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On the last track, we discussed Post-Traumatic Stress Disorder and Postpartum. This included PTSD and pregnancy and childbirth and PTSD.
On this track, we will discuss Eating Disorders and Postpartum. This will include pregnancy and the course of the eating disorder and the eating disorder and the baby. If you are already familiar with pregnancy and eating disorders, you might use the first part of this track as a review.
Eating disorders are nearly always marked by an almost fanatical degree of secretiveness. Luckily, however, it appears that more women, especially those who have struggled successfully to conquer their illness, are now willing to speak about the problem in public. Many of us, for example, are aware of the late princess Diana’s bingeing and purging, which became worse during pregnancy, and which also appears to have been associated with postpartum depression.
As you may know, bingeing and purging, or bulimia nervosa, is the most common of the three major eating disorders. Anorexia nervosa is characterized by an extreme restriction of food consumption, to the point where the client can appear skeletal. The clinical diagnosis of anorexia, in fact, depends up on the client’s having lost more than 15% of his or her body weight.
Both bulimia and anorexia appear to be associated with the client’s need to establish a degree of control in her life. Because she believes that other aspects of her life are out of control, she seeks to find it in the one place she can, by controlling her food intake and body weight, except, of course, that this is a false sense of control, since in actuality, she has no control over the disease itself.
The third type of eating disorder, termed as "eating disorder not otherwise specified," involves periodic bingeing without compensatory purging and is both less prevalent and less physically dangerous than either bulimia or anorexia.
Pregnancy and the Course of the Eating Disorder
One question is whether pregnancy is likely to improve or worsen an existing eating disorder, and the answer to that seems to be that it can go either way.
When she became pregnant, however, Felicia began avoiding weighing herself at her prenatal classes. When she occasionally did weight herself, she either avoided looking at the number on the scale or stood on it backward. When a nurse brought this behavior to the attention of Felicia’s obstetrician, he began to monitor her more closely until, in her second trimester, Felicia’s lack of weight gain prompted him to ask her point blank if she had been restricting her food intake.
At that point, Felicia became quite agitated and refused to pay any more prenatal visits to that particular doctor’s office. Luckily, the nurse who had first noticed Felicia’s weighing behavior took it upon herself to make a visit to Felicia’s home. With the nurse’s encouragement and at her husband’s insistence, Felicia went back into treatment and was able to begin eating normally again, gain weight appropriately, and give birth to a healthy baby, although she still needs to be monitored to be sure she doesn’t relapse postpartum.
The Eating Disorder and the Baby
In one such case... a public health nurse who was making a postpartum home visit noticed that her patient, Trina, was giving the baby her breast for no more than a minute before announcing "Now your’re done." After monitoring the situation for a period of time, the nurse found that the baby was rapidly losing weight. At that point, the nurse became quite concerned and called the family doctor, who referred Trina to me.
As I learned during our sessions together, Trina had wanted to be sure that her baby, Serena, was adequately fed, but she was equally concerned that she not become fat. Trina described herself to me as having been a chubby child who was constantly teased during elementary school.
Trina’s pregnancy had been perfectly planned, the delivery went perfectly, and her baby was the perfect weight. And yet she continued to have visions of Serena’s turning into a "fat little Trina." The only way she could see to prevent this from happening was by making sure that the baby didn’t feel too hungry at the outset, as she recalled she had done as a child, and her mother had kept reminding her by telling her how much she’d eaten as a baby.
Do you have a Felicia or a Trina who might benefit from hearing this track in your next session?
On the next track, we will discuss Bipolar Disorder and Postpartum. This will include postpartum psychosis and depression and bipolar disorder.
Online Continuing Education QUESTION 12
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