Eating disorders during pregnancy are rarely discussed at OB appointments, but they’re not uncommon (a 2014 Norwegian review of studies surrounding women and eating disorders found that eating disorders in pregnancy are “relatively common” and may cause health risks for both mother and baby; some experts hypothesize one in twenty women suffer an eating disorder while pregnant). Bottom line: They should definitely be a topic of conversation between patients and health care providers, especially if a pregnant person has a history of disordered eating. “For women who have struggled with eating disorders in the past, a pregnancy is a time when special attention should be paid to their psychological wellbeing and physical health. Seeking support during this time may be wise,” says Ovidio Bermudez, MD, a psychiatrist and Chief Clinical Officer at Eating Recovery Center, an eating disorder treatment center in Denver, CO.
And the postpartum period is one where a new parent can be equally vulnerable: Stress, exhaustion, and pressure to bounce back to a pre-baby weight can all exacerbate disordered eating behavior, even if the person hasn’t exhibited symptoms in years. But what’s particularly worrisome, says Bermudez, is the fact that many moms may hide their eating disorder because they’re ashamed. “A woman may feel like she’s not a good mom because she’s struggling, when it’s an illness, it’s something bigger than her and has nothing to do with her self-control or her parenting skills,” says Bermudez. That’s why it’s crucial to get help from an expert. If you are struggling with an eating disorder and are in need of support, please call the National Eating Disorders Association Helpline at 1-800-931-2237. For a 24-hour crisis line, text “NEDA” to 741741.
Here, writer Anna Davies shares how disordered eating became an issue when her daughter was six months old.
I walked into the elevator of the office building of my new job, bracing myself for comments and hoping my put-together outfit — sleek black dress, chunky gold necklace and four-inch heels — would distract from the bruise blooming around my black eye.
But I could tell, from the sidelong glances given to me by other people in the elevator, that it hadn’t. By the time I got to my desk, I’d crafted a story.
“Lucy kicked me in bed,” I said, referencing my seven-month-old daughter. My coworkers laughed — I worked at a company that made baby products, there were plenty of other parents on staff: They got it.
It wasn’t the truth. The truth is, I had given the black eye to myself. I had made myself throw up that morning, and the force of the vomiting had caused blood vessels in my eyelids to rupture. I learned that from the ophthalmologist I visited the next day, who had asked me if I’d recently had a bout of the flu. I lied and said yes.
But I knew my eye was the least of my problems. I was anxious and stressed and exhausted as a single new mom, and, to cope, I’d been purging in the bathroom. I would do it while my daughter was in her crib, running the shower so she couldn’t hear. I felt guilty doing it as a parent — after all, the last thing I wanted was to model disordered eating for my daughter as she grew older — but I couldn’t stop.
I had been dealing with disordered eating since I was in my late teens, and by my twenties I was purging multiple times a week. I tried seeing a few therapists, but none were the right fit, and I was surprised at the lack of knowledge that some of the therapists I confided in seemed to have about disordered eating patterns (one told me it “wasn’t like I was that skinny, anyway,” and another tried to psychoanalyze my purging patterns, convinced it had something to do with my relationship with my mother.) I tried to manage my disordered eating on my own, and by the time I was 28 and training for a marathon, I stopped completely because I was afraid of the ramifications purging, combined with heavy exercise, would have on my body. As I became more interested in training for different races and trying workout challenges, I began to develop a more positive relationship with my body. By the time I was thirty, I was convinced that my purging days were behind me.
And then I got pregnant. I was worried that my disordered eating might become a problem as my body changed, and I tried to bring up the topic with my OB. On the first office visit, I told her I didn’t want to see my weight. While she was okay with letting me look away from the displayed number, over time, it was clear she didn’t understand that my request came from a deeper place than vanity. One time, in my second trimester, she scolded me for gaining seven pounds. I burst into tears on the exam table — the only time during my pregnancy I cried.
The truth is, I had given the black eye to myself.
“It’s okay, I know how it feels,” she said, awkwardly trying to console me, even though I was pretty sure she didn’t understand at all. All I wanted to do was run to the bathroom and vomit. The only thing that stopped me was the fact that it wasn’t just my body anymore.
I was too afraid to ask my OB for a referral for a therapist; as a single mom, I already felt like I was under so much scrutiny. I didn't want my OB to think I couldn’t handle the challenge.
I didn’t purge during my pregnancy. It wasn’t until my daughter, Lucy, was six months old that I felt the urge again. And while I wasn’t 100% satisfied with my post-baby body, the urge was anchored in so much more than body image. I liked the control I felt when I purged; liked the feeling of an empty stomach. I never binged, my purges could occur after any meal or no meal at all. I was stressed about making money, stressed about finding a job, stressed about being a good parent, and purging felt, weirdly, like a form of self-care. It was something that could make me feel better, fast.
But when I got the black eye, I realized things needed to change. This time, I was very careful about which therapist I decided to work with. Before, anyone who took my insurance and worked within a five block radius of my office was fine. This time, I asked other new moms for recommendations for therapists who specialized in postnatal depression or postnatal anxiety; while I wasn’t sure I had either, it was imperative the therapist I spoke with had extensive experience with new moms. Once I had a few recommendations, I asked about how their eating disorder expertise: I wasn’t sure I would be able to stop purging right away, and I wanted to make sure that a therapist I worked with would help me figure out a way to stop that wouldn’t feel overwhelming. I also wanted a therapist to understand the pressure I put on myself — that I already felt so guilty for purging; I needed to feel like someone was in my corner.
Eventually, I found someone. Instead of focusing on not purging, I began focusing on the stressors in my life. One of the huge ones was my job — I began looking for new positions and left that one after a few months. I also had been putting a ton of pressure on myself to do everything perfectly. I didn’t want people to think I was struggling as a single mom, so I tried my hardest to make it look like everything was easy to me — even if it wasn’t. For example, one time, when my new mom friends and I planned a potluck barbeque, instead of offering to pick up napkins or tableware, I volunteered to bring desserts. I made five desserts that day while my daughter played in the kitchen, all for the I could never do what you do compliments.
And that was the biggest takeaway from therapy: That I didn’t need to prove myself, and that every parent — single, married, whatever — needs help sometimes. I began asking friends to watch Lucy, stopped trying to be Supermom when it came time to plan the playdates, and also confided in my friends when I was feeling anxious or stressed out.
Now, Lucy is two, and I’m so much better than I was. I don’t see a therapist anymore, and I feel so much happier and at ease than I was that winter morning a year and a half ago. But I’m not “cured.” I’m very sensitive to conversations surrounding weight. Discussions of losing the baby weight make me so angry; an innocuous message from a friend-of-a-friend asking me if I’m interested in her weight-loss coaching because she “specializes in new moms” led me to fire back an angry diatribe, explaining just how many new moms might be triggered by that type of language. I think eating will always be a fragile topic for me, and I know that if I do feel like I want to purge, it’s a sign I may need to check in with my therapist and figure out what’s out of whack with my life.
I’m also open about just how hard all of this was to navigate, because I wish I had known back then that I wasn’t alone, that new parenthood can bring up issues you thought were in your past, and that part of being a great parent is knowing when to ask for help.
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