Eating Disorders and Pregnancy

When I began my training as an eating disorder therapist, I assumed most of my clients would be teenagers or college students. After all, that was what I had seen in the media. I quickly realized this was not the case. It’s actually quite the opposite and eating disorders can show up in a person’s life at any stage, regardless if you’ve had a history of body image concerns or disordered eating. 

Although people are often hesitant to acknowledge 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. In an effort to reduce shame and barriers to seeking help, I thought I’d write a little about 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. 

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. 

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 so many things. Not only is your body changing, your identity shifts and relationships can look different. Discomfort or over-concern with your appearance and weight are inherent to eating disorders, and incredibly common during pregnancy. Regardless if you’ve had a history of body image concerns, a person may “feel fat” or uncomfortable in their skin while pregnant. Feeling uncomfortable with your changing body is incredibly normal and doesn’t mean you will develop an eating disorder. However, it is important to keep your eye out for risk factors or red flags. 

Risk factors for developing an eating disorder during pregnancy

With your focus understandably 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. An obvious risk factor that is on most people’s radar is a history of an eating disorder. Here are some other things to consider even if a person has no prior history of a clinical eating disorder:

• Rigid eating or a difficult relationship with food can evolve into an eating disorder in pregnancy
• Pregnancy may trigger body image dissatisfaction 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 magnify these struggles. This may trigger a full blown eating disorder.

Things to keep in mind

• 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 which can then fuel the eating disorder even more.
• The sufferer gets bombarded with information on the risks of eating disorder behaviors during pregnancy such as:  
  • Low birth weight and associated concerns
  • High risk for miscarriage
  • Risk of premature birth
  • Risk of 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
  • causes overwhelming fear and anxiety 

All of which are fuel for an eating disorder.

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. It’s just something people don’t tend to talk about. 
• Support is critical. Recovery is next to impossible without support. Given that pregnancy can be complicated, both psychologically and physically, a team approach is vital.
• If you’re unsure how to talk with your doctor about your struggles, help is available. A therapist experienced in eating disorders can be an advocate for you. 

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

• Express your concern. Many times, those who struggle don’t say anything because they aren’t sure what or how to say it. These conversations can be difficult but are critical to have.
• Listen without judgment and offer compassionate concern.
  
• Recognize that you can’t fix this, your loved one needs professional help.
  
• Seek support for yourself, especially if you are the partner.