As a clinical psychologist, I run a group in our eating disorders inpatient program in which patients work to identify and stay connected to meaningful motivators for recovery. I came to this position having previously worked in a Perinatal Psychiatry Center, and more recently, have had the experience of becoming a mother. Together, these experiences sparked my curiosity about the intersection of eating disorders and perinatal mental health.
Pregnancy and the postpartum period are, by nature, a time marked by changes in body shape, size, and function. They are also periods of time where many mental health issues can first emerge, re-emerge, or worsen.
Body changes coupled with greater rates of anxiety and depression can lead to increased struggle with body image throughout the perinatal period. Similarly changes in appetite and nutritional needs can pose challenges with meal plans and regulating eating. These issues can emerge in those with stable eating patterns or can worsen in those who have previously experienced disordered eating.
During my time working with perinatal patients, I often heard individuals without any eating disorder history struggle to accept body changes while progressing through pregnancy and after delivery. To some degree, this is a normal, expected part of the perinatal experience. Similarly, I have worked with patients with eating disorders who have become pregnant and grappled with new challenges: from increasing intake to support a growing fetus or to breastfeed to accepting inevitable (and needed!) weight gain.
Pregnancy and Parenthood as a Motivator
The hope of having a family and a related drive to reestablish reproductive health is a strong motivator for recovery for some individuals with eating disorders. To bring this motivator to life, these folks may find it useful to:
- envision their future self in a body with restored reproductive function (and body fat) necessary to become pregnant,
- consider what it might be like to experience necessary body changes during and after pregnancy, or
- focus on what will be required physically, emotionally and cognitively to care for a child.
The more specific, the better. Because a detailed image can clarify the benefits of recovery and the steps necessary to achieve it.
In terms of eating, research findings are also suggestive of pregnancy as a driver for health. Studies indicate that pregnancy can lead to adaptive changes in eating behavior. For example, individuals with a history of a restrictive eating disorder who become pregnant may start increasing their intake. Those with binge eating, purging, or restrictive eating all tend to begin eating in ways that are more consistent with overall health and well-being.
Why might the chances of improved eating increase during pregnancy? Perhaps because during this time, women tend to be more aware of and attentive to how nutrition is affecting neonatal development.
The Perinatal Period as a Stressor
On the other hand, for both those with an active eating disorder and those with a history of an eating disorder in remission, the perinatal period can also be a time of increased stress. This stress can exacerbate pre-existing issues with food and/or body image or incite new concerns. Moreover, for those without a history of an eating disorder, pregnancy and the postpartum period have been shown to pose an increased risk for the development of disordered eating and eating disorders.
The perinatal period can pose numerous new and challenging experiences, such as:
- weight gain
- increased body awareness
- increased attention towards one’s body from others
- hormonal changes
- sleep deprivation
- schedule changes
- identity shifts
- comparisons to others
- postpartum body changes
These experiences can lead the vulnerable individual to the use of eating disorder behaviors to cope.
Effects of Eating Behavior on Pregnancy
The majority of women with eating disorders do have normal pregnancies and deliver healthy babies. Still, eating disorder symptoms experienced during pregnancy have been linked to several problems. These include problems with weight gain and delivery, as well as health issues in offspring, such as low birth weight. Therefore, those with a prior or current eating disorder diagnosis, or those with emerging subclinical symptoms, may benefit from close monitoring and potential intervention during pregnancy.
Self-Advocacy during Pregnancy
It is important to talk to your healthcare providers about any eating disorder symptoms (or early warning signs) you may be experiencing during pregnancy.
If you are a patient who is already participating in eating disorder treatment, ask if your treatment providers can collaborate with your obstetrician to make sure your care is tailored to your needs during and following pregnancy. For example, your meal plans or medication may need alterations to accommodate perinatal-specific factors.
You can also collaborate with your providers on
- how weight gain is monitored and how often and in what ways it is discussed,
- coping with recommended changes to physical activity (if advised to make any), and/or
- managing food cravings or aversions in a manner that is consistent with your recovery.
Additionally, it may be helpful to research perinatal mental health providers in your area to access specialized mental health services during preconception planning, pregnancy, and the postpartum period. Pregnancy and the postpartum period are good times to leverage your social support system. Reach out to others in your life for help at mealtime, increased accountability, or assistance in seeking treatment. The old adage, “it takes a village to raise a child,” still rings true. And that same village can also be there to support new parents through the transition of the perinatal period.
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