The Connection Between Eating Disorders and Postpartum Depression
Pregnancy brings on a lot of changes quickly -- both physical and mental. It's no surprise to me that women previously diagnosed with eating disorders are at a higher risk for postpartum depression, but recently Stephanie Zerwas of the University of North Carolina flipped it around and looked to see if women who came in for postpartum depression and anxiety had previously suffered from an eating disorder. Thirty-five percent of them had -- compared to seven or eight percent in the general population. Eating disorders, then, could be a risk factor for postpartum depression.
Stephanie is the associate research director of UNC's Eating Disorders Program. It comprises both research studies and treatment programs with inpatient, outpatient and partial hospitalization programs. Her special interest is eating disorders during pregnancy and postpartum. She and other researchers have studied 100,000 moms and babies in Norway, looking at moms who had eating disorders right before becoming pregnant and the later outcomes for both the moms and the kids.
Here are some of the findings she shared with me.
Overview of Research into Eating Disorders and Pregnancy
- Out of 50,000 women they've reviewed, about 50 had anorexia right before becoming pregnant.
- Of the women with anorexia, about 50% of the pregnancies were unplanned, compared to 18% of the group who didn't have anorexia and who also had unplanned pregnancies -- it's possible the anorexic women had stopped menstruating regularly and thought perhaps they couldn't get pregnant.
- Two thousand women had binge eating disorder, which is binge eating without purging behavior afterward.
- Five hundred women had bulimia right before pregnancy.
- Fifty-four women were purging without binging (purging disorder or eating disorder not otherwise specified).
- Seven hundred women developed binge eating disorder for the first time during pregnancy.
- Moms with previous or current eating disorders were more likely to say their babies were fussy.
I didn't really know much about binge eating disorder. Stephanie defined it as:
A sense of loss of control over what you're eating -- you have a sense that food is irresistible, and you can't stop once you start. It's a combination of that loss of control and a large amount of food. But it gets even trickier, because quantifying "large" is actually really hard. If you're restricting and you eat a normal meal, you might think that's a lot. Basically it's eating almost two meals' worth in a sitting.
What Pregnancy and Postpartum Can Do for a Woman With a Past or Present Eating Disorder
Again, much like when I talked to Dr. Bermudez about eating disorders and kids, I felt like I was listening to my life story being researched. I had undiagnosed postpartum depression and actually depression and anxiety during pregnancy because I couldn't handle the rapid weight gain. It was pretty much about that -- knowing I had to gain a bunch of weight and not knowing if I would be able to lose it again triggered all sorts of anxiety that I thought I'd already overcome. Even though I monitored my food intake religiously, I still gained 45 pounds (I've always gained weight easily). Getting on the scale became absolute torture, and I'm looking at my pregnancy journal now and see how militantly I monitored the process of taking that weight back off. It took me four months -- which now seems shockingly fast -- but I thought it was a million years at the time.
Stephanie said moms with eating disorders are gaining more weight while pregnant and losing the weight more quickly postpartum. She also said the percentage of people struggling with eating disorders actually goes down during pregnancy -- that in some ways pregnancy puts them in remission and can be a transformational event. That was interesting to me, because I really think my pregnancy reset my metabolism -- prior to pregnancy, I couldn't eat more than 1,200 calories a day without gaining weight, which is probably not so shocking considering I spent about two years eating 800 calories a day. Since my pregnancy, I'm able to exercise three or four times a week and eat a healthy but normal diet and keep a pretty consistent five-to-eight pound range. I asked Stephanie if she thought that was possible.
She said something really important: Bodies are very different. "We like to think weight management is a mathematical equation -- calories in versus calories out -- but everyone's body processes food a little bit differently and some people a lot differently. Accepting your own body type is an important part of the recovery process for a woman with an eating disorder. "
In my Dr. Bermudez interview post about whether or not you can prevent your child's eating disorder, we talked about the fear women can have about passing on their eating disorders to their kids, especially their daughters. UNC has created an intervention program for moms who have or have had eating disorders and also have young kids. The focus is on teaching your kids about nutrition and breaking the cycle of risk. And it's a conference call -- it's possible to participate even if you don't live in North Carolina.
Stephanie says: "The focus on pediatric obesity is confusing things. Moms who have had eating disorder are more likely to take special approaches to their kids' diets (no sugar/vegan, etc.) Disordered thoughts and worries about food and weight can get translated to their kids if they are still thinking about it."
Now, I'm not a fan of mother-blaming, but as someone who cringed when my weight was shouted across the gym during Presidential Fitness Test Week and lectured by my pediatrician about gaining weight, I understand the unique shame that can develop from benign neglect to a kid's feelings and sensitivity about weight at a time when her sense of self isn't fully developed. It's not just mothers or even parents, but everyone who can potentially make those comments -- but a parent and especially a mother who has suffered from disordered eating in the past can be a protector and ally for an anxious kid who might otherwise go in that direction, precisely because she understands.
What I liked about my interview with Dr. Bermudez was that he assured me that eating disorders aren't set in stone, they aren't a surety -- they are something we as parents can manage against by watching for anxiety to go from "trait to state" and getting the child help if it does. We as parents are our kids' first and best teachers -- they watch us for cues as to how the world works, and we inadvertently can do harm with our passing or direct comments about our own bodies or theirs.
Though I talked to Stephanie before I read liveoncejuicy's post, Why I Don't Watch My Kids' Weight, I remembered some of the comments I saw there as I sat down to write this.
Anecdotally, one of my most painful childhood memories is of my mother sitting me down to have that 'it's time to start watching what you eat' talk. I was eight or nine.
I internalized the shit out of that (and my mother's general concern about weight in relation to herself). I hated myself. I spent hours in the bath pulling at all the fat on my body and crying and *hating* myself. I was cutting myself by the time I was ten.
My parents never meant any harm when they talked to me about my weight, but their words DID harm me. The pressure to be thin, combined with a personality predisposed to compulsive behavior and anxiety, resulted in the battle I have waged for truly more than a decade of my life.
There were many, many other comments on that post saying parents should comment on their kids' weight if they think they are becoming unhealthy. It certainly is a contentious issue. I wanted to write about my conversation with Stephanie, though, because the more we as women and family members recognize the truths about mental illness, postpartum depression, eating disorders -- all of it -- the more likely we are to help the sufferer instead of judging her.
My debut young adult novel is The Obvious Game, published InkSpell Publishing. The Obvious Game is based on my experience with anorexia. I'm represented by Eric Myers of The Spieler Agency.
The Obvious Game is available in paperback and ebook (all formats) online at Kobo, Amazon, Barnes & Noble, InkSpell Publishing and Indiebound. If you are a librarian and are having trouble finding my book, please write me at email@example.com to purchase the book at the 40% author discount price.