Pregnancy can be difficult for many, but for women who have battled eating disorders like anorexia, this joyful time can be incredibly complicated to navigate. Lana Andelane looks into the hidden battles anorexia survivors face during pregnancy.
For Isobel*, pregnancy has been complicated.
Vomiting, food aversions, swelling, and weight gain can be hard for any pregnant woman to navigate, but for women who have recovered from eating disorders like anorexia nervosa, these symptoms can be nothing short of traumatic.
Isobel always knew her journey to motherhood would be difficult. Having battled anorexia and other health issues throughout her twenties, the Auckland woman was told her fertility could be affected and she would need to gain weight in order to conceive. Falling pregnant, however, was relatively simple: being pregnant has been anything but.
“In the first trimester, the thought of my body changing was quite scary. Even though I’ve always wanted children, I hadn’t put much thought into how I would feel about those changes during pregnancy. I thought I would just be happy to be pregnant, and things like my postpartum body wouldn’t rattle me like they did,” she shares.
‘An amazing but scary process’
Anorexia is an eating disorder characterised by food restriction and an obsession with weight. Symptoms can include an intense fear of gaining weight, and persistent behaviour that prevents weight gain or leads to ongoing weight loss, such as food restriction or excessive exercising. People with anorexia also often have a perception of their body that isn’t rooted in reality: for example, seeing weight to lose where there is none.
Says Associate Professor Jennifer Jordan, a clinical psychologist at the University of Otago who specialises in eating disorder research,
“Eating disorders are usually driven by a sense of needing to be in control of eating to maintain a certain body weight and shape to feel okay. Pregnancy is an amazing but weird and scary process where the body takes control in a way the person has never experienced.”
For women like Isobel who have suffered from anorexia, pregnancy can be extremely triggering. While they may no longer be clinically underweight, overexercising or restricting their diet, they may still experience a distorted body image or disturbed perception of themselves. Seeing their body dramatically change throughout the pregnancy can be incredibly distressing, as weight gain – an inherent fear – is suddenly inevitable.
Says Isobel, “Initially it was the small changes, like my boobs growing, but also the amount of vomiting I was doing was stressing me out. I would vomit, and then get stressed that I’d have to eat more to make up the calories. Feeling like I kept needing to eat… that made me feel a bit f***ed up.”
“The first time I got weighed at my maternity appointment, I had actually lost weight because I was vomiting so much. I was a bit rattled by that. Knowing how much I have to be weighed during the pregnancy also brings up negative feelings to me,” she adds. “I have to rationalise that, of course, I’m going to gain weight – I’m literally growing a human. But it still bothers me.”
For recovery coach and anorexia survivor Jess Dyson, pregnancy still presented challenges even after 13 years of remission. Like Isobel, being weighed regularly was difficult for her to navigate, especially as she had lost weight due to hyperemesis: a severe form of pregnancy-induced nausea and vomiting.
“It was difficult not to let it become about the number on the scale again, and I had to actively use strategies to keep myself grounded in health and self-compassion,” Jess shares.
“During the first 25 weeks of my pregnancy, I lost a significant amount of weight and received countless compliments. A fleeting thought crossed my mind: ‘What if I kept this up after pregnancy?’ But I quickly recognised it for what it was – a voice from my past.”
Aside from physical changes to the body, other potential triggers for women can include not being able to fit in their pre-pregnancy clothes, changes to their appetite, being unable to comfortably exercise, and the constant reminders of their changed shape – from their breasts to their baby bump.
“There may be mixed emotions, and additional fear about the loss of control along with distress about the loss of their familiar body. She may worry she may never get back to how it was before,” Jordan explains.
While more information is known about managing pregnancy in women with a history of anorexia, those who have suffered with bulimia – an eating disorder marked by bingeing and purging – can face similar concerns, Jennifer notes.
Anorexia and pregnancy: relapse is possible for survivors
For women who have suffered and recovered from an eating disorder like anorexia or bulimia, relapsing during pregnancy is a recognised risk.
In 2020, a Japanese study examined women who had experienced both pregnancy and eating disorder remission. Of the 24 participants, 16 (67%) relapsed during pregnancy and 12 (50%) relapsed after birth.
“Our study revealed that recurrence of EDs [eating disorders] and the occurrence of postpartum depression were higher in this population, indicating the need to closely monitor EDs both during pregnancy and after birth,” the research concludes.
The fear of relapsing will likely be a source of anxiety for these women during pregnancy, as they are forced to confront deep-seated fears or struggle to undo learned, sometimes ingrained behaviours.
“Pregnancy is recognised as a high-risk situation for exposure to body image dissatisfaction,” Jennifer explains. “Women with current restricting behaviours will be juggling their fear of eating more and gaining weight, versus worry about the wellbeing of their baby. Some who exercise at a high level as a way of managing their eating disorder, or anxiety or stress, may be very anxious about reducing this and will need support in doing so.”
The risk of relapsing is largely due to the reactivation of old patterns, Dyson explains, such as overexercising or calorie-counting to mitigate weight gain. The key is awareness of your triggers and preparation for when they arise.
“Knowing your personal triggers and creating a plan to respond to them can be incredibly protective. It also helps to have someone in your corner – a therapist, partner, or support person – who can walk with you through the harder days.”
While Isobel says she experiences the occasional intrusive or obsessive thought during her pregnancy, she knows she isn’t at risk of relapsing. She wants other recovered women to know their feelings are normal and valid, and they can acknowledge the complicated emotions without acting on them.
“I think the hardest thing for me is the fact there’s not a lot of real-life stories that I can call on during this experience,” she says. “I think [it’s important] for people who are recovered to have that reassurance that what you’re feeling is normal. It doesn’t mean you’re going to relapse, and it doesn’t mean that you don’t feel happy about being pregnant.”
‘Bouncing back’
Unfortunately, society continues to pressure new mothers into regaining their pre-pregnancy body as quickly as possible. The concept of “bouncing back” has been pervasive in Western media for decades, from magazines documenting women’s postpartum “transformations” to celebrities and influencers sharing “progress pictures” on social media.
“Three months postpartum, I remember scrolling Instagram at 3am while feeding my son. Seeing ‘before and after’ photos of other mothers who had seemingly ‘bounced back’ triggered deep body image struggles. I had to remind myself of the incredible things my body had done in growing, birthing, and feeding a baby,” Jess says.
This misogynistic concept is detrimental for all women, and is another avenue for perpetuating unrealistic beauty standards. These harmful beauty ideals, such as “bouncing back” after pregnancy, can lead to body dissatisfaction, ultimately increasing the risk of unhealthy eating habits and eating disorders. They can enable a dangerous cycle of comparison, low self-esteem, and distorted body image, and people who already have a history of disordered eating are particularly susceptible to falling victim to these unreasonable expectations.
Isobel agrees. “Try not to read anything about postpartum bodies or ‘bouncing back’, because that’s something I’ve found quite triggering. On my social media, I was seeing 8-month-pregnant women doing deadlifts and s**t in the gym, and I’m like, ‘I can barely move’. Not focusing too much on what social media is doing and focusing on yourself is really important.”
Support is available
For women with a history of eating disorders, there are wraparound services available that offer crucial support before, during and after pregnancy. Access to healthcare professionals with experience in managing eating disorders, such as psychologists and dietitians, is imperative. Community support such as antenatal groups may also be beneficial, Jordan says.
Building a solid support network is also invaluable, Jess stresses. This circle could include a therapist trained in eating disorder recovery or perinatal mental health, a supportive GP or midwife, and trusted loved ones who can offer practical and emotional support.
For women who are actively trying to conceive, Jess recommends preparing mentally for the pregnancy as much as possible. Learning to expect and accept change is crucial, as well as listening to your body: hunger, cravings, and aversions are your body’s way of communicating what it needs.
For Isobel, her circle includes her maternity clinic, her family, her husband, and friends. She says her healthcare team has provided incredible support, and she knows there is no risk of her “slipping through the cracks” of the system.
“Definitely talk about it with your support network: don’t feel like you need to hide these thoughts, because that’s when it can get dangerous. Try to rationalise it within yourself as much as you can, because obviously, it’s completely normal for your body to change,” she says.
“As long as you’re eating enough and listening to your body, that’s all that you can do. It’s not just about you anymore – it’s about the baby that you’re growing.”
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* Name has been changed.
