My anorexia first surfaced when I was 11. In the decades since, I’ve struggled with the disease to different degrees, but one thing was relatively constant: I didn’t get a period.
Because of my eating disorder, I’d been amenorrheic (meaning that you don’t menstruate) for almost all of my adult life, so pregnancy never seemed realistic to me. That’s because if you’re not getting a menstrual period, there’s a good chance you’re also not ovulating, so I figured that I couldn’t conceive without some intervention.
But I always knew that I wanted children—two—so when I found myself married and in my 30s, at a more solid point in my recovery but still without a period, I knew it was time to start investigating my options.
I began working with a fertility doctor, who required that I see a psychiatrist given my eating disorder history. It wasn’t the first time I’d seen a therapist for my eating disorder—I’d seen one off and on over the years. But at that point, I considered myself pretty stable. I certainly wasn’t in the throes of my anorexia, nor had I been for the past five years. The reality, though, is that an eating disorder never really goes away and recovery is not black and white, so working with a psychiatrist made sense, then and now.
I remember that requisite psych evaluation being pleasant. I laid out why I’d be okay with gaining weight if I got pregnant. It seemed so manageable, such a nonissue—though in retrospect, I probably felt this way because I went into the conversation still assuming on some level that pregnancy would never happen for me.
After getting the all-clear from the psychiatrist, my doctor put me on a regimen of fertility drugs that essentially helped stimulate ovulation and support and maintain an early pregnancy. We did eight months of failed cycles, which involved taking the drugs and timing intercourse during the ovulation window (very romantic), then taking more drugs. At that point, I was fully convinced that pregnancy wasn’t in the cards for me.
Then, on a muggy day in August, I got the call: I was pregnant. In my eyes, the impossible had happened. I was overjoyed. But now it was time for another set of challenges.
Here I am, nearly 22 weeks pregnant and still navigating my eating disorder recovery.
When I got pregnant, I would have described myself as in remission—though that phrase doesn't mean much, as eating disorders never fully disappear. Indeed, the presence of my anorexia during my pregnancy is an undeniable one: I can’t help but compare my pregnancy weight to the numbers on the recommended weight gain charts. I prefer to avoid mirrors and my reflection in profile for fear of the thoughts it could trigger.
I feel pulled in two directions, one being the tyrannical voice of my eating disorder, and the other being the desire to keep my baby healthy.
Oddly, I often feel as if my pregnancy has made everyone else in my life forget my struggle with the disease. They seem to believe that, now that I’m pregnant, the anorexia must be completely gone, the prospect of motherhood so consuming and magical that it dissolved the thoughts and behaviors that have driven me for decades.
Friends who saw me hospitalized years ago now make casual comments about my belly; loved ones who used to check in with me about how I’m doing mentally have stopped; doctors who know my whole history happily report my weight gain. They don’t have any ill intent, I know. But it still occurs.
To be completely transparent, my eating disorder behaviors haven't fully disappeared, though they've lessened in frequency and severity, and I am always open about these things with my doctor. Now that I’m pregnant, they manifest in strange and sometimes conflicting ways. For instance, I love checking the app that tells me my baby’s size each week as compared to a piece of fruit, but the idea of wearing maternity pants spins up a barrage of negative self-talk from my anorexia. I give myself permission to eat when I’m hungry—feeling comforted by the fact that this food is for a different being, not myself—but I still find myself tracking every calorie. I love putting my hand on the hard, round bump of my low belly as I lie in bed, but I recoil when I catch a glimpse of my stomach in a reflection.
At times, I feel robbed of the usual joy that most get to experience during their pregnancies. For instance, I sent a video of myself getting an ultrasound to my mom, so she could hear the baby’s heartbeat. In her excited reply, she commented on how “sweetly rounded” I looked. All I could fixate on was the word “rounded” and how it sounded, and how disgusted it made me feel with myself. When the doctor told us that the baby was three days ahead, size-wise, I couldn’t help but think that this meant that I had somehow “let myself go.”
I know these thoughts are harmful and backward; I know, in one part of my brain, that my growing belly is amazing, that the love I already feel for the squirmy little girl inside me is stronger and so much more important than my desire to be smaller. But in another part of my brain, these thoughts persist, showing just how strong a grip an eating disorder can have on the way you perceive reality.
Years ago, I remember talking with a therapist about my ability to gain enough weight to have a child someday and being surprised by her response: She reminded me that this weight gain I would experience before and during pregnancy could, in theory, be temporary. She wasn’t suggesting I relapse, of course, but she was pointing out that by viewing my weight gain as temporary, the pregnancy process might feel much more manageable. On the other hand, she said, I could also gain weight and get used to it, and notice that it feels OK.
The point is that I can't know for sure how my body will change, nor how I'll react to those changes. Although this might sound a bit unconventional, this perspective has helped me at moments I’ve felt the most vulnerable.
When I reached out to eating disorder experts while working on this piece, they confirmed that the experience of becoming pregnant with an active or dormant eating disorder is a complicated one.
“People with anorexia who become pregnant often struggle with feeling that the body they’ve been striving to ‘keep in line’ or make smaller suddenly feels out of their control,” psychologist Ashley Solomon, Psy.D., managing regional director at Eating Recovery Center in Ohio, tells SELF. This relates, of course, to the weight gain, but also to the other ways in which pregnancy affects a person’s body: shortness of breath, nausea, hunger you can't ignore, insomnia. “For a woman who is already at odds with her body, the feeling that it is foreign and working against her can intensify,” says Solomon.
Another expert says that my experience is one of several ways that people with a history of disordered eating may experience pregnancy. A different, though similarly common, reaction is almost a feeling of freedom from the eating disorder, even though that's not quite what it is: "Sometimes women view pregnancy as permission to get bigger," Ariane Machin, Ph.D., cofounder of the Conscious Coaching Collective, tells SELF. The symptoms of the eating disorder might become less intense for these people, but this isn't necessarily a sign that the disordered thoughts have disappeared: After all, giving yourself "permission" to get bigger in size is still an unhealthy way to think about food and your body, and it certainly won't mean you're “cured” once the pregnancy is over. This is especially true because that permission is usually contingent—it only exists because the food is for a different human; once that human is gone, so is the permission to eat.
Knowing how you’ll react—scared, ambivalent, angry, or suddenly free from a tyrannical disease, maybe—is impossible to predict until you’re in the moment. For me, at least, I feel all of these things any number of times on a given day.
To cope with these unpredictable challenges, experts ultimately recommend seeking out support wherever possible.
That means being totally transparent about how you’re feeling with your medical providers. “Don’t sugarcoat it, and make sure you’re offering the full picture,” Solomon says. She also recommends working with a dietitian, who can help you objectively understand and fulfill your new nutritional needs.
Machin recommends getting consistent help from a mental health professional who works with people recovering from an ED, noting that “if a woman is feeling vulnerable and has excessive thoughts about food, exercise, or maintaining a certain body type, this is an amazing time to seek support via therapy or a coach.” Solomon agrees, adding that group therapy, too, can be “immensely helpful” in connecting with others going through similar experiences. Individual and/or group therapy can also help you identify the coping mechanisms and strategies that work best for you, since what helps one person in recovery may not necessarily be what works best for another.
Being mindful and present throughout the process, the good and the bad, can be a useful coping mechanism as well. Writing (like this essay) can potentially even help “elicit a calmness and awareness,” Machin says. It can be therapeutic when people in recovery write, talk about, or read about their disease and their journey, she explains. Karla Mosely, an ambassador for the National Eating Disorders Association (NEDA), also tells SELF that it’s helpful to focus on and remind yourself regularly of the reason behind all of your bodily changes: “Know that on the other side of this isolation is joy beyond belief,” she says.
I may have considered myself in recovery when I got pregnant, but this new chapter has confirmed that my anorexia may continue to pop up as I face new challenges and enter new phases of my life. And with each reappearance, I must find ways to manage the latest manifestation.
Recently, I got back in touch with my old dietitian and disclosed my entire history of my eating disorder to all my doctors. I do my best to open up to my husband in difficult moments. When I feel unhappy with or ashamed of my body, I put my hand on my belly and wait to feel her kick; when I feel an unhealthy compulsion to work out, I think about her breathing, her heart rate. Even in writing these words, I’m hoping to elicit that sense of calm that Machin describes.
Still, even with all of these tactics, I’ve kept those words from my therapist in my back pocket, and they’ve given me reassurance during difficult moments. But as my baby becomes realer to me, the idea of going back to my old ways post-pregnancy becomes far less comforting or enticing.
My eating disorder didn’t disappear when I got pregnant. And that reality is, perhaps, why I felt so compelled to be raw and honest about this experience.
It’s true that pregnancy defines me in many ways these days, that it has changed me. But it’s also true that it doesn’t cure psychological conditions that ebb and flow. Many people still navigate forms of mental illness—eating disorders, depression, addictive tendencies, or any number of other mental health issues—and their recovery process while simultaneously navigating a journey to parenthood.
This general denial that these challenges cannot co-exist with pregnancy can make people like me feel that much more alone. I hope that, in time, we’ll learn to recognize the pregnant person as a whole, imperfect human, with their own hurdles to face, just as they did before becoming pregnant.
But in the meantime, I’m finding ways to maintain my physical and mental health. If I’m flooded with guilt, I read updates about my baby’s development in my pregnancy app. If the way my clothes fit makes me feel bad, I think of the little button nose on the sonogram, the perfect baby curled up beneath the zipper of my jeans. If I have a moment when I miss my old body, I remember that this new body is serving a purpose.
And when I feel a tiny kick, a hiccup below my belly button, I know that, despite the challenges behind and those that lie ahead, one thing that I am not is alone.
If you or someone you love struggle with disordered eating, contact the National Eating Disorders Association (U.S.) helpline at (800) 931-2237 or National Eating Disorder Information Centre (Canada) at (866) 633-4220.