Bodies out of control: Relapse and worsening of eating disorders in pregnancy

Abstract

BackgroundBeing pregnant is a vulnerable period for women with a history of eating disorders. A central issue in eating disorders is searching control of one’s body and food preferences. Pregnancy implies being increasingly out of control of this. Treatment and targeted prevention start with the patient’s experience. Little is known about how women with a history of eating disorder experience being pregnant.MethodWe interviewed 24 women with a history of eating disorder at the time of pregnancy, recruited from five public pregnancy controls at local family health centers in Norway. Interviews were analyzed by means of ideal type analysis, with a particular focus on how the participants experienced pregnancy and perceived triggers in possible experiences of relapse or worsening during pregnancy. All participants completed the Eating Disorder Examination Questionnaire (EDE-Q) and were diagnosed (DSM-5) by using the Eating Disorder Examination (EDE).ResultsOn becoming pregnant, 23 of the 24 participants experienced worsening or relapse of their disorder. This occurred both at first time and after several pregnancies, and either interviewed early or late in pregnancy. Ideal type analyses indicated seven different personal features associated with worsening or relapse: the “chaotic” “rigid” “perfect” “worried” “shameful” “motherhood fearing” and “the mother with lost identity” Perceived triggers of worsening or relapse were: “loss of control” “unpredictability” “competition” “change of appearance” “shame and nausea” and “loss of identity.”ConclusionPregnancy is a vulnerable period for women with a history of eating disorders. A great variation in personal psychological dynamics seems to interact with perceived triggers in worsening or relapse of eating disorder. Our findings have important implications in understanding mechanisms of relapse in pregnancy, preventing relapse and help tailoring adequate intervention.

IVF-induced pregnancy and early motherhood among women with a history of severe eating disorders

“…This unified and unambiguous pattern of core phenomena among women with a history of AN undergoing IVF contrasts with our previous study. In that study, we found that women with a history of severe eating disorders in general, attributed a very different psychological meaning to being pregnant ( Sommerfeldt et al, 2022 ).…”

“…Some studies have indicated that women with a history of eating disorders are particularly at risk of deteriorating mental health during pregnancy and early motherhood, including relapse or worsening of their eating problems ( Arnhold et al, 2019 ; Sollid et al, 2021 ; Sommerfeldt et al, 2022 ). Furthermore, infertility, IVF, and its side effects seem to increase the risk of worsening or relapse of eating disorders ( Suthersan et al, 2011 ; Grilo et al, 2012 ; Bruneau et al, 2017 ; Janas-Kozik et al, 2021 ), or of promoting disordered eating ( Hecht et al, 2022 ).…”

“…Women with a history of eating disorders are at high risk of worsening or relapse of their eating problems during pregnancy and motherhood ( Arnhold et al, 2019 ; Sollid et al, 2021 ; Sommerfeldt et al, 2022 ). Additionally, the stressful experience of undergoing IVF increases the risk of relapsing into an eating disorder ( Grilo et al, 2012 ; Bruneau et al, 2017 ).…”

“…Many women are advised to lose weight prior to conception, which may promote disordered eating ( Cavalcante et al, 2019 ). Advice such as to lose or to gain weight will adversely affect their pathological, though very diverse, cognitive projects ( Rodino et al, 2016 ; Bruneau et al, 2017 ; Sommerfeldt et al, 2022 ) that characterize women with a history of eating disorders. The identification of eating pathology among IVF candidates is therefore of high importance and strongly recommended ( Janas-Kozik et al, 2021 ; Le Floch et al, 2022 ).…”

Trajectories of severe eating disorders through pregnancy and early motherhood

“…Pregnancy and early motherhood are known to be vulnerable times for women with EDs (3)(4)(5)(6)(7). Reported prevalence during pregnancy is 5-8% (8,9), increasing to 12.8% after birth (9), compared with 0.8% for AN and 2.8% for BN for comparable age groups in the general population (10).…”