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:
- 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.