Intersections Between Disordered Eating and Reproductive Trauma

Intersections Between Disordered Eating and Reproductive Trauma by Shira Collings, MS, NCC, LPC

Trigger warning: this article contains mention of reproductive trauma.

As an eating disorder therapist, I feel that more attention needs to be drawn to the intersections between disordered eating and reproductive trauma. While there is increasing awareness of the ways that pregnancy can be a risk factor for the development or exacerbation of disordered eating, I feel that a missing piece of the conversation is the ways that struggling to become pregnant and pregnancy loss can contribute to disordered eating.

Although infertility, pregnancy loss, and other forms of reproductive trauma are quite common, we as a culture tend to see these experiences as abnormal and rare because they are so stigmatized and, therefore, not discussed openly. I believe that this mentality contributes to a great deal of shame and blame. People experiencing reproductive trauma are often made to feel broken and inadequate, as if they are not deserving of becoming parents, or if they are doing something wrong that is causing their infertility or losses. In the infertility and TTC space, there can be a great deal of pressure to do everything one can to maximize the odds of a pregnancy and live birth, alongside a subtle (or not so subtle) message that infertility or loss is the result of failing to do so.

This can lead to an incredibly perfectionistic mentality in lots of areas of life, and it is no wonder that this commonly shows up around food. Diet culture is a term used to describe the ways that our society moralizes food, viewing some foods as healthy and “virtuous” and other foods as unhealthy and “indulgent.” Diet culture is pervasive in the fertility space. It is not hard to see how this can lead people experiencing reproductive trauma to obsess over the quality and quantity of the food they are eating, and to scrutinize their plates and bodies in a way that interferes with their mental health. While disordered eating often results at least in part from the belief that one is not “enough” or is not doing enough to be deserving of good things/happiness/health/etc., what is so dangerous about disordered eating is that for many people struggling with this, no amount of limiting foods or exercising ever feels like “enough.” Diet culture messaging can find something negative to say about almost every food or food group, and many individuals are left feeling like there is nothing that is fully safe to consume. More generally, it is rare for people experiencing reproductive trauma to be told that they are doing enough to have a pregnancy and live birth, and instead, it is common for people to constantly be offered advice and directives on what they should be doing more of. This, combined with diet culture, can lead to a dangerous path of relentless restriction, compulsive exercise, and all-consuming obsessions about food. It is all too common for the body, food, and movement to become a site of scrutiny and judgment rather than a source of comfort, enjoyment, or nourishment.

It is important to name weight stigma in conversations about diet culture and disordered eating. Weight stigma – i.e., the idealization of thinness, pathologization of fatness, and the belief that being thin is inherently healthier than being fat – goes hand in hand with diet culture and is a major contributor to disordered eating. As a culture, we tend to assume that being in a larger body is a result of poor food and exercise choices and that people in larger bodies are to blame for any health issues they may be experiencing due to these choices. In reality, body size diversity is natural and normal; our body size has much more to do with genetics and other factors outside of our control than food or exercise choices. (I recognize that this is a different perspective than many people have heard and runs counter to a lot of what we are told about body size. Please see below for a list of resources to learn more.) Unfortunately, in fertility spaces, people in larger bodies are often blamed for their reproductive trauma. People in larger bodies are often denied fertility treatment due to their BMI or have infertility and losses blamed on their body size without other factors being investigated. This, of course, can drive disordered eating and body image distress and puts people in larger bodies at an especially high risk of these concerns.

Another way that reproductive trauma can intersect with disordered eating is that disordered eating sometimes can result from a need to externalize pain. Many people with eating disorders feel that their emotional pain and struggle are not valid or legitimate unless it is visible in the form of appearing emaciated. This mentality is reinforced by our cultural misconceptions about eating disorders – a major misconception is that it is possible to tell whether someone has an eating disorder, as well as what type and how severe their eating disorder is, based on their body size. Although this is highly inaccurate, and people of any body size can have an eating disorder, this misconception can make people feel that their pain does not matter unless they are below a particular weight. 

Similar to our misconceptions about disordered eating, our society also has a lot of misconceptions about infertility, pregnancy loss, and whose pain is and is not valid or legitimate. People experiencing infertility and early pregnancy loss are often not given the space to grieve their losses. These losses are invisibilized by our society and not seen as important or as deserving of space as other losses. This may contribute to individuals using disordered eating as a way to externalize pain and feeling that their appearance needs to be visibly altered in order to be deserving of space to grieve.

Therapists and other professionals who work with people experiencing reproductive trauma need to check in with their patients about disordered eating and body image and be prepared to address these issues as they come up. It is also important for us to examine any implicit biases or beliefs we have that may inadvertently reinforce a patient’s disordered eating or negative body image. Because diet culture and weight stigma are so pervasive in our society, it is easy for us to internalize and absorb these ideologies without realizing it. Below are some suggestions for ways to address disordered eating and make sure not to reinforce it in your practice:

  • Assess all of your patients experiencing reproductive trauma for disordered eating. Don’t assume that you can tell by someone’s body size whether they have an eating disorder/disordered eating, or the type or severity of eating disorder that they have. 
  • Learn about the Health At Every Size paradigm. I would recommend starting with the book Anti-Diet by Christy Harrison, which provides an excellent overview of some of the myths and facts about body size and why the assumption that fatness is unhealthy is inaccurate. The podcasts Food Psych and Maintenance Phase are also great resources.
  • Develop a working knowledge of fat-positive and eating disorder-informed fertility/loss resources to refer to. Find out which healthcare providers in your area are sensitive to the needs of people in larger bodies and people with histories of disordered eating. An educational resource that could be helpful to point patients toward is the work of fat-positive fertility coach Nicola Salmon.
  • Advocate for your patients’ needs in healthcare settings, as this can be a place where weight stigma is pervasive and can be quite triggering to those with disordered eating. If you are working with someone with a history of disordered eating who is going through fertility treatment, ask for their weight not to be discussed at appointments.
  • Understand and recognize how reproductive trauma might intersect with risk factors for disordered eating, including perfectionism, minimization of emotional pain, and societal stigma. Check in with your patients about how these factors might be impacting them. 

Resources on body size:

Eating disorder resources:

Shira Collings, MS, NCC, LPC (she/they)

About the Author

Shira Collings, MS, NCC, LPC (she/they)

Shira Collings, MS, NCC, LPC (she/they) is a psychotherapist in Philadelphia, Pennsylvania. She primarily specializes in eating disorders, disordered eating, and body image, and is especially passionate about providing neurodiversity-affirming, LGBTQ+ affirming, and fat-affirming eating disorder care. Shira’s own experience with pregnancy loss sparked their interest in exploring how reproductive trauma can intersect with disordered eating as well as weight stigma in the fertility field.

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