Eating Disorders And Pregnancy: Common Disorders, Symptoms, And Treatments

While a variety of conditions can complicate pregnancy, eating disorders may have a number of distinct effects that can make pregnancy particularly challenging. These disorders can affect both the physical health of the individual who is pregnant and the development of the baby, leading to potential risks and complications. In order to fully understand the associations between eating disorders and pregnancy, it may be beneficial to begin by learning more about what eating disorders are and what symptoms they can cause. 

What is an eating disorder? 

According to the American Psychiatric Association (APA), an eating disorder is a behavioral condition that can affect a person’s social, physical, and psychological function. Eating disorders can disturb how a person thinks about and interacts with food. The APA estimates that 5% of the population experiences an eating disorder. While individuals of any age can develop an eating disorder, these conditions may be more likely to occur during young adulthood and adolescence. 

Can an eating disorder occur during pregnancy? 

Which eating disorders are most common?

In 2020, the one-year prevalence rates for common eating disorders were as follows:

• Binge eating disorder: 0.96% for females and 0.26% for males
• Bulimia nervosa: 0.32% for females and 0.05% for males
• Anorexia nervosa: 0.16% for females and 0.09% for males

These disorders can present with unique symptoms that may have negative effects on those experiencing them, including pregnant individuals. 

What is binge eating disorder?

Binge eating disorder (BED) often involves periods of significant food consumption that can exceed what one would typically eat in that amount of time. These periods may be referred to as episodes of binge eating. For an individual to be diagnosed with BED, they need to experience recurrent binge eating episodes. According to the Diagnostic and Statistical Manual of Mental Disorders 5th Edition Text-Revision (DSM-5-TR), binge-eating episodes can be defined by the following criteria:

• Eating an amount of food that could be considered larger than what most people would consume in a similar period of time (for example, within a 2-hour period)
• Feeling a lack of control over one’s eating. This can manifest as the feeling that a person cannot stop eating, control what they are eating, or control the quantity they eat. 

Binge eating disorder symptoms

Binge eating isn’t the only way to recognize BED. There may be a variety of signs and symptoms that can indicate someone is experiencing this disorder.

Binge eating disorder symptoms can include:

• A tendency to hide episodes of binge eating or to eat in secret
• Feelings of shame or guilt around eating
• Significant changes in weight
• Low self-esteem
• Frequent failed attempts to diet
• Social withdrawal
• Concerns with body weight or shape

What is bulimia nervosa?

Like BED, bulimia nervosa can involve periods of binge eating. However, one significant difference can be the behavior that may follow eating. Individuals with bulimia nervosa typically engage in behaviors after binge eating episodes (and regular periods of consumption) in an effort to not gain weight. These behaviors can be referred to as “purging” and may involve:

• Use of laxatives and diuretics
• Forced vomiting
• Excessive exercise
• Excessive fasting

Bulimia nervosa symptoms

The behaviors common in bulimia nervosa may have significant emotional and physical consequences, making it essential to recognize and address the signs of bulimia nervosa early. The signs and symptoms of bulimia nervosa can include:

• Difficulty stopping eating, even if one doesn’t want to continue
• Specific habits or rituals built around eating
• Feelings of anxiety or depression
• Attempts to hide binging or purging behaviors
• Throat inflammation or pain
• Fatigue
• Erosion of tooth enamel 

What is anorexia nervosa? 

Anorexia nervosa is typically characterized by a restrictive food intake that can lead to insufficient nutrition and lower body weight. Individuals experiencing anorexia nervosa can experience distorted self-perception, in some cases believing they are overweight when they are severely underweight. These distortions in perception can also cause a person to not notice how serious their condition is becoming, which can put them at risk of serious harm and even death. 

Anorexia nervosa symptoms

In order to potentially avoid these consequences, it may be helpful to look for anorexia nervosa symptoms. The signs and symptoms of anorexia nervosa can include:

• Low body weight
• Significant preoccupation with eating
• Fear of gaining weight 
• Excessive exercise
• Dehydration
• Thin nails and hair
• Yellowed skin
• Fatigue

Can pregnancy weight gain affect eating disorders?

Research suggests that the weight gain that may accompany pregnancy can lead to a worsening or recurrence of eating disorders. Pregnancy weight gain can exacerbate the self-conscious aspects of eating disorders, causing individuals to experience anxiety as their weight increases or body shape changes. 

Besides weight gain, how can pregnancy and eating disorders impact one another?

According to the American Pregnancy Association, eating disorders can have several effects on an otherwise healthy pregnancy, such as:

• Respiratory challenges
• Labor complications or premature labor
• Fetal death or stillbirth
• Fetal growth delay
• Low birth weight
• Increased risk of miscarriage
• Depression

Eating disorders can also impact fertility, particularly in the case of anorexia nervosa. The American Pregnancy Association also estimates that approximately half of individuals living with bulimia do not experience regular menstrual cycles. This can reduce the chances that someone will conceive. These cycle disruptions may be the result of several aspects of eating disorders, including excessive exercise, psychological stress, and reduced calorie intake. 

What treatments can help pregnant individuals with an eating disorder? 

According to the National Institute of Mental Health (NIMH), there are several treatments that may help individuals with disordered eating. While these treatments may vary for those who are pregnant, treatments may include therapies like enhanced cognitive behavioral therapy and medications like antidepressants. The NIMH also notes that an individual’s family members can play a significant role in treatment, as they can learn more about what doctors consider to be healthy eating behaviors, provide support to their loved one, and encourage them to seek assistance. Mental health professionals can also provide support for any self-destructive habits or other mental health challenges that may be exacerbating eating disorders. 

Mental health treatments for eating disorders

One therapeutic approach that may be effective for the treatment of eating disorders is enhanced cognitive behavioral therapy (CBT-E). CBT-E can offer a personalized approach to eating disorder therapy by providing a way for individuals to analyze their condition and understand how to stabilize their eating patterns. This type of treatment may also help individuals find ways to overcome setbacks they may face in addressing the challenges of their disorder and maintain the changes they make going forward. 

While CBT-E and other types of therapy may be beneficial for pregnant individuals experiencing eating disorders, in-person forms of therapy may not always be convenient. In some cases, pregnant individuals may not have the time to schedule appointments or travel to a therapist’s office. Others may live in a remote region or an area that doesn’t have a sufficient number of mental health professionals. In these situations and many others, alternatives like online therapy may be beneficial. 

Research suggests that online therapy can be as effective as in-person therapy for the treatment of several mental health conditions. In a 2022 meta-analysis and systematic review, researchers compared data from multiple studies to determine the comparable efficacy of these therapeutic formats. Their analysis, which included 12 studies and 931 total patients, found no significant differences between online and in-person therapy on a variety of outcomes. These outcomes, which were measured both immediately after treatment and at 3, 6, and 12 months, included symptom severity, overall improvement, function, working alliance, and client satisfaction. 

Also, individuals don’t have to have an official diagnosis of an eating disorder to see an online therapist. Online therapists often treat people with a variety of mental health problems, relationship challenges, and body image concerns.