Experiencing pregnancy and anticipating future parenthood comes with many emotions, trials, joys, and stressors. For those who are currently struggling with an eating disorder, or have in the past, this period of time often comes with complex emotions and challenges. Pregnancy and postpartum can be one of the most common times in a person’s life for developing or relapsing into an eating disorder. And it’s no wonder; besides the anticipation of one’s body changing during and after pregnancy, our culture has increased the pressure to “get your body back”. Examples include getting weighed frequently at the doctors office, hyperfixation on what and how much food to eat during and after pregnancy, and regularly receiving comments by loved ones and even strangers on your body. Not to mention changes in food tolerances, physical ability, symptoms of illness commonly experienced, and a sense of feeling “out of control” in many aspects.
Pregnancy in the modern age brings additional stressors never experienced before. Pregnancy apps and other social media platforms allow strangers to connect to others going through similar experiences and these sites can also bring about excessive focus on food, weight, exercise, and body in harmful ways. These sites can increase body dissatisfaction and comparison that negatively impacts mental health, body image, self-worth, and shame. The media also promotes this by comparing celebrity “baby bumps” and featuring entire segments about celebrity pregnancy. “Pregorexia” is a term that was coined by the media to describe eating disorders that persist through or emerge during pregnancy. Calorie restriction, binge eating, purging through exercise or vomiting, using laxatives excessively and eating only particular types of food are all eating disorder symptoms that may occur during pregnancy.
Studies Into Pregnancy and Eating Disorders
Studies suggest that 4 percent of women of reproductive age suffer from an eating disorder. The prevalence of these eating disorders that persist into and throughout pregnancy, however, is estimated to be lower. This may suggest that for some women, their eating disorder symptoms improve or go into remission when they are pregnant. However, it may also be that, due to stigma and shame, fewer women admit to having an eating disorder while they are pregnant. It is estimated that only 44 percent of pregnant women with eating disorders admit to having an eating disorder.
Sometimes the eating disorder shifts when a woman becomes pregnant making diagnosis even more challenging. A Norwegian study found that after 18 weeks of gestation, more women were diagnosed with Other Specified Feeding or Eating Disorder (formerly known as Eating Disorder Not Otherwise Specified), whereas before pregnancy these women had been diagnosed with Bulimia Nervosa or Anorexia Nervosa. That is, the eating disorder may look different or lose intensity, but remains distressing and harmful to the body.
The Norwegian study, which looked into 41,157 pregnant women, also found that binge eating disorder was less likely to remit and more likely to arise during pregnancy than anorexia and bulimia.
Those who have a history of an eating disorder of any kind are at a greater risk for relapsing into eating disordered behaviors during pregnancy. Pregnancy is considered to be a stressful time with many physical, emotional, and psychological changes, and for this reason, it can trigger an eating disorder. This is true for those who have a history of the illness, and for those who prior to pregnancy, had no history of eating disorders. It’s common to experience some distress over the natural body changes and shift in identity during this time and some may feel symptoms of grief from the loss of their former identity or life as it was. It can bring up difficult childhood memories as you begin to imagine your future.
For those who experience disordered eating symptoms, becoming pregnant can amplify these symptoms to the point of fitting criteria for an eating disorder. This mostly affects people who have a problematic relationship with food already. However, in our fatphobic culture, weight gain during pregnancy can be stressful even for those who have not had an eating disorder.
Signs and Symptoms
Failure to make the expected weight gains over the course of pregnancy may signal an eating disorder. Skipping meals, calorie counting, obsessive food-related behaviors, and a preference to eat alone are also potential warning signs. Heavy and rigid exercise is another potential problem and a sign that someone is abusing exercise to cope with the changes. Other signs can be a generally heightened level of stress and irritable disposition.
Pregnancy and Eating Disorder Complications
It can be more difficult to diagnose someone with an eating disorder when they are pregnant. The natural change in weight and shape can camouflage what is actually happening. In most cases of people suffering from an eating disorder, the illness is not physically detectable, so outward appearance can be deceptive. The media has portrayed a very narrow view of what someone looks like when they have an eating disorder and many cases go undetected.
Diagnosing an eating disorder can be complicated at any stage of life. Pregnancy adds another degree to this and is a time when the person with an eating disorder themselves may be less likely to understand that something is wrong. Families and loved ones may notice a change in behavior or an additional element of stress, but may dismiss their concerns and attribute the behaviors to the hormonal aspects of the pregnancy.
Pregnancy and Eating Disorder Treatment
A 2008 study found an increased risk of neonatal complications and adverse pregnancy issues when someone has an eating disorder during their pregnancy. This points to the importance of early detection and treatment.
Without treatment, there are considerable dangers posed to both the parent and the baby. The baby may be more at risk of birth defects, birth-related complications, respiratory distress, difficulties with feeding, low birth weight, premature birth, and the parent is at a higher risk of miscarriage, dehydration, electrolyte imbalance, depression, and cardiac issues.
As with all eating disorders, this can be a severe condition and treatment should be given as soon as possible. A team of specialists should be consulted including a medical doctor, licensed therapist, registered dietitian, and if needed, a psychiatrist.
Written by Tabitha Farrar
Special Thanks to Maggie Baumann, MFT, CEDS