By Dr. Sarah Long

Dr. Sarah Long is a clinical psychologist at The Catalyst Center, and has been working with people struggling with eating disorders for over a decade. She shares her insight and advice for how we can better understand eating disorders in pregnancy.

Eating Disorders do happen in pregnancy

  • A study of 54 postpartum women published in the Journal of Midwifery & Women’s Health found that nearly 28 percent had psychological and behavioral traits associated with eating disorders, but only one woman’s medical records listed a history of eating disorders.
  • In one study, 20% of women seeking help at a private fertility clinic met criteria for an eating disorder. None of them had told their doctor.
  • Research suggests that roughly 1 in 20 pregnant women are suffering from an eating disorder.
  • Eating disorders include Binge Eating Disorder, Anorexia Nervosa, Bulimia Nervosa, and Other Specified Feeding and Eating Disorder.

Although people are often hesitant to acknowledge it or talk about it, eating disorders can be present during pregnancy. Despite significant risks to both mother and baby, women suffering with disordered eating are often frightened to ask for help because of shame, stigma, and fear of judgment from others.

Pregnancy can be the perfect storm that triggers an eating disorder

Although many women embrace pregnancy and the changes that go along with it, pregnancy can also be a perfect storm for the development of an eating disorder or a relapse after a period of recovery. This is due to the nature of both an eating disorder and pregnancy.

For someone with a history of an eating disorder or disordered eating, pregnancy is a risk factor for relapse even if you’ve been in recovery for a significant amount of time. Many women in recovery haven’t had to deal with eating disorder thoughts in quite some time. Learning you’re pregnant may be a time of joy and excitement. With your focus on the changes happening in your life, it can be easy to miss the red flags that the eating disorder is still lurking in the corner of the room.

Major life transitions = Significant relapse risk

Those familiar with eating disorders know that times of transition are a significant risk factor for the development or relapse of an eating disorder. The very nature of pregnancy involves transition, of many things. Not only is your body changing, your identity shifts and relationships can look a little different. Discomfort or over-concern with your appearance and weight are inherent to eating disorders, and incredibly common during pregnancy. During pregnancy, even people who have no prior history of body image concerns may “feel fat” or uncomfortable in their skin. Feeling uncomfortable with your changing body is incredibly normal and doesn’t mean you will develop an eating disorder, that said it is important to keep your eye out for risk factors of developing an eating disorder in pregnancy.

Risk factors for developing an eating disorder during pregnancy

Even if a person has no prior history of a clinical eating disorder…

  • If she is struggling with rigid eating or has a difficult relationship with food, this can evolve into an eating disorder in pregnancy
  • Pregnancy may trigger body image issues and/or disordered eating, which can then lead to an eating disorder in pregnancy
  • For women who have previously struggled with dieting, rigid eating, and negative body image, pregnancy can increase these issues and may trigger their first full blown eating disorder episode

What I’ve learned from my years working in eating disorder treatment centers

  • Shame and secrecy often prevents sufferers from seeking help right away. This is magnified exponentially if you’re also pregnant.
  • The sufferer, not to mention her loved ones, assume that the love of the baby should be enough to cease behaviors (“eat for the baby”, “don’t you know what purging or laxatives will do to your baby?”) This can trigger intense shame when the eating disorder persists anyway
  • The sufferer gets bombarded with information on the risks of eating disorder behaviors during pregnancy such as low birth weight, high risk for miscarriage, premature birth, or developing hypertension and gestational diabetes if struggling with binge-eating disorder. Information alone is never enough to make an eating disorder go away. It is vital to remember that eating disorders are not “bad behavior.” They are complex physical and psychological conditions that are difficult to treat
  • These reactions from others, not to mention the mere existence of an eating disorder can cause more shame and secrecy, makes someone feel alone, and causes overwhelming fear and anxiety all of which are fuel for an eating disorder.

With all this mounting pressure you may find yourself in a vicious cycle, feeling alone.

What to know if you think you may be struggling with an eating disorder during pregnancy:

  • Know you’re not alone. You are not the only one that this has happened to.parent therapy
  • Support is critical. Recovery is next to impossible without support, with something as complicated psychologically and physically as pregnancy, a team approach is vital
  • If you’re unsure how to talk with your doctor about your struggles, help is available
  • Find a therapist experienced in eating disorders. She can be an advocate for you

If you suspect your loved one is struggling with eating disorder behaviors while pregnant:

  • Express your concern, a lot of times people don’t say anything because they don’t know what or how to say it, avoid pretending it’s not happening
  • Listen without judgment, offer her compassionate concern
  • Recognize that you can’t fix this, your loved one needs professional help
  • Seek support for yourself, especially if you’re her partner