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Published in final edited form as: Appetite. 2024 Dec 24;206:107841. doi: 10.1016/j.appet.2024.107841

Is Trauma Associated with Plant-Based Diet Choice?

Faith O Nomamiukor a,b,c,*, Madeline A Smethurst a,b,1, Molly R Franz d, Evelyn G Hamilton a,b,2, Anissa Garza a,b, Diana Padilla-Medina e, Maxine Davis f,3, Casey T Taft a,b,c
PMCID: PMC11797213  NIHMSID: NIHMS2046064  PMID: 39725065

Abstract

Examinations of links between plant-based diets (e.g., vegetarian and vegan diets) and indices of physical and mental health have received increased attention in the scientific literature in recent years. However, there has been little to no published research examining predictors of plant-based diet choice. Researchers have suggested that plant-based diets could be linked to trauma for a variety of reasons, including the idea that trauma can increase the risk for mental illnesses, and plant-based diets may be adopted to self-medicate mental illness and promote recovery. The current study examined the link between trauma across the lifespan and experiences of intimate partner violence (IPV) with adherence to a plant-based diet. Participants were a nationally representative United States sample of 1,665 individuals who completed self-report questionnaires. Consistent with hypotheses, bivariate correlations indicated that all measures of trauma were associated with an increased likelihood of being plant-based. Findings from a logistic regression analysis indicated those with a history of IPV were 2.31 times more likely to be plant-based, and those with any experience of trauma more broadly were 1.09 times more likely to be plant-based. These results suggest the importance of considering the role of trauma and victimization when examining links between plant-based diet and other outcomes and point to a number of possible avenues for additional investigation to better understand these associations.

Keywords: intimate partner violence, interpersonal violence, diet choice, vegan, plant-based, trauma

1. Introduction

Plant-based diets, defined in this study as vegetarian (i.e., a diet excluding meat or fish) or vegan (i.e., diet excluding meat, fish, and animal byproducts such as eggs and dairy products) diets, have been increasingly popular over the past decade, with an estimated 7% of those in the United States following this diet (Mathieu and Ritchie, 2024). Plant-based diets are worthy of further study because of the diet’s unique associations with health outcomes and trauma. Regarding health, findings are generally consistent in demonstrating links between plant-based diets and better physical health (Pettersen et al., 2012; Tonstad et al., 2009; Tonstad et al., 2013), as well as animal product consumption and poorer health (Cross et al., 2007; Larsson & Wolk, 2006; Vang et al., 2008). However, findings that demonstrate these associations of improved physical health may also be influenced by additional factors, such as plant-based eaters being more likely to engage in several health promoting behaviors like increased exercise and avoidance of smoking (Cramer et al., 2017).

Regarding mental health and diet choice, research findings are more mixed in comparison to the associations between diet choice and physical health. For example, a meta-analysis found that vegetarians and vegans were more likely to have higher depression, but lower anxiety, in comparison to meat eaters (Iguacel et al., 2020). Additionally, prior work that has included plant-based comparison groups generally have shown either no differences in measures of depression, stress, and anxiety (Timko et al., 2012), lower symptoms in plant-based dieters (Beezhold et al., 2015), or higher depression rates for plant-based dieters (Ocklenburg & Borawski, 2021). These findings can further be contextualized by more recent works by Lee et al. (2024) and Walsh et al. (2023), whom found that associations between diet choice and mental health are impacted by diet quality, such that higher quality diets (e.g., higher protein, higher consumption of fruits and vegetables) are predictive of less depression, regardless of diet type. (Lee et al. 2024; Walsh et al., 2023). One additional variable however that can also help improve understandings of mixed findings concerning mental health and plant-based eaters, which has been understudied, is the experience of trauma. Studies have shown that independently, plant-based diets and trauma are both related to mental and physical health, but few studies have examined these associations concurrently (e.g., Lee et al. 2024; Maschi et al., 2013; Ocklenburg & Borawski, 2021; Walsh et al., 2023). In the current study, we examined associations between lifetime experiences of trauma, including lifetime exposure to intimate partner violence (e.g., domestic violence; IPV), with current adherence to a plant-based diet in a United States sample.

1.1. Trauma Exposure, Mental Health, and Plant-based Diets

There is a dearth of literature on whether trauma exposure impacts the decision to abstain from animal products and/or byproducts. However, trauma exposure can be linked to plant-based diets for a few reasons. For one, researchers have theorized that exposure to painful experiences such as pre-existing mental illnesses, which is higher among those with trauma histories, may encourage individuals to follow a plant-based diet (Lavallee et al., 2019; McLean et al., 2022; Michalek et al., 2012), as an expression of increased empathy toward nonhuman animals, or as a means of self-managing mental health symptoms.

Theoretically, plant-based diets may be more common among trauma exposed because those with trauma may have increased empathy. Work has shown that posttraumatic growth, defined by Tedeschi et al. (2018) as positive psychological changes following trauma or extreme stress, can also encompass trauma survivors having increased altruism or empathy for others (Greenberg et al., 2018; Staub and Vollhardt, 2008). This highlights one potential theoretical avenue for why trauma and diet choice may be related. For some trauma survivors, adopting plant-based diets might be an expression of their empathy, allowing them to show compassion for animals through their dietary choices.

Beyond a potential for increased empathy, trauma exposure has also been linked to plant-based diets through associations with mental disorders. One mental illness that has often been theorized to be associated with plant-based diets, that is also higher among the trauma exposed, is disordered eating. Researchers have explored whether some individuals may use plant-based diets to mask disordered eating (McLean et al., 2022), and this is especially relevant given that increased trauma exposure is associated with a higher likelihood of having an eating disorder (Tagay et al., 2014). In this context, adopting a plant-based diet may provide trauma exposed individuals with a higher perceived sense of control. However, it is important to note that associations between plant-based diets, eating disorders, and trauma are nuanced (Boutin et al., 2024; Mclean et al., 2022). For example, research has shown that standard measures of eating disorders are not as valid among vegetarians and vegans, because they are likely to exaggerate the diet’s association with disordered eating (Boutin et al., 2024; Mclean et al., 2022), marking their restrictions based on moral reasons as a potential symptom of an eating disorder. While some plant-based eaters may indeed use these diets as a means of masking disordered eating, many others are driven by ethical, environmental, or health considerations (McLean et al., 2022), therefore more work is needed to parse out these associations.

In addition to examining links between eating disorders and plant-based diets, researchers have also examined whether plant-based diets are common among those with other mental illnesses such as depression, anxiety and somatoform disorders. For example, Michalek et al. (2012), found that the age of onset of a mental disorder ( i.e., depressive, anxiety, and somatoform disorders) was associated with later adoption of a plant-based diet, even after controlling for sociodemographic factors. Michalek et al. (2012) theorized that mental disorders are associated with plant-based diets, because some individuals may view plant-based diets as healthier, and hope that switching their eating habits will result in better management of their mental illness. This second theory has some additional research support as well. In fact, emerging literature concerning plant-based diets and trauma, has shown that plant-based diets can promote resilience, in the domains of improved physical and mental wellbeing, by mitigating the negative physical or mental health impact of trauma (Herbert et al., 2023; Morton et al, 2021; Tan et al., 2020). Notably, a recent feasibility study sought to understand how feasible it is to implement a high-fiber plant-based diet among veterans with co-occurring posttraumatic stress disorder (PTSD; a mental disorder that develops after trauma exposure (Miao et al., 2018)) and chronic pain. This study found that adopting a high-fiber plant-based diet led to reduced symptoms of both PTSD and chronic pain (Herbert et al., 2023). However, no studies have examined whether those with more trauma exposure are more likely to adopt a plant-based diet.

In summary, past work has established two key findings. First, mental disorders, which are more pronounced among the trauma-exposed, are inconsistently associated with plant-based diets. Second, individuals may adopt plant-based diets if they believe it can be used to self-medicate and thereby ameliorate the negative mental impacts of trauma. Given these findings, more investigation is needed to fully understand links between trauma and diet choice, so that researchers may better understand the unique, understudied group of plant-based eaters. This study can be a critical starting point for examining how trauma may partially explain the complex, mixed associations between plant-based diets and mental health outcomes. We examined the relationship between measures of trauma and adherence to a plant-based diet in a representative U.S. sample, while controlling for age and gender. We hypothesized that cumulative lifetime trauma exposure, including exposure to intimate partner violence (IPV; i.e., abuse that occurs in romantic relationships), would be associated with adherence to a plant-based diet at the bivariate level and after controlling for covariates.

2. Methods

2.1. Participants

Participants were recruited from an online research panel by Qualtrics, a survey company that used stratified quota sampling to gather a diverse sample of the United States. All participants volunteer for an opt-in panel with the intent to participate in research surveys, but the survey invitation did not include specific details about the nature of the study to avoid self-selection bias. All surveys included in the online research panel are offered equally to potential participants, and no one survey is advertised over another. Data were derived from a larger study in which the purpose was to test the usefulness of several measurement instruments. Eligibility requirements included living in the United States and being 18 years of age or older. Data were collected between April 2020 and May 2020. All procedures were approved by the Institutional Review Board of the University of Arlington, Texas (IRB Protocol #: 2020–0193). All procedures were performed in compliance with relevant laws, institutional guidelines, and ethical standards of the Institutional Review Board of the University of Arlington. Additionally, the privacy rights of human subjects have been observed, and written informed consent was obtained from all participants.

Three-thousand seven-hundred fifty individuals expressed interest through the online research portal, of which 1,987 were excluded. Qualtrics is unable to report on the exact number of people who saw a survey but did not partake but estimates that the number of people invited to complete a survey is nine to 10 times the amount of people who complete the survey. Thus, it can be estimated that approximately 33,750 to 37,500 people were invited to participate in the study. Exclusions were based on failing to meet eligibility requirements, participants not sufficiently filling out measures used in the parent study, and refusals. In total, 1763 people filled out the survey, however, an additional 98 people were dropped for missing data because they did not answer items related to their diet and/or trauma exposure history. For this study, the final sample was 1665 participants. The average age was 48.45 years old (SD = 17.06), and the gender breakdown of this sample consisted of 51.2% women and 48.8% men. Further demographic information for this sample can be found in Table 1. Participants were compensated $4.80 for their participation.

Table 1.

Demographic Characteristics

Baseline characteristic n % M SD
Age 1663 48.46 17.06
Gender
 Female 851 51.2
 Male 812 48.8
Diet
 Vegan or Vegetarian 255 84.7
 Meat or Fish inclusive diet 1410 15.3
Race/Ethnicity
 White/European American 1143 68.7
 Black/African American 187 11.2
 Latinx/Hispanic American 292 17.6
 Asian/Asian American 86 .05
 Native Hawaiian/Other Pacific Islander 1 0.1
 American Indian/Alaskan Native 4 0.2
 Multicultural 11 0.7
 Other 4 .2
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Note. n’s range from 1663–1665 due to missing data.

2.2. Procedure

Before beginning the survey, participants were informed of the general purpose of the study and that they could end their participation at any point in time. Upon providing consent, participants were prompted to begin the study. Demographic questions were provided first, followed by the other study questionnaires. After the study measures were completed, participants were provided with resources for intimate partner violence and debriefed.

2.3. Measures

2.3.1. Plant-Based Diet Assessment

To assess whether participants followed a plant-based diet, they were asked to endorse the best option reflecting their diet among three choices: (1) “I exclusively eat a plant-based diet (no animal foods or ingredients)”; (2) “I eat a vegetarian diet that includes eggs and/or dairy but no meat”; (3) “I eat a diet that includes meat”. Participants who endorsed exclusively eating a plant-based diet or vegetarian diet that includes eggs and/or dairy but no meat were coded as plant-based. Participants who ate a diet including meat were coded as not plant-based. Plant-based diets were coded as 1 and non-plant-based were coded as 0.

2.3.2. Lifetime Trauma Exposure

The International Trauma Exposure Measure (ITEM; Hyland et al., 2021) was used to examine lifetime exposure to trauma. This measure consists of 22 items that assess traumatic life events across three developmental periods: childhood, adolescence, and adulthood. Example items from the ITEM include, “You were diagnosed with a life threating illness,” “Someone close to you died in an awful manner,” “You were physically assaulted by a parent or guardian,” and “You were exposed to a natural disaster where your life was in danger.” Psychologically threatening events were excluded from the measure. This resulted in a total of 19 items. Participants determined if they experienced each event “up to the age of 12,” “between ages 13–18,” and/or “after the age of 18.” Lifetime cumulative trauma was scored by summing across all time points from childhood, adolescence, and adulthood. Responses to the open-ended item “Any other event not listed (please specify)” were not interpreted, so they were not included in the sum scores. As expected, scores for lifetime trauma were positively skewed such that most individuals endorsed no trauma exposure. Please refer to supplemental Figures 1, 2, 3 and 4 for histograms and bar graphs of predictor and control variables.

2.3.3. Intimate Partner Violence Exposure

The Revised Conflict Tactics Scale Short Form (CTS2S; Straus & Douglas, 2004; Straus et al., 1996) was administered to examine experiences of IPV. This measure consists of separate subscales for physical assault, injury, psychological aggression, negotiation, and sexual coercion. Each subscale consists of 2 behaviors, which are repeated to assess the participants and their partners’ behaviors in the past six months. For this study, we measured IPV victimization history by scoring individuals who indicated any past lifetime history of physical assault and injury as 1 and no history of physical assault or injury as 0. The CTS2S has demonstrated concurrent and construct validity like that of the CTS2, which has exceptional construct validity, content validity, internal consistency, and reliability (Straus and Douglas, 2004; Straus et al., 1996; Newton et al., 2001).

2.4. Data Analysis

Analyses were conducted with IBM SPSS for Windows, Version 27.0. There was no evidence of multicollinearity among predictor variables (all r < .70). Our final sample included 1665 participants (15.3% plant-based; 51.2% female). We examined bivariate associations among study variables and conducted a logistic regression analysis to examine associations between measures of trauma and diet. Specifically, we included demographic factors (participant age and gender) and the predictor variables of lifetime cumulative trauma exposure and lifetime IPV victimization in predicting the diet choice outcome. In addition to bivariate correlations, we also performed a logistic regression to understand associations among diet, lifetime trauma exposure and IPV. For our logistic regression, our outcome was a dichotomized plant-based variable. Our predictor variables included age, gender (coded as 0 = female, 1 = male), cumulative trauma and IPV (coded as 0= no IPV, 1 = any form of IPV) exposure variable. Data for this manuscript can be made available upon reasonable request, from the corresponding author. Due to privacy restrictions, the data are not publicly available.

3. Results

3.1. Sample Characteristics and Bivariate Correlations

Please refer to Table 1 for full demographic sample characteristics. Of the 1665 participants included in this study, a total of 255 participants (15.03%) reported eating plant-based diets (defined as a vegan or vegetarian diet) while 1410 participants (84.7%) reported eating a diet consisting of animal (e.g., fish or meat) flesh.

Table 2 shows bivariate correlations among all demographic variables and primary constructs of interest. As hypothesized, participants eating a plant-based diet were more likely to report greater rates of trauma and IPV victimization. Regarding additional correlations that were run, results showed that age was significantly associated with lifetime cumulative trauma exposure, lifetime IPV victimization, and diet. Gender was associated significantly with cumulative lifetime trauma, lifetime IPV victimization, and diet. Cumulative trauma was associated with lifetime IPV victimization and diet. Lastly, lifetime IPV victimization was associated with diet. The only nonsignificant correlation was between age and gender.

Table 2.

Summary of Correlations

Age Gender Cumulative Trauma IPV
Age
Gender −.002
Lifetime Trauma −.136** .113**
Lifetime IPV −.226** .1568* .411**
Diet −.200** .062* .267** .257**
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Note. Diet is dichotomized such that 1 = plant-based diet and 0 = diet that includes animal flesh. Gender is dichotomized such that 0 = female and 1 = male. Due to missing data, n‘s range from 1663 to 1665. IPV is dichotomized such that 0 = no exposure and 1 = any exposure on the physical assault and physical injury scales on the Conflict Tactics Scale Short Form.

*

p < .01,

**

p < .001. Lifetime Trauma = total sum scores on the International Trauma Exposure Measure.

3.2. Logistic regression among diet, lifetime trauma exposure and IPV victimization

A logistic regression was performed to ascertain the effects of age, gender, cumulative trauma, and lifetime exposure to IPV on the likelihood that participants are currently plant-based (see Table 3). The logistic regression model was statistically significant, χ2(4) = 166.020, p < .001 and explained 9.5% (Cox & Snell R2) to 16.5% (Nagelkerke R2) of the variance in diet choice. The model correctly classified 86.3% of cases and the Hosmer-Lemeshow test showed no evidence of poor fit, χ2(8) = 9.981, p = .266. Gender was unrelated to diet choice. Increasing age was associated with a decreased likelihood of being plant-based. Those with a history of IPV were 2.31 times more likely to plant-based, and those with any experience of trauma more broadly were 1.09 times more likely to be plant-based.

Table 3.

Logistic Regression Analysis Predicting Plant-Based Diet Choice Based on Age, Gender, Lifetime Trauma, and IPV Exposure

B SE B OR [95% CI]
Age −.027*** .005 .973 [.964, .982]
Gender .103 .016 1.109 [.828, 1.486]
Cumulative trauma .089*** .178 1.093 [1.060, 1.127]
IPV .837*** .232 2.309 [1.628, 3.275]
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Note. Diet is dichotomized such that 1 = plant-based diet and 0 = diet that includes animal flesh. Gender is dichotomized such that 0 = female and 1 = male. IPV is dichotomized such that 0 = no exposure and 1 = any exposure on the physical assault and physical injury scales on the Conflict Tactics Scale Short Form. Lifetime Trauma = total sum scores on the International Trauma Exposure Measure. Due to missing data, n‘s range from 1663 to 1665.

*

p < .01,

**

p < .001.

4. Discussion

The purpose of this study was to examine links between trauma exposure and diet choice (i.e., plant-based, or animal-based) in a nationally representative U.S. sample. As hypothesized, trauma variables were associated with adherence to a plant-based diet both at the bivariate level and when controlling for other demographic variables. The Cox & Snell R2 and Nagelkerke R2 for the logistic regression model indicated that the model explained 9.5% to 16.5% of the variance in diet choice. Therefore, other factors not fully captured in our model also impact diet choice. However, the odds ratios indicated that those who had greater experiences of trauma, especially IPV, were more likely to choose a plant-based diet. We are not aware of any prior published study that has documented these associations. Overall, our work highlights the need to take trauma exposure into account when examining why some plant-based eaters have higher levels of mental disorders. We may have found trauma to be associated to plant-based diets for a couple of reasons. For one, we know that past work has theorized that those exposed to trauma might have increased empathy given their own experiences with trauma (e.g., Greenberg et al., 2018), and it is plausible that this increased compassion can extend towards non-human animals (Lavallee et al., 2019). Additionally, while traumatic experiences may create or exacerbate psychopathology, those consuming plant-based diets may desire to cope by eating more healthily, or by adopting a plant-based lifestyle if they feel it aligns with their values of being more empathetic (Michalak et al., 2012).

This study therefore poses promising directions for future work. While prior research has connected pre-existing mental health disorders, such as anxiety, depression, and eating disorders, to plant-based diet choice, it often overlooks the potential role of trauma itself and whether adopting a plant-based diet serves as a coping mechanism. Although evidence suggests that trauma may increase the risk of mental health issues like eating disorders or PTSD, further studies are needed to determine if plant-based diets are used as a means of promoting recovery from trauma-related outcomes or, conversely, as a way to mask mental illnesses like eating disorders. Future research could explore such questions via quantitative and qualitative methods to better understand possible links between trauma, diet, and mental and physical health outcomes.

There may be other negative relevant experiences related to stress and trauma that were not examined in the current study. For example, evidence indicates that plant-based eaters experience more negative social stigma and negative reactions from others (Bresnahan et al., 2016). They may experience more social isolation and distress as they are regularly challenged about their views and are perceived as judgmental by their family and peers (Greenebaum, 2012; Guérin, 2014; Hirschler, 2011; Lindquist, 2013). To develop a clearer understanding of links among stressor variables and dietary choice, it is helpful to consider contextual factors from a trauma-informed, biopsychosocial perspective. Another potentially important area of future study is diet quality. Some recent evidence suggests that diet quality may moderate the association between plant-based diet and mental health outcomes such that a healthier plant-based diet confers greater benefit (Lee et al., 2021, 2024; Walsh et al., 2023). Other limitations of this study include a reliance on self-reports of the variables of interest and cross-sectional analyses. An additional limitation of this study is that it was unable to explore how plant-based diets impact trauma survivors and their experiences with mental health. Future work should therefore examine if plant-based diets impact the course of trauma related mental health outcomes. Lastly, an important limitation is that vegetarians and vegans were grouped together in the same plant-based category for analysis. Future work should consider oversampling plant-based eaters to allow for more nuanced and distinct findings between these dietary groups. Future work should also use longitudinal studies and multi-modal assessments including clinical interviews, use of biological data, and fuller assessments of dietary factors, nutrition, stress, and trauma.

5. Conclusion

Despite these limitations, this study has unique strengths. Notably, this is the first study to examine and provide initial evidence that demonstrates that trauma exposure, including exposure to IPV, increases one’s likelihood of developing a plant-based diet over and above the effects of age and gender. Future research should seek to replicate findings and examine causal relationships between different trauma exposures (e.g., IPV, interpersonal violence more broadly, childhood trauma) and diet choice. Future research should also seek to understand whether trauma accounts for associations between mental health disorders and plant-based diets. Overall, these results suggest the importance of considering the role of trauma and victimization when examining those who adopt a plant-based diet.

Supplementary Material

1
2
3
4

9. Funding source

This work was partially supported by the National Institute of Mental Health (NIMH), Grant Number: T32MH019836

Footnotes

6.

The authors declare no conflict of interest.

10.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

7.

CRediT authorship contribution statement

Faith Nomamiukor: Conceptualization, Formal analysis, Writing – original draft, Writing – review & editing. Madeline Smethurst: Conceptualization, Formal analysis, Writing – Original draft. Molly Franz: Conceptualization, Writing – review & editing. Evelyn G. Hamilton: Conceptualization. Anissa Garza: Conceptualization. Diana Padilla-Medina: Conceptualization. Maxine Davis: Conceptualization, Resources. Casey Taft: Conceptualization, Supervision, Writing – review & editing.

8.

Ethics approval

Data were collected between April 2020 and May 2020. All procedures were approved by the Institutional Review Board of the University of Arlington, Texas (IRB Protocol #: 2020–0193). All procedures were performed in compliance with relevant laws, institutional guidelines, and ethical standards of the Institutional Review Board of the University of Arlington. Additionally, the privacy rights of human subjects have been observed, and informed consent was obtained by human subjects.

Ethics Statement

Data were collected between April 2020 and May 2020. All procedures were approved by the Institutional Review Board of the University of Arlington, Texas (IRB Protocol #: 2020–0193). All procedures were performed in compliance with relevant laws, institutional guidelines, and ethical standards of the Institutional Review Board of the University of Arlington. Additionally, the privacy rights of human subjects have been observed, and informed consent was obtained by human subjects.

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11. Data availability

Data will be made available on request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

1
NIHMS2046064-supplement-1.docx (69.5KB, docx)
2
NIHMS2046064-supplement-2.docx (58.4KB, docx)
3
NIHMS2046064-supplement-3.docx (86.5KB, docx)
4
NIHMS2046064-supplement-4.docx (94.8KB, docx)

Data Availability Statement

Data will be made available on request.

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