Baby makes four: When mothers have eating disorders

According to most mainstream media articles and more than a century of psychological research, eating disorders are the near-exclusive purview of young teenage girls. But what happens when that girl grows up? We know now that eating disorders can follow sufferers through college, young adulthood, and into partnerships, marriage, and pregnancy. As much as we assume that giving birth magically transforms a woman into a mother, the fact is that people are a package deal. Sometimes women experience a retreat of ED thoughts during pregnancy; for others, they get worse.

So what happens when the woman comes home from the hospital with a partner, a baby, and an eating disorder?

Look around at articles on “pregorexia” (even typing that word makes me want to hurl), and many of the writers cast pregnant women and mothers with active eating disorders as selfish. The premise is that they are choosing to be ill, and need to be taken to task.

Okay, let’s get something out of the way first: yes, a parent is responsible for their child’s health and safety. But a women isn’t solely a mother. She’s a person, too, with all of the quirks and foibles and everything else that we all have, so we really don’t need all the shock that someone with a child can also have an eating disorder.

Secondly, can we just stop with the idea that people choose to get sick and stay sick? No. Just no.

So with all of this mythology around femininity, childbearing, parenting and eating disorders, what’s it really like for mothers with eating disorders? Not surprisingly, I’m not the only person thinking about this topic. Australian psychologists Stitt & Reupert (2013) recently published a qualitative study asking nine women with EDs who were also mothers what it was like to juggle kids, life, and a deadly mental illness.

Let’s start with the title. Mothers with an eating disorder: ‘food comes before anything’. I totally cringed. It just sounds so…Judgey McJudgeypants. Certainly when you have an ED, food will come before lots of things, and it will probably be prioritized a LOT. I get that. It has the potential to greatly interfere with the basic parent-child relationship. But it is NOT AT ALL representative of the mothers I know who have EDs. They generally bend over backwards to juggle their disorder, hide it from their kids, and keep everything normal-looking on the outside.

Aside from the title, I thought the work was valuable in that we really haven’t talked to mothers themselves about what it’s like to have an eating disorder. Statistics are great–I’m a number geek. But life experiences are also really helpful to document and understand.

Of the 9 participants, 4 had AN, 4 had BN, and 1 had EDNOS. They had between 1 and 4 children, all had received some treatment for their ED in the past and all were also diagnosed with a co-occurring mental illness like depression or anxiety.

The researchers identified on six main themes:

Themes of the study

  • impact of the parents’ ED on children
  • modelling-disturbed eating behaviours
  • ‘Food comes before anything’
  • ‘There would be no world without them’: children motivate recovery
  • secrecy around the eating disorder
  • treatment needs

The women identified difficulties setting proper boundaries and establishing discipline with their children, as well as social isolation.

… . how much time you spend in your head obsessing about your weight or how you look, or whether you’ve eaten, or what you’ve eaten, if you look back you probably lost time that you could of just spent doing things with the kids … . I sort of wonder, how much times did I lose, or, how many times did I snap at them, how many times was I unfair?

Many of the women hoped and believed that their ED wasn’t affecting their young children, though basically all of them reported worries that their children would copy their disordered behavior.

‘Probably the biggest thing is that what if they copy … . it’s my coping thing and I’m scared that they might see … . okay, well Mum does this to cope so we will too.

As much as children could increase anxiety in that they could interfere with ED behaviors and rituals, they were also a huge motivation for recovery.

I don’t want my kids growing up with a mother who’s dysfunctional in any way … . I’m dealing with it for their sake … . the inspiration and drive for me to fix myself is so that they can grow up in a healthy environment. If it hadn’t been for him, I would probably be, either dead or still well and truly in relapse, to be honest.

There were also major barriers to receiving appropriate treatment. Many of the women noted that much of the services offered were directed at younger women without families, nor did therapy appointments always allow for the inevitable difficulties of scheduling appointments when there are young children around.

… . therapists don’t quite get that everybody doesn’t have babysitters they can ring up at short notice … . I actually had one woman who … . basically said ‘If you can’t commit to come every single week then I can’t treat you’ and I said ‘Look, I’m trying but if my kids are sick, what do I do’ … 

In the end, the researchers concluded, the women with an ED were impaired in both their own lives and in their parenting abilities much like other mothers with mental illnesses.

There are many seemingly contradictory results in this study. While many mothers acknowledged the adverse impact of their ED on their children, some minimized the impact this had on younger children. Interestingly, one mother hinted that this minimization was part of her denial about having an ED. The secret shame associated with ED and the subsequent hiding of their ED from their children is perhaps associated with this perception. Some mothers report prioritizing their ED over the needs of their children’s needs and yet, at the same time, report being motivated to enter treatment and recover for their children. These findings indicate that mothers are juggling with the competing demands of the ED and their children, and being pulled from one to the other, in a way that they find difficult to resolve. As such, this presents an ideal opportunity to support mothers with ED, once clinicians identify their client’s parenting role.

To me, it seems mothers with EDs are doing the best they can to manage their illness and their responsibilities as parents. The fact that we either ignore the possibility that parents can have EDs or shame them for being selfish and still struggling with ‘childish’ or ‘selfish’ issues only makes it worse. Parents need treatment that is tailored to their needs and also addresses the extra burden of caring for children. ED behaviors are so crazy-making, both in the sufferer and in the family, that it’s easy to blame the sufferer. Parents with an ED or any mental illness will have a huge impact on their children, and we can’t and shouldn’t ignore that. I’m not trying to minimize the suffering of the children, either.

Given the growth in awareness and treatment of older women, I think support groups and therapy for children and spouses could be a really useful avenue of providing support. We know with research into FBT that supporting the parents of younger patients improves outcomes. Cindy Bulik’s work with UCAN at the University of North Carolina shows that harnessing spousal support also improves outcomes in preliminary studies. Kids should also receive help and support when they have a parent with a life-threatening illness, including an ED.

More compassion, less judgement.

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21 Responses to “Baby makes four: When mothers have eating disorders”

  1. This was a very relatable article for me. The first time I entered treatment a year ago, I felt rushed out and “unfinished” with treatment because I had to return to my motherly duties. I was only there for 3 weeks. My OP therapist told me that she wanted me to come twice a week to see her, once a week for DBT, and once a week for support group. This just wasn’t possible seeing as my oldest son also has a list of mental health issues, and I was constantly taking him to appointments. I have friends and family tell me all the time that I should “just think about my kids,” and then I could recover. I wish it was that simple. I struggle daily with my depression, anxiety, eating disorders. Add my two very active boys on top of that. I will always put their needs above my own. Even if that means I live with ED the rest of my life.

  2. Thank you for this compassionate post. If my ed had a face, arms, and legs, and was standing next to my children, and someone told me I had to choose- the ed or my babies- I would instantly throw my arms around my precious babies and never look back. Unfortunately, the ed has no such form to reject, but instead has secret, invisible tendrils that have woven themselves throughout my entire mind and body. It is not a question of choosing it or them. I choose my children every day. But my ed continues to choose me and infiltrate my person. I continue to choose to try to fight it, and allow my treatment team to help me hack off the tendrils that we see.

    I am terrified of my children being harmed by my ed. Support for children who have a parent with an ed is mentioned here- do you (or does anyone else) think it imperative that the children know about a parent’s ed?

    I would love to hear and consider feedback on this.

    I have not told my children. What I HAVE told them is that my body is not quite healthy, and that the doctor wants me to gain weight to help keep my body safe. They see me keeping food journals and drinking Ensure. (Actually, they both think they deserve a yummy chocolaty Ensure each day, too- they decided it isn’t fair that only I “get” to drink them. 😀 So now my children and I ALL drink Ensure.) I know they notice that I get emotional about eating or won’t sit at the table with them sometimes or eat what they are eating. So I explain that I am trying to gain weight and be healthier, and that this is difficult for me, but I do NOT give it a name. I never say “eating disorder” to them.

    My reason is simple: They are young, and won’t know how to handle this data. They might, unthinking, tell a friend, and then it might go around, and then stigma might get attached and suddenly they become the kid with the mom who’s anorexic. I want to limit the negative impact that my struggle has on them, and I feel like that could make things harder- I feel it is data too big for little minds to process- terms too heavy for them to carry.

    So what am I really doing? Am I protecting my children by not telling them? I feel that I am. Or is there more to it? Am I also dealing with shame or denial by not telling them? Is it healthy to deal with this the way I am dealing with it? I am curious as to what other people think.

    I wish I could offer my children a mother with no problems, no flaws. But then, of course, I would not be human, since no such person exists!

    • I agree with Dr. Ravin. You are absolutely handling it the best way possible. I don’t think it harms kids to know that parents can get sick. That’s just life. But you are explaining it in a way that they can understand.

  3. I was raised by a mother who is inrapatured in her ed and not to blame her but ed hit me very hard….. now 26 yrs later i am finally making an improvent and reaching for recovery… at 31 the same age my mother had moi……. i personally am terrified to have kids due to the long history in my fam….. thank you or this article

  4. Excellent post, Carrie.

    On a related note, are you aware of any data or evidence-based recommendations for women who have recovered from ED who want to get pregnant? My recommendation to patients is that they have at least one year of full remission from ED (at healthy weight, normal menses, complete absence of restricting, binge, and purge behaviors, minimal cognitive symptoms) before trying to conceive. I believe that this is protecting the woman’s physical and mental health, increasing her chances of remaining in remission, getting her body strong enough to carry a child, and protecting the health of her future children. The one year in full remission is kind of arbitrary – I chose that time frame because I know that relapse is most likely in that first year. And I know that a full year is a good period of time to create new habits and new neural pathways that are likely to stick. So, I am wondering if you are aware of any other recommendations, and what is the evidence behind them.

    To the reader who asked about disclosing an ED to her children: it sounds like you are doing a great job at conveying to your kids, in age-appropriate language, that you have an illness and you are working on getting better. I believe that it is important for kids to know about their parents’ illnesses, to the extent that they can understand at their age. Since most psychiatric illnesses have a genetic basis, the children are at risk for developing the same illness, regardless of the parents’ behavior. By acknowledging that you have the illness and that you are getting treatment, that sets a good example for the kids. Then if they develop similar symptoms in the future, they will be more likely to be open with their parents and more willing to accept help.

    • Dr. Ravin,

      No, I don’t know about time in recovery that is best to have before trying to get pregnant. My guess is that no one does. For one, we don’t have a good definition of recovery. For another, we’re just beginning to acknowledge and understand EDs in the non-teenage population. But I would recommend one year of strong recovery as well. I personally have always been ambivalent about having children (I like kids, but I also like my life as it is right now, so…) so it’s not something I’ve really considered. I don’t think I would be ready for pregnancy now- I would need some extra coaching before I could make that step.

    • Thank you, Dr. Ravin. I am trying my best to make it understandable and to let them know that the stress I feel is my own, and not due to them or including them.

      I am an Aspie, and I do not have (and never have had) recognizable hunger cues. And I have a painful aversion to many textures, temperatures, tastes, and to feeling full. My younger son also is an Aspie and he is very skinny, with a BMI of about 13. He has told me that he does not like how food feels in his tummy, and that he is afraid if he eats too much and gains weight, he will not be able to run as quickly. So I have already run into food issues with him.

      I have explained to him that food is required, not optional, for our bodies to function- I told him I understand not liking feeling full, as I do not like it either, but we have to use food as fuel and consistently take it in. I told him that’s why there are things like Ensure- to help keep our bodies safe when food is hard.

      I have noticed that as long as I keep a careful watch to be sure he is eating regularly, he eats well, and will even say he is hungry throughout the day, and this encourages me. If I am not paying attention (for example, if I tell the boys to get their own lunch because I am out running errands) and he doesn’t think to eat much one day, then the next few days will become a horrible trial of making him eat more while he howls and says he can’t. I have to stay on top of it, because it can get out of hand in just one day. I try to teach him to eat by a schedule, not by hunger cues, as he does not always have them.

      I do not feel badly about doing this work with him- it is my job as his mother. But it is difficult to monitor and encourage him at times when I, myself, am gagging on my food and having to hide that from him. Sometimes even looking at or smelling food makes me feel ill, and I have to smile and serve it up as if it is palatable and enforce eating it and then force it down my own throat and go cry alone. But, like I said, as long as I stay consistent with him every day, the only one having food problems in the house is me.

      I hope as he gets older he will internalize the idea of eating according to nutritional needs, and not be lost when I am not around to feed him. It is something we discuss regularly. Aspies need repetition and routine.

  5. Excellent post Carrie with equally excellent comments. Personally relating in every possible (alas) way …and I will be sending this to family and ED team members. Thank you.

  6. Carrie, the research and your perspective greatly echo my own experience.

    I had an ED as a pre-teen/teen that went undiagnosed for a number of reasons — the main one being that my coaches thought my dieting was good for me and my performance.

    The restrictive behaviors ended in college, but the disordered thinking did not.

    25 years later, after having marrying and having two girls, the restriction came back. I guess you would say I’m “in recovery” although I don’t like my current weight (too high).

    The first few times I shared what was going on with my reoccurring ED I immediately got the (well-meaning) feedback of, “You don’t want to do this to your girls do you? Think about what you are teaching them!”

    But I had been hiding it as best I could from them. They never see (or hear) me weigh myself. They don’t notice that I restrict. I don’t talk about weight and fat and skinny — instead I talk about nutrition and being healthy. I’ve explained how I know “skinny” people who are quite unhealthy while at the same time knowing “fat” people who are very healthy.

    But it still comes back to “but what about the children?!”

    I don’t think mom’s with EDs are given enough credit for protecting their children. We DO see this as potentially life-threatening for our children, if not for us. And there is that primal need to ensure the survival of the next generation that helps me to keep it from my children. You know, that same primal “must. feed. baby. guard. cave” that we experience during 2am feeding sessions.

    So thank you for writing this post. It’s imperative that we ED moms are met with sensitivity and compassion and not a call to Child Protective Services. Being shamed and hiding the disorder only makes the illness worse, for us AND our children

  7. It’s fantastic that this is finally being discussed (and its way overdue !) I developed an ED in my early teens, ‘recovered’ to a point and had my first child at nineteen with the next three born by the time I was twenty-eight. Once the chaos of raising four children as a sole parent had levelled out with the youngest reaching school age, my anorexia returned with avengence. I had no partner and no family living close. Treatment was not an option and my health spiralled into a crisis. That youngest child is now a teen and all my children are fully aware of my eating disorder. I kept them protected to a point but I also know that it is frustrating for them now as young adults to see the limits that my long term disorder has created for me and for them. I do not believe in shrouding my ED in secrecy and shame and I am glad I never did. I have had this incredible opportunity to discuss many topics and emotions with them in regards to themselves, their peer groups, social influences, marketing and the media. I am glad that I was able to seek help for my daughter when ED began in her life mid teens. It was not about me and I refused to make it so- she deserved the attention and validation of her inner struggle without it being dismissed as a ‘copied behaviour’. She fully recovered in a relatively short time and now has a child of her own. My other three kids, sons, are very aware of the low self esteem that accompanies teenage and young adults particularly girls and women. They are not , thankfully, the boys in the school yard teasing and berating females over their size and shape. As a family, we have used humour to get through adversity and we still joke about my disgustingly thick novasource drinks that kept me alive at one point.
    Mental health workers need more education and training around mothers with eating disorders-I have had some awful comments made to me by nurses and allied health professionals. I also feel that single mothers are especially vunerable. Its like an extra layer of stigma over the whole lot. The last paragraph from Jen (above) sums up exactly my experience and, it seems, the experience of many women and children.

    • I don’t want to be hurtful to moms with an eating disorder but have some thoughts
      My mom has always had anorexia. I am recovered after a long battle so I see things from both sides.
      Having a mom with an eating disorder is so hard to deal with. The worry, fear, sadness, confusion a child faces watching their mom struggle and having to worry if their mom will die from the eating disorder takes such a toll.
      Even when I was 5 I knew something was wrong with my mom. I did not know the name anorexia then but I knew something was not right from how she never ate,never sat still and had to exercise. Also of course hearing family worry.
      Even if you don’t tell your kids you have an eating disorder they know something is not right.
      It is so hard to worry and fear what may happen to your mom. Even today at 35 when I don’t hear from my mom I fear her eating disorder took her. Then there are the smaller things in life but are carefree items I missed. Like I remember seeing my mom for the first time at 9 eat ice cream but it was only because she was having surgery and would not be able to eat for awhile. Having ice cream with your mom may not sound like a big deal, it is. It represents a carefree and fun time. Also shows a child how to have fun and relax.
      My reply is not to hurt but to help mom’s get honest with themselves so they don’t live in denial on the impact their eating disorder has.

  8. Thanks J for sharing this. It is very true that kids know when something is up and they usually assume it is their fault or their imaginations take over . I think it is better to be honest and give it a name and let them ask and discuss. Most women have disordered eating-I think its more destructive to pretend that the behaviours are ‘normal’. Kids who grow up with this do miss out on these childhood experiences that you mention . Many mothers are not going to recover however much they try or want to so we really need to chip away at the shame and find experiences that we can share with our kids so that they don’t feel as if they are missing out and if services were not so recovery focused it could go a long way to easing the ‘worry’ burden from the minds of our children. A family focused, holistic approach would be great.A play on the beach and flying a kite also represents carefree and fun times and swimming together can be great, too. It is so true the denial needs to go and so does the shame and blame. They feed into each other.There does need to be a healthier way put forward for both mothers and their children.

  9. This post is very interesting, and I wonder if you’ve come across anything about the effect of EDs within relationships? That is, when both members of the relationship are peers (such as marriage) rather than parent/child etc? How does a relationship affect the course of recovery, or the ED effect the relationship? I think that would make an interesting post alongside this one to dispel the “only young women have EDs” mythology.

    Sorry if I’ve asked before, I can’t remember and it’s something I’m very interested in.

  10. A new research study at Stanford University examines a unique prevention program for mothers with eating disorders, designed to improve child feeding. Mothers with eating disorders whose children are between the ages of 1 and 5 years old are welcome to contact us!

    http://edresearch.stanford.edu/studies.html

  11. Mothers with history of eating disorders sought for study at Stanford University

    Moms with eating disorders: The Eating Disorders Research Program at Stanford University is now studying a new parenting program for mothers with a history of an eating disorder, who have a child between 1-5 years old. This research takes place at Stanford University. The program is designed to help mothers and fathers with their dilemmas in child feeding. If interested, please contact tfeldman@stanford.edu

  12. Mothers with eating disorders who have young children (ages 1-5 years old) are invited to participate in a parent-based prevention research study at Stanford University. If you would like to receive more details, please contact tfeldman@stanford.edu

  13. Hi, yup this post is actuaqlly good and I have
    learned lot of thins from it about blogging.
    thanks.

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