She sat in the corner of my office couch, teary-eyed, body stiff, hands clasped tightly in her lap below her slightly swollen stomach as the silence in the room began to blossom until it felt like a cloud filled with rain before the rain pours. . The air was heavy with the emotion he was trying to hold back, but he wanted to let it out.
Finally, with a deep breath, the cloud broke and the tears flowed. She slowly raised her eyes and whispered, “I’ve always wanted to be a mom. Because of my eating disorder, I never thought I would be a mother. So why can’t I eat more to provide enough food for me and my baby? Why can’t I eat for my baby? I feel so ashamed.”
Sitting on the same couch an hour later, another mother with a bright smile on her face and hope in her eyes, but said skeptically, “Pregnancy is really good; I don’t engage in any behaviors – no restricting and bingeing or purging! I forgot what it felt like to be free of these behaviors. As I’m nearing the end of my pregnancy, I’m starting to worry about what my eating disorder will be like once the baby is here. Why can’t I just get out of here?”
“I’ve been in recovery from disordered eating for over five years and the thoughts keep coming back because I’m so wild, I’m always nauseous, and my body changes so quickly. I feel like a failure in recovery!”
“All my life, I’ve struggled to have confidence in my body, but I’m getting more confident, even during pregnancy. This postpartum body has thrown me for a loop! I’m really struggling. I’m scared because I want I want to raise my child without body shame. How can I do that when I’m already struggling?”
While these are not direct quotes, I have heard variations of these thoughts in my office countless times.
One of these quotes may be similar to you and your story. And I want you to know, you are not alone. So many good women, good mothers, are also struggling.
The presence of eating disorders during pregnancy and postpartum (referred to as the perinatal period) is not discussed often enough, in either the eating disorder world or the perinatal world. This silence leaves mothers feeling isolated and confused about how to care for themselves and their children.
Let’s break some of that silence now. I could write 50 different blogs (at least!) about pregnancy, postpartum, and eating disorders, but let’s start by bringing gentle awareness to a sensitive issue.
Before working within perinatal mental health, I specialized in eating disorder work and was surprised at how common the two were! Perinatal Mood and Anxiety Disorders (PMADs) and eating disorders (EDs) share many commonalities that surprised me as well.
Here are some similarities between the two:
Under-screened, underdiagnosed, undertreated
Eating disorders and perinatal mental health are both underdiagnosed and underdiagnosed, and often untreated. Because both are commonly associated with misconceptions and stigmas, both are often ignored and therefore not diagnosed, without treatment recommended by professionals.
There is no discrimination, but racial differences are the same
There is no discrimination, meaning they can affect anyone of any culture, gender, race, religion, socioeconomic status, weight, and age. We see racial disparities in both EDs and PMADs, with BIPOC and LGBTQIA being disproportionately affected.
Develop from a bio-psycho-social perspective
Both are developed from a bio-psycho-social perspective, meaning there are many factors that cause someone to develop an eating disorder or perinatal mood and anxiety disorder. No one person or event or thing is to blame. We see a high correlation between trauma and the presentation of both, but trauma does not cause either development.
They often go hand in hand
Another interesting interplay is that pregnancy and the postpartum period are vulnerable times for the development of a new eating disorder or a time for the return of old behaviors and thoughts. In addition, having an ED increases the risk for a PMAD during pregnancy or postpartum. They don’t always go together, but they are usually seen together.
With appropriate screening and intervention, there is hope!
An encouraging analogy is that with appropriate screening and intervention, there is hope and healing from both struggles! When you’re in the midst of an eating disorder or PMAD, it seems like there’s no hope.
There is always hope!
So what can you do?
Whether you’re reading this for yourself, a loved one, or someone you work with in a pregnancy or postpartum capacity, it’s important to know that there are steps you can take.
Know the signs and symptoms
There are different signs and symptoms for eating disorders and PMADs depending on the exact disorder presenting. However, there are some red flags that may trigger you and your loved ones to seek help.
- Sudden or drastic changes around eating, exercise, or body image
- Trouble bonding with baby (or other children, pets, or partner)
- Withdrawal and withdrawal from previously pleasurable activities
- Mood changes (sadness, irritation, confusion, anger, suspicion of others)
- Changes in sleep patterns
- Fatigue that is not relieved by adequate sleep
- Skipping meals, eating only certain foods
- Obsession with appearance, weight, food, exercise, body
- Exercising when sick or injured
The National Eating Disorder Association has a quick video on ED signs and symptoms and there’s a free screening tool, as well blogs on pregnancy and ED.
Reach out for help
Regardless of any signs or symptoms, trust your gut if you feel something is wrong. Whether you’re struggling and feeling like you’re not yourself, or you’re watching from the outside, talk to safe people in your life about how you’re feeling and thinking. If their response feels dismissive, talk to someone else. It’s sad, but I hear many stories about feeling unheard at the first attempt to ask for help. Keep reaching out – someone will listen!
Seek professional help and find resources
There are many free resources – two great online communities are Mandwell (blog, podcast, social media accounts, and workshops) and PsychedMommy (blogs, social media, workshops). There are so many professionals who want to support you! Search the PSI directory for trained professionals. International Association of Eating Disorder Professionals and the Center for Body Trust there are also directories.
When you are in the midst of perinatal mood and anxiety disorder or eating disorder, it seems hopeless. Sometimes it seems like negative thoughts and self-hatred are WHO YOU ARE, but that’s not the truth.
There is hope. You are good, you are worthy, you are lovely.
You deserve the loving care and attention you so desperately seek, even when it’s difficult. You can get help and you can get better.
Whether you are a loved one or a professional, please move toward the person hurting in front of you. Slowly name the struggle and pain you see and walk with them. Encourage testing to seek accurate diagnoses and the appropriate help.
