminent researchers and leaders. Before coming to Nationwide Children’s, Abbie used her communication skills to engage audiences with a wide variety of science topics. She is a Medical Writer Certified®, credentialed by the American Medical Writers Association.

Pam Georgiana is a brand marketing professional and writer located in Bexley, Ohio. She believes that words bind us together as humans and that the best stories remind us of our humanity. She specialized in telling engaging stories for healthcare, B2B services, and nonprofits using classic storytelling techniques. Pam has earned an MBA in Marketing from Capital University in Columbus, Ohio.