What It’s Like to Deal With Anorexia While You’re Pregnant
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.