Complex Motherhood: The Perspectives of Mothers with Eating Disorders

Studying, as I do, in a department of family relations, I have become interested in family relationships and parenting. Accordingly, I have begun to take note of interesting studies that link family dynamics and parenting with eating disorders, including studies that look at the sibling relationship (as I wrote about here), family-based treatment, and motherhood/fatherhood in the context of eating disorders.

The literature appears to have shifted, lately, from a focus on “eating-disorder generating” families toward an acknowledgement of the complex family dynamics that can play into the development and treatment of eating disorders. A move away from mother- or family-blaming discourses is essential, I would argue, to gaining a better understanding of the lived experience of eating disorders for individuals and families alike.

Accordingly, I was pleased to stumble across an article by Tuval-Mashiach et al. (2013) that used a qualitative approach to explore the experiences of mothers with eating disorders. The authors suggest that their study helps to fill a gap in the literature surrounding how mothers experience the intersections between their motherhood roles, their eating disorder, and their familial relationships.

Acknowledging the mixed findings surrounding mothers’ perspectives on their children’s well-being in relationship to their eating disorders, they sought to understand the two-way relationship between mothering and eating disorders (i.e., how the “mother” role impacts the disorder and how the disorder impacts motherhood).

Which Mothers?

The experience of motherhood, much like the experience of eating disorders, is obviously not homogenous. So, before making claims about the “motherhood role,” it is important to take participant characteristics into account. This particular study took place in Israel, where authors recruited a sample of 13 mothers from an inpatient eating disorder unit housed at a hospital. This group of mothers:

  • Had been coping with an eating disorder for an average of 15 years
  • Ranged in age from 23-48
  • Had children ranging in age from 7 months to 24 years
  • Had between 1 and 7 children (average 2.5)


  • 12 were married, and one divorced
  • 3 were diagnosed with BN
  • 4 were diagnosed with AN-R
  • 6 were diagnosed with EDNOS

I was a bit concerned about the heterogeneity in the sample; in focus group studies, we generally aim for a relatively homogenous sample to increase the chance that participants will be able to discuss shared experiences. I would suspect that the experiences of a mother of a 7-month-old would differ drastically from those of a mother of a 24-year-old. The researchers did attend to the complexity of these mothers’ experiences, however, by modifying the focus group method and holding more sessions than would be used in a typical focus group study.

Focus Group Procedures and Analysis

Two of the authors (a psychiatrist and dietician) led 2 focus groups, one with 6 participants and one with 7. Each group met for 10 sessions; two mothers stopped attending after 2 sessions. Focus groups were centered around specific topics in the area of the motherhood-ED relationship, and were largely participant-driven (i.e., the content reflected the interests and experiences of the mothers).

The researchers took a narrative approach to data analysis, following Lieblich, Tuval-Mashiach & Zilber’s (1998) textual analysis model. Their analytic framework was based in prior understandings of the ways in which eating disorders may complicate the mother-child relationship, while remaining open to emerging information not captured in prior literature.


Two main themes surfaced through analysis, and were underscored by several subthemes, which I will briefly describe below.

1. Mothering practices and roles

The mothers in this sample identified a number of challenges linked to being mothers with eating disorders, including:

a. Discussing the illness with the child

Mothers articulated the difficulty of shielding their children from their eating disordered behaviours and the discomfort they felt in knowing their children were aware of their behaviours. The child’s age factored into some mothers’ openness in discussing their behaviours; mothers were more likely to be open with older children, as one might expect.

I know he knows everything, but we don’t talk about it. When I’m in the bathroom (to vomit), he knows he can’t talk or bother me. I know he knows everything, but he wouldn’t say a thing.

b. Child as caregiver

The mothers also identified a role reversal, in some cases, between parent and child. This was something that the mothers associated with a great deal of discomfort, and many made attempts to decrease the degree to which their children were involved. For example, some mothers described certain areas of their family lives as “conflict-free spheres,” (e.g., assisting children with homework, etc.) where their eating disorder did not impede their mothering roles.

c. Concerns about providing bad modeling

Children’s awareness of and involvement in their mothers’ disordered behaviours provoked strong, negative feelings among the mothers in this sample. Mothers were concerned that their behaviours could have a negative impact on their children through providing poor examples of healthy eating behaviours. Many hoped that their children would not look up to them, but also felt uncomfortable when their children would point out their disappointment in their behaviours, seeing this as a compromise to mothering authority.

I feel guilt about my current situation. I want to be a model for my daughter and I’m such a negative model, this is not a good model for a child her age. I don’t know what she thinks of my eating disorder deep inside her, of the other women here in the department. Would she like to reach this place too? I’m afraid, because a few days ago, she didn’t want to take a picture together with me because she’s more fat than I am, bigger than me.

d. Strategies developed to manage challenges of mothering

In order to combat some of the more negative aspects of their experiences, mothers developed a number of compensatory mechanisms to support their children. For example, participants used their experiences to inform their daughters in particular about the complexity of the human experience (i.e., that no one is perfect).

The best thing would be if we could let our children know that we are not perfect, and that they can choose what to take from us, and take the good things.

2. Motherhood as a defining aspect of a woman’s identity

Motherhood is described as an essential element of these women’s experiences, coloured by the experience of an eating disorder in both positive and negative ways.

a. Motherhood as a normalizing experience

Motherhood helped some of these women to feel more “normal” in the context of the family-oriented country in which they live (Gooldin (2002) comments on normalcy in the context of family-orientation). Though mothers’ experiences of parenting while simultaneously coping with an eating disorder are described as fraught with difficulty, these mothers articulated positive aspects of their experiences through their familial relationships as well.

b. The child as a motivation to recover

In the face of the difficult experience of coping with an eating disorder, mothers articulated a desire to recover that centered around wanting to be a good role model for the child or minimize the child’s suffering.

I’m tired of thinking and talking only about myself. If I didn’t have a family, with people who love me, it would have been much easier to be sick. But because there are others, and they suffer, it makes it much more difficult to give up.

c. Deficient motherhood

While motherhood helped some women to feel motivation to recover and to feel more “normal,” some mothers also felt as though their eating disorders made them inadequate mothers. Interestingly, this was often linked to their experiences of being mothered, earlier in their lives, and how they attempted to not follow their mothers’ examples.

All my life I’ve been trying to be different from my mother. It’s obsessive and it is exhausting. What can I do? If she gave me bad tools for life, than [sic] that’s what I have. If I feel stressed, immediately what comes to my mind is that I’m like my mother. How can it be? I tried so hard to do it differently.


The authors suggest that together, these themes point to the complex ways in which mothers negotiate different aspects of their identity, including the roles of mother and of individual suffering from an eating disorder. This knowledge may have clinical implications, such as the need to attend to the experiences of mothers with eating disorders. For example, specialized group or individual therapy might help mothers to develop or enhance strategies for coping with the guilt they may feel in relation to their children’s awareness of their behaviours.

While I think we need to be cautious in interpreting these results due to the relatively small sample size and the heterogeneity of the group, this study helps to shed light on the complexity of the motherhood experience in the eating disorder context. Particularly interesting to me is the way in which these mothers saw motherhood as both a helpful and stressful experience, in light of their eating disorder.

As the quotes illustrate, these mothers are acutely aware of the potential impacts that their behaviours might have on their children. In some cases, this awareness might contribute to an increased commitment to recovery. I also think it is important to continue to avoid blaming mothers for any potential impacts on their children’s well-being; no matter how much these women might want recovery, recovery can be extraordinarily difficult to attain.


Tuval-Mashiach R, Ram A, Shapiro T, Shenhav S, & Gur E (2013). Negotiating maternal identity: mothers with eating disorders discuss their coping. Eating Disorders, 21 (1), 37-52 PMID: 23241089

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Andrea is a PhD candidate focusing on individual, familial, and health care definitions and experiences of eating disorder recovery. She has an MSc in Family Relations and Human Development and a BA in Sociology. In her Masters research, she used qualitative and arts-based approaches (digital storytelling) to explore the experiences of young women in recovery from eating disorders. Andrea has recovered from EDNOS. She can be reached at andrea[at]scienceofeds[dot]org.


  1. I would like to start this comment off by saying that no mother should feel inadequate as a mother just because they have an eating disorder, but you should continually be working to better that disorder for the sake of your child. Secondly, I wish you would go into more detail about which eating disorders the mothers are experiencing. There are four main types of eating disorder which are: Anorexia nervosa, Binge-eating disorder, Bulimia Nervosa and then eating disorders that are not exactly specified. Anorexia Nervosa is basically when a person decides that they no longer wish to eat much of anything because they must retain a slim figure. If you are on your way to motherhood, you better not have this disorder because it would be very unhealthy for your child. Bulimia nervosa is the fear of being fat, which is a main problem in society today. If you have this disorder and you have children, you are being a terrible example to your children. The comment about the mother knowing that the child knew about her disorder, and she still would not allow any discussion of the matter is just sad. I totally agree that becoming a mother can and should influence you to become a better role model not only to yourself, but to your child as well.

    • Hi Evan, thanks for commenting. I agree that, as you say, no mother should feel inadequate because they suffer from an eating disorder. I hope that came through in the post! In terms of the eating disorders these mothers had, this is outlined under the “which mothers?” subheading. 3 were diagnosed with bulimia nervosa (BN), 4 were diagnosed with anorexia restricting subtype (AN-R), and 6 were diagnosed with eating disorder not otherwise specified (EDNOS).
      I may be misinterpreting, but I can’t help but feel that your suggestion that “you are being a terrible example to your children” is somewhat at odds with how you begin your comment? When I was reading the article that formed the basis for this post, I felt a great deal of empathy for these mothers who, as I have written in the post, may desire recovery very much- but “recovering” is not as easy as simply deciding that one WANTS to recover- eating disorders are incredibly complex and often tenacious illnesses. Further, despite the amazing clinicians and researchers working in the field to develop and evaluate treatment programs, there is no consensus as yet as to the best way to facilitate recovery. Just a few things to think about!

    • Hi Evan,

      I know I’m late to the party here, but I think this warrants clarifying, if only for other folks who may later read these comments: the definitions you posit for Anorexia Nervosa and Bulimia Nervosa indicate what I see as a serious misunderstanding of what motivates these illnesses.

      Everyone’s experience is a little bit different, but as someone in recovery from anorexia (sick for 3 years, then recovering/healthy for 4 years, then relapsed for 1 year), I often have to explain that I never “decided” that I didn’t want to eat, and that I’m not a particularly body- or thinness-focused person. For me, an initial period of undernutrition triggered a cascade of obsessions, compulsions, fears, and behaviors that became more ingrained the longer they were in place. That’s why early detection and treatment are so important, and why, by the time a woman with anorexia is old enough to be a mother, her eating disorder can be particularly intractable. The women in this study had been ill for an average of 15 years. I hope you are as struck as I am by the profound sadness of that fact.

      Here’s how I explain my anorexia to friends and family (I can’t say much about bulimia except that it is also very serious, very painful, and can be life-threatening): Most people react to undernutrition by finding food and eating it. If you had a stomach bug for a few days, you might feel very hungry and want to eat a lot once you got well. That’s because we like eating, and it makes us feel good! But in those prone to anorexia, who are often folks who are already experiencing a higher-than-normal level of anxiety for one reason or another (I was simply always an anxious person; it runs in my family!), stumbling upon undernutrition can be very dangerous. I “stumbled” upon it twice. I had always been a skinny kid, and as a teenager in sports, failed to eat enough to put on weight after a major growth spurt. Anorexia (binge/purge subtype) followed. Years later, I relapsed (restricting subtype) after a short bout of clinical depression made me lose my appetite (and a bit of weight). I found that eating less soothed my anxiety and made me feel actually quite good. The obsession with body and calories, the drive for thinness- all of that came a bit later, and it got worse the more weight I lost.

      I did not eat less because I wanted to be thin. I wanted to be thin (and thinner, and thinner) because I wasn’t eating enough! If you’re interested, it might help to take a look at Ancel Keys’ Minnesota Study, which documents how forced semi-starvation can cause many of the behaviors and thoughts we often associate with anorexia in otherwise healthy people.

      Eating disorders are really complicated and unintuitive. I’ve offered only a piece of the narrative and am missing some major pieces of the puzzle. An interesting question, for instance, is why some people are prone to anorexia while most people aren’t. Also, how the illness can eclipse and replace healthy coping skills and relationships in a sufferer’s life.

      What’s really unfortunate is that eating disorders “look” like a lot of things that they aren’t, especially in our society, where short bouts of self-imposed semi-starvation (diets) are considered normal. “Dieting gone wrong”, “dying to be thin”, even “fear of being fat”, aren’t fair ways to talk about these illnesses. Eating disorders are intensely psychologically and physically painful for sufferers; it can feel hopeless, disorienting, and scary to be in the midst of this illness. Eating disorders kill, and I believe we owe sufferers our compassion and serious attempts at understanding. Trust me, they get plenty of judgment from other sources.

      P.S. What about the children? I was the child of a mother who had fully recovered from bulimia nervosa years before I was born. My mom was always body- and food-positive with us. I can’t imagine how sad and frustrating it must be to have a parent with an active eating disorder. It is distressing for a child when their parent has any serious illness. Even adult children may have lingering anger and resentment, which is understandable. But for the rest of us, we should recognize that having an eating disorder is not a choice, and as we see in this study, many parents with eating disorders, past or present, take extreme precautions to make sure they are not modeling unhealthy behaviors for their kids. My two cents? Let’s develop and provide treatments that offer strong nutritional and cognitive support to the sufferer and emotional/practical support and hope to their families, get these parents into remission, and help folks move on with their lives.

      • Thanks, Alexandra, for this fantastic clarification and narrative of your own experiences. I hope that Evan takes the time to read your thoughtful reply! I particularly like that you say “I believe we owe sufferers our compassion and serious attempts at understanding. Trust me, they get plenty of judgment from other sources,” and I absolutely agree, and I hope that comes through in my posts. I also agree that we need to be putting our efforts toward developing accessible treatment to help facilitate the difficult process of recovery.

  2. I really enjoyed reading your blog, it is very closely related to what I am learning in my psych 101 class right now. We are learning about child birth and how postpartum depression after a women has a child. It is extremely common for a women to go through some type of depression after giving birth and one of the main symptoms of postpartum depression is sleep and eating disturbances, so it not surprising that some mothers might just ignore these symptoms and not try and reach out for some form of help and then this symptom of postpartum depression can later turn in to a eating disorder when gone untreated. And there are so many different types of eating disorders, but the ones ive learned about are anorexia nervosa (which is starving yourself) and bulimia nervosa (which is binging on food and throwing it up right after). So every person is different, and there is no harm in admitting that you need help. I feel like no mother or anyone should be ashamed of having an eating disorder, or think that they are a bad mother to their child because they have one. That is not the case what so ever, just because you have an eating disorder doesn’t mean you are a bad parent, because you are in no way harming the child. But with that being said I do agree that once the child is old enough to figure out that you have an eating disorder that you should immediately seek some help because what your child see’s is what they will begin mimic. And no one should every want there child to see them with an eating disorder and let them think that is okay, you need to be a better role model for you child then that, and you need to be a better role model for yourself.

    • Hi Megan, thanks for commenting. I hadn’t thought about potential links to postpartum depression, but now I think I might turn to the literature and see if there are any studies linking eating disorders and postpartum depression. I’d be careful with your definitions of anorexia and bulimia- please recognize that eating disorders take a lot of shades, and don’t exist solely in these binaries. I also think it is important to be a bit cautious in avoiding placing the blame on individuals- as I noted in my response to the comment above yours, recovering from an eating disorder is not as simple as just wanting it, or wanting to be a better role model to oneself or to ones children, as the women in this study so brilliantly articulated. There are a number of potential barriers to treatment and to recovery that differ depending on an individual’s social location (i.e. gender, sexual orientation, socioeconomic status, ethnicity etc.), and treatment effectiveness can vary as well based on the course of one’s disorder, the therapeutic alliance, and other factors in an individual’s life. I’m glad you enjoyed the post and I hope that you continue to learn about eating disorders and other mental health issues.

  3. Being the child of a mother who has suffered from an eating disorder, both anorexia and bulimia, this was a very interesting article o read. In response to the first comment, yes a child can be a good starting point for motivation to seek treatment, however if the mother truly wants to seek help and treatment it ultimately has to be for her, something she wants for herself. Otherwise, in my personal observations, the treatment won’t be successful for long term. And yes, growing up in a household where a parent struggles with an eaing disorder does take a tole on the child. I am extemely self-concious about my own body image and I believe that is largely due to my environment growing up. It is a terrible disease to have for both the sufferer and their family members.

    • Thanks for commenting- it’s great to get your perspective. I definitely agree that ultimately seeking and obtaining treatment is an individual choice, in order to lead to long term change.

  4. I enjoyed reading on your blog that you posted. I never really thought about mothers going through having eating disorders until recently learning about eating disorders and how most mothers can go through postpartum depression after childbirth in my psychology class. It’s common for most women to go through a stage of depression after giving birth. Some symptoms of postpartum depression is having sleep and eating disturbances. But whether they are suffering from anorexia or bulimia it’s in their best interest and up to them to want to get help. When their children become aware or are involved in their mother’s disorder it is also affects them. The mother’s behavior would most likely have a negative impact on their child by showing poor examples of healthy eating behaviors. All children do however, look up to their parents as their role model and you don’t want them to grow up thinking that behavior is okay. But it is extremely important for any mother that is suffering from those kinds of disorders to get help to get better and be there for their child and see them grow up.

  5. Mothers with history of eating disorders sought for study at Stanford University. We are testing a new parent-based prevention program for mothers with histories of eating disorders, who have children between 1-5 years old. For more information, please contact

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