There is a common misconception that eating disorders somehow disappear during pregnancy; that becoming a mother stops all those silly worries about being slim and attractive. This is not necessarily the case, and unfortunately, there is a lot of stigma associated with talking about disordered eating behaviours during pregnancy. Openly admitting to it is an invitation, it seems, to being called selfish and vain. The implication is that eating disorders are something only young girls struggle with, and that pregnancy and motherhood are such big and important things that they should be enough to overcome an eating disorder.
Over recent decades, eating disorders have entered the public’s consciousness. They are regularly discussed, and often trivialized, in the popular media, depicted as no more than dieting gone wrong or overzealous weight loss. Yet these conditions warrant serious consideration because they are potentially life-threatening and can persist for years, ruining individuals’ long-term health, their personal and their social functioning.
In a large population-based study of 12,254 pregnant women in the UK, over 4% of women experienced past or present eating disorders (Micali et al., 2007). In this study, Tierney and colleagues wanted to find out how those women with present or past eating disorders experienced pregnancy and early motherhood.
They interviewed eight women between the ages of 17 to 37 about their experiences during pregnancy and (if applicable) motherhood. Some women were expecting their first child while others already had three. Five out of eight women were interviewed post pregnancy (from 2 months to 24 months post pregnancy). All had an eating disorder prior to becoming pregnant. All except one developed their eating disorder during their teens (one developed AN after the birth of her second child).
The authors identified four sub-themes which fell under a major theme of divided loyalties between putting their child first and heeding to their eating disorder:
THEME 1: FEAR OF FAILURE
Breast-feeding was a common area where mothers felt inadequate:
I really, really wanted to be able to eat more in order to produce better milk and I couldn’t do it and I felt that I’d failed him. I can remember crying when I was buying the formula for the first time and I couldn’t. . .be around when he was given the formula because it upset me. . .I didn’t want anyone else to know he was getting the formula.
Many women were not open with their partners about their eating disorder behaviours (such as purging) because they felt that they were letting down their spouses. Some participants avoided socializing with other mothers because they were uncomfortable talking about weight gain/gain.
Participants were also worried about how others would judge them, fearing others would not understand their compulsive need to engage in behaviours as a coping mechanism.
I think people who haven’t experienced it can be very judgemental of someone who’s pregnant and can’t eat properly. I took part in an article for [newspaper] last year about eating disorders in pregnancy and although I had a lot of very positive feedback and supportive comments from my family and friends, over the internet there were a lot of really nasty comments about it posted on the website ‘these selfish women, they shouldn’t have children’, things like that. . . if you haven’t got that experience then it seems, it just seems like you are putting your appearance above your child’s health and that’s how it must seem to people I think.
THEME 2: TRANSFORMING BODY AND EATING BEHAVIOURS
Interviewees varied in how they felt about their changing bodies. Some hated it because they were at their heaviest, whereas others were fine with it after it became obvious that they were pregnant (and not “getting fat”.)
Some loved their baby bumps. One participant said it was the happiest she had ever been with her body, “valuing its productiveness.”
Many participants said they felt that their food intake was closely monitored by their partners, at work, or by professionals. Many struggled to eat an adequate amount of food and put on sufficient weight. One participant continued to eat small portions of low fat food and exercise rigorously. Some, however, were able to overcome their anxieties.
A craving for fish and dairy products caused participant 8 to eat these foods when pregnant, even though she had refused to consume them for five years. She recalled how doing this got easier the bigger she became during the pregnancy.
THEME 3: UNCERTAINTIES ABOUT CHILD’S SHAPE
Participants worried about their child becoming obsessed with food, but they also worried about their child becoming obese. As a result, the women tried to hide their own anxieties about food and weight, and attempted to eat as a family, even though this often increased their anxiety levels.
The preceding description of data implies that women with an eating disorder may see their child’s shape as an external marker of their success as a parent. Recent social messages about obesity in childhood could increase anxieties about an offspring’s weight and the need to monitor this closely. As noted above, a desire for control and striving for perfection have been associated with eating disorder onset and could extend to food consumed by children; some women with an eating disorder may see their child’s body as an extension of their own, viewing any changes in their offspring and his/her eating behaviours as indicative of their own self-control, potentially projecting their condition onto the youngster as a consequence.
(I’m really curious if other mothers relate to this?)
THEME 4: EMOTIONAL REGULATION
Eating disorders are a powerful way to modulate (or suppress) emotions. Women in this study struggled with anxiety and depression through-out their lives, and some admitted to suicide attempts in the past. Unfortunately, low moods persisted for some during pregnancy and/or after giving birth.
Many women reported using exercise as a way to regulate negative emotions during pregnancy, but others relied on their eating disorders.
As well as exercise, a number of interviewees talked about inducing vomiting whilst pregnant to regulate emotions. They felt some guilt about how it might affect the child but also depicted this behaviour as compulsive, adding that it brought them relief. Participant 7, in particular, noted how hard it was to refrain from doing so in pregnancy because negative feelings (e.g. of greed and being weak) encountered after eating were so powerful and only abated once she had been sick.
Several participants also engaged in self-harm during and after pregnancy. One participant found it hard to adapt to motherhood. She said that she loved her child, but didn’t want him, feeling that she wasn’t capable of caring for him (“because she struggled to understand what he needed when he cried.”) One woman cut her abdomen several times during pregnancy as she struggled with her changing body.
Some participants did not experience an immediate connection with their child, in part because of the guilt they felt for engaging in eating disordered behaviours and self-harm during pregnancy. For others, motherhood was a turning point: for one participant, the birth of her child was a catalyst in helping her finally begin to recovery from her eating disorder.
The authors suggest that for many women, pregnancy and motherhood result in a “conflict between doing the best for their child and heeding to the demands of their eating disorder.”
They also suggest that there were three broad categories of women in this study. Women in the first group “seemed unable to cease their dangerous behaviours during pregnancy”; women in the second group “appeared able to put these on hold, but could be vulnerable to relapsing after giving birth”; and finally, women in the third group “relinquished their weight control during pregnancy and saw this as a long rather than a short-term break from such practices.”
This was an interesting paper and I’m becoming more interested in how women with eating disorders experience pregnancy and motherhood, and what treatment teams can do to help expecting and new mothers, so expect more on this topic in the future.
Not being a mother or ever being pregnant, it is hard for me to comment on the paper, and so I’m especially curious to find out if any of the material in this paper resonates with the readers of this blog. As always, I’d love to hear your thoughts!
Tierney, S., Fox, J., Butterfield, C., Stringer, E., & Furber, C. (2011). Treading the tightrope between motherhood and an eating disorder: A qualitative study International Journal of Nursing Studies, 48 (10), 1223-1233 DOI: 10.1016/j.ijnurstu.2010.11.007