Wednesday 5/3/2024
PHOTO: Arbues Pelayo
Text: Laura Torrens Fernández, Lina Camacho y Alejandra Misiolek
It is commonly known that becoming a mother shakes and completely reshapes a woman’s sense of identity; experiencing their body change throughout and after pregnancy, constant emotional fluctuations, changes in their work life, and frequent fears and doubts regarding their mothering skills, are just the first challenges to navigate in the lifelong journey of motherhood. Between these and several other challenges, we can agree that a woman’s mental well-being is especially vulnerable during pregnancy and the first years of motherhood.
Now, if the mother has a history of eating disorders (ED), it can be extremely challenging as the physical changes open the door for new triggers, and the probability of relapsing into harmful behaviors, both for the mother and their babies, gets high. Worrying about weight, body image and food, are the usual symptoms that along with other different psychological traits, can trigger maladaptive behaviors during pregnancy such as restrictive eating, fasting, binging, and self-induced vomiting.
Despite how vulnerable this period is in a woman’s life, the intersection between ED pathology, pregnancy, and motherhood is little studied (1). In this blog, we will try to give a glimpse of the most recently studied data on the matter. We are going to talk about how women with a previous history of ED cope with their symptoms during pregnancy and which factors are related to improvement, worsening, or relapse from the pathology. As is well known, pregnancy and motherhood follow very personal and unique trajectories; in terms of previous ED history, some mothers experience relapse and others, paradoxically, improvement and/or recovery.
In the recent study (2024) done by Sommerfeldt B., Skårderud F., Kvalem I.L., Gulliksen K. and Holte A. (1), five different perceived trajectories through pregnancy and early motherhood were identified: 1.“The mastering mother,” in which an ED pathology seems to be absent through pregnancy and early motherhood; 2. “The succeeding mother,” in which the ED worsens during pregnancy, but reduces in early motherhood. 3. “The inadequate mother,” in which the ED pathology worsens before pregnancy, through pregnancy, and early motherhood; 4. “The depressed mother,” in which the ED is put on hold during pregnancy, but worsens in early motherhood; and 5. “The overwhelmed mother,” in which the ED worsens during pregnancy and early motherhood.
“The mastering mother”
The women who reported recovering through pregnancy and early motherhood were mothers who described several protective factors. They experienced small body changes during pregnancy, they experienced mastery of motherhood by feeling bonded to both the baby through breastfeeding and the husband by feeling supported and by having a project together. If the delivery was close to the delivery date, they felt safe and with a sense of control over their body, which lowered their stress about body and food.
“I had a normal birth, and for the first time felt in control of my own body. It was stronger than I thought.” “Being able to feel pain and at the same time have a sense of control was important to me.”
“Being a mother gives me a bit of a break from all these thoughts about food and exercise, and how this exercise and awareness of what I can eat finally makes sense. After all, now I have to keep myself healthy and fit for another person.
“The succeeding mother”
These women experienced a relapse in their ED during pregnancy followed by improvement in early motherhood. They reported feeling out of control during the months of gestation, low self-esteem and not feeling good enough combined with rigidity and inflexibility around weight. Concerns about their body changing triggered a strong need to ensure staying thin during pregnancy with strict rules and fixed diets. Then, after giving birth, something surprising happens, they experience the feeling of becoming someone. They describe finding new meaning to life and a stronger feeling of self-worth by becoming a mother. They reported bonding with their baby through breastfeeding, which made them feel valuable to the baby and gave them self-confidence.
During pregnancy: “I need to have control over everything I do, but when I got pregnant nothing went as I had planned.”
After birth: “The role of being a mother gave me a focus and a clear role: In a way, I avoided walking around feeling inept, as I had done in all other areas.”
“The inadequate mother”
The women in this category reported that their ED pathology resurfaced or intensified during pregnancy and persisted afterward. They were plagued by self-contempt and guilt, constantly worrying about their unborn child and fearing they might inadvertently harm them. The fear of being judged by others only added to their distress and exacerbated their ED, which they relied on as a means of control amidst the chaos of pregnancy and motherhood. All the women in this trajectory experienced pregnancy as extremely overwhelming and all the rumination over doing things right led to the mothers feeling detached from their body and their baby. Several of them became pregnant through IVF which made them feel inadequate and was triggering for their ED symptoms as they experienced their inability to become pregnant naturally as a loss of control. The feeling of inadequacy during pregnancy continued into feeling inadequate as a mother. It was common for this group of mothers to prioritize exercise over quality time with the children, as they hoped that by focusing on their body shape, appearance, and weight, they would feel better about themselves. This focus helped them obtain a sense of mastery but reduced their attention on their baby. Their parenting thus became inconsistent and unpredictable, which consequently only made them feel more inadequate and increased their concern of how others might think of them as a mothers. Feeding their baby was also a great challenge, as the baby’s appetite and hunger were very difficult to deal with. What this group of mothers described was a vicious cycle that was very difficult to get out of.
“I have always been concerned about what others think of me. What did other people think of me, knowing about my history with EDs? This was something I was obsessed about during pregnancy and as a mother.”
“That someone else is completely dependent on me scares the crap out of me.”
“The depressed mother”
This group of mothers experienced EDs worsening after birth. All of them were diagnosed with postpartum depression. During pregnancy, the women in the depressed mother group put their ED pathology on hold by focusing on planning how to manage their body, weight, and changes after childbirth. However, the ED pathology intensified into early motherhood when nothing went as planned. All the women in this trajectory experienced complications during childbirth, which only further triggered the sense of lack of control. Since reality didn’t meet their expectations, they found themselves unable to fulfill their plans for exercise and healthy dieting. This made them feel like a failure. Moreover, difficulties with breastfeeding and soothing the baby’s distress worsened the overwhelming nature of motherhood for individuals grappling specifically with anorexia and postpartum depression.
“I am nothing. I wasn’t able to complete anything. I got restless and exhausted.”
“If he cried, nothing I did calmed him down. He was struggling with a lot of stomach difficulties and cried a lot.”
“The overwhelmed mother”
This group of mothers was characterized by feelings of chaos, shame, and guilt throughout pregnancy and early motherhood. The women in this group used ED pathology to deal with the chaos during pregnancy and early motherhood, as well as a kind of self-affirmation of “me as a bad person.” An ED pathology while being a mother increases self-blame and provokes shame and guilt.
“I cannot deal with the baby inside me. I cannot do it because it makes me feel guilty and like a terrible person for still doing all these harmful things to my body.”
“I need something I can hold onto and help me forget everything else. I cannot control anything right now. Planning my overeating helps me.”
As is seen in their testimonies, their quotes paint a vivid picture of the internal struggles faced by overwhelmed mothers grappling with guilt and shame. Overwhelmed by these emotions, they feel unable to confront their symptoms directly, instead, they turn to disordered eating patterns as a way to regain a sense of control. This cycle often continues into early motherhood, exacerbating their struggles and hindering their ability to fully engage with their role as mothers. They also expressed a sense of ambivalence towards their baby and a fear about connecting to the child. The overwhelming nature of breastfeeding added to their overwhelm and their feelings of shame. They described breastfeeding as something “suffocating”. After some months, they decided to start with a bottle, and their partners took responsibility for the feeding. Good support from the partner was identified as an important protective factor in early motherhood.
Studies like this (1) highlight the emotional complexity and challenges faced by women struggling with eating disorders during pregnancy and early motherhood. Through personal testimonies, we can see how these women experience a whirlwind of emotions which can lead to a variety of trajectories, from guilt and shame to self-determination and personal growth. While the journey may be difficult, many find strength and motivation in the bond with their children and the support of their loved ones. It is crucial to recognize the importance of providing a supportive environment and empathy for these mothers, as well as promoting awareness of the unique challenges they face. By sharing the stories in this study, we hope to inspire meaningful conversations and foster a greater understanding of the intersection between eating disorders and motherhood.
References:
- Sommerfeldt B., Skårderud F., Kvalem I.L., Gulliksen K. and Holte A. (2024) Trajectories of severe eating disorders through pregnancy and early motherhood. Front. Psychiatry 14:1323779. doi: 10.3389/fpsyt.2023.1323779