When Eating Disorders and Perinatal Mental Health Collide
She sat tucked into the corner of my office couch, eyes downcast, body rigid, hands tightly folded in her lap below her slightly swollen belly as the silence in the room began to bloom until it felt like a cloud full of rain right before the downpour. The air was heavy with emotion that she was trying to suppress, but desperately wanted to release.
Finally, with a deep breath in, the cloud broke and let the tears loose. She slowly raised her eyes and whispered, “I’ve always wanted to be a mom. Because of my eating disorder, I didn’t think I could be a mom. So why can’t I eat more to provide enough nourishment for me and my baby? Why can’t I eat for my baby? I feel so much shame.”
Sitting on the same couch an hour later, another mom had a bright smile on her face and hope in her eyes, but with some hesitancy stated, “Pregnancy has been really nice; I haven’t engaged in any behaviors – no restricting and bingeing or purging! I forgot what it felt like to be free of these behaviors. As I’m at the end of my pregnancy, I’m starting to worry what my eating disorder will be like once the baby is here. Why can’t I just be free of this?”
“I’ve been in recovery from disordered eating for over five years and the thoughts are creeping back in because my appetite is so wild, I’m nauseous all the time, and my body is changing so quickly. I feel like such a failure at recovery!”
“Throughout my life, I’ve struggled to feel confident in my body, but I was getting so much more confident, even during pregnancy. This postpartum body has thrown me for a loop! I’m really struggling. I’m scared because I want to raise my child without a sense of body shame. How do I do that when I’m struggling so much?”
Although these are not direct quotes, I’ve heard variations of these thoughts in my office countless times.
One of these quotes may sound similar to you and your story. And I want you to know, you are not alone. So many good women, good mothers, are struggling, too.
The presence of eating disorders during pregnancy and postpartum (defined as the perinatal period) is not discussed often enough, in either the eating disorder world or the perinatal world. This silence leaves moms feeling isolated and confused about how to care for themselves and their children.
Let’s break some of that silence today. 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.
Prior to working within perinatal mental health, I specialized in eating disorder work and was surprised at how common the two are! Perinatal Mood and Anxiety Disorders (PMADs) and eating disorders (EDs) share many commonalities that also surprised me.
Here are a few commonalities between the two:
Under-screened, underdiagnosed, undertreated
Eating disorders and perinatal mental health are both under-screened and underdiagnosed, and often left untreated. As both are commonly associated with misconceptions and stigmas, both are often overlooked and therefore not screened, without treatment recommended by professionals.
Neither discriminate, but both share racial disparities
Neither discriminate, meaning they can affect anyone of any culture, gender, race, religion, socioeconomic status, weight, and age. We do see racial disparities in both EDs and PMADs, with BIPOC and LGBTQIA being affected disproportionately.
Develop from a bio-psycho-social standpoint
Both develop from a bio-psycho-social standpoint, 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 do see a high correlation between trauma and the presentation of both, but trauma does not cause either to develop.
They often co-occur
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 relapse of old behaviors and thoughts. In addition, the presence of an ED increases the risk for a PMAD during pregnancy or postpartum. They don’t always go hand in hand, but it’s common to see them together.
With appropriate screening and intervention, there is hope!
An encouraging commonality is that with appropriate screening and intervention, there is hope and healing from both struggles! When you are in the middle of an eating disorder or a PMAD, it doesn’t feel like there is hope.
There is always hope!
So what can you do?
Whether you are reading this for yourself, a loved one, or someone you are working with in a pregnancy or postpartum capacity, it’s important to know there are steps you can take.
Know the signs and symptoms
There are varying signs and symptoms for eating disorders and PMADs that depend on the exact disorder that is presenting. However, there are a few red flags that can trigger you and your loved ones to seek help.
- Sudden or drastic changes around food, exercise, or body image
- Trouble bonding with baby (or other children, pets, or partners)
- Withdrawal and isolation from previously enjoyable activities
- Shifts in mood (sadness, irritability, confusion, rage, suspicion of others)
- Changes in sleep patterns
- Fatigue that is not eased with adequate sleep
- Skipping meals, only eating certain foods
- Obsession about appearance, weight, food, exercise, body
- Exercising when sick or hurt
The National Eating Disorder Association has a quick video on ED signs and symptoms and has a free screening tool, as well as blogs on pregnancy and EDs.
Reach out for help
Regardless of any sign or symptom, trust your gut if you sense that there is something off. Whether you’re struggling and feel like you aren’t yourself, or if you are watching from the outside, speak to safe people in your life about what you’re feeling and thinking. If their response feels dismissive, talk to someone else. It’s unfortunate, but I hear a lot of stories about feeling unheard on a first attempt to reach out for help. Keep reaching out – someone will listen!
Find professional help and seek resources
There are plenty of free resources – two great online communities are Momwell (blog, podcast, social media account, and workshops) and PsychedMommy (blog, social media, workshops). There are so many professionals that want to support you! Search the PSI directory for trained professionals. International Association of Eating Disorder Professionals and the Center for Body Trust have directories as well.
When you are in the middle of a perinatal mood and anxiety disorder or an eating disorder, it feels like there is no hope. Sometimes it feels like the negative thoughts and self-hatred are WHO YOU ARE, but that’s not truth.
There is hope. You are good, you are worthy, you are lovable.
You deserve the tender care and attention you deeply long for, even when it’s hard. You can get help and you can get better.
If you are a loved one or a professional, please move towards the person hurting in front of you. Gently name the struggle and pain you see and walk with them. Encourage screening to seek accurate diagnoses and the appropriate help.
Melodye Phillips is a Licensed Professional Counselor-Supervisor (LPC-S), Certified Perinatal Mental Health Provider (PMH-C), Certified Eating Disorder Specialist (CEDS) and Spiritual Director in Texas. She owns Maternal Mental Health of East Texas where she specializes in working with mothers during pregnancy, postpartum and motherhood after loss, complicated pregnancies, birth trauma, and those that struggle with disordered eating and body image issues and faith and spirituality concerns. Melodye has three children of her own and has had experiences that ushered her into working with other mothers during pregnancy, postpartum, and beyond. She enjoys watching and talking sports with her husband, baking, cooking, crocheting, and reading.