Pregnancy-related eating disorder pregorexia causes

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Pregnancy-related eating disorders, or pregorexia, are eating disorders that develop during pregnancy, after childbirth, or throughout parenthood.

The scientific literature estimates that up to 7.5 percent of pregnant individuals experience an eating disorder during their pregnancy. (1) 

An eating disorder during pregnancy can have serious implications for both mother-to-be and her unborn baby. The mother is at increased risk of cardiac irregularities, miscarriage, and malnutrition, while the child is at risk of feeding difficulties and birth irregularities, including preterm labor and low birth weight.

There is no single cause of pregorexia. The eating disorder develops through the interaction of several biological, psychological, behavioral, and social factors.

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Biological factors of pregnancy-related eating disorders

Brain chemistry

The stress of pregnancy can activate the hypothalamic-pituitary-adrenal axis in the brain, as well as release hormones involved in the modulation of food intake. 

Stress also stimulates particular neurons that suppress the secretion of the NPY neurotransmitter, reducing its appetite stimulant and anxiety-relief actions. (2)

Genetics

While there is not a specific gene linked to the development of eating disorders, research has revealed there is a genetic component to eating disorders. (3) 

Twin studies show genetics accounts for between 40% - 60% of the risk of developing an eating disorder. Plus, research has revealed that people with an immediate family member suffering from anorexia are approximately 11 times more likely to develop the disease themselves. (4)

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Environmental factors of pregnancy-related eating disorders

Psychological/emotional/identity

Fear of gaining weight

Perhaps the most significant physical change during pregnancy is weight gain. Many women struggle to cope with pregnancy-related weight gain, particularly when their changing bodies invite comments from strangers. (5)

This can lead to feelings of guilt and shame about weight gain, which may result in the urge to manage and restrict food intake, for fear of being judged by others.

History of eating disorders

For some people with eating disorders, pregnancy is a motivation to stop or reduce their eating disorder behavior. 

However, in general, pregnant individuals with an eating disorder or a past history with disordered eating behaviors are more at risk of increased body image issues, concerns over an expanding abdomen, and problems adjusting to hormonal and physical changes over which they have no control. (6)

The experience of pregorexia will be different from a person’s previous eating disorder, as the body undergoes drastic changes during pregnancy. Struggles with changing body weight and shape can result in individuals feeling grotesque and like they are losing control. (7) 

This may cause individuals to revert to their disordered eating behaviors, such as restricting food, overexercising, and purging, to regain a sense of control.

The stress of becoming a mother

Becoming a parent is a frightening experience for some people, and they may use control as a way to cope with this life-changing transition. 

The emotions and physical changes experienced throughout pregnancy can feel overwhelming. This may lead some to turn to compensatory behaviors, like bingeing, purging, laxative use, and excessive exercise, as coping mechanisms to negative thoughts and emotions.

Body image issues

A key contributing factor to any eating disorder, including pregorexia, is the drive to be thin and the weight gained during pregnancy can have a negative effect on self-esteem. (6) In fact, body weight and body shape dissatisfaction can occur during pregnancy in those with or without a history of eating disorders. (8)

History of trauma

Trauma has been shown to play a significant role in the development of eating disorders, including pregorexia. The prevalence of eating disorders is much higher in those with post-traumatic stress disorder or who have experienced past trauma. (9)

Types of trauma associated with the development of eating disorders include:

  • Sexual, emotional, and physical abuse
  • Sexual assault and sexual harassment
  • Bullying
  • Neglect
  • Unhealthy and abusive relationships
  • Conflict within the childhood home
  • Alcohol or drug use within the home
  • Death of a loved one
  • Divorce
  • Financial instability

People who have undergone trauma often struggle with shame and guilt, feel a lack of control, and have body dissatisfaction. (8) Becoming pregnant can make victims of trauma hyper-aware of their lack of control as their body starts to change. As a way to regain control over their body, or cope with intense emotions, some may develop disordered eating behaviors.

Mental health issues

Mental health issues can also play a key role in the development of eating disorders. Those with an obsessive-compulsive personality disorder are more likely to develop anorexia nervosa and people with borderline personality disorder are more vulnerable to bulimia. 

Other psychiatric disorders, such as depression, anxiety, and the use of substances, can also contribute to the onset of eating disorders. (10) Pregnant individuals with unresolved mental illness may develop eating disorder symptoms as a response to the unique stressors of pregnancy.

Social/peer pressure and competition

Societal & cultural pressures

Western cultures tend to emphasize thinness as a physical ideal. Every day, pregnant people are flooded with images of and messages about how their bodies should look. Social media bombards them with images and talk of how much weight certain celebrities gained during pregnancy or how quickly they lost their baby weight, as well as information on how to stay fit and healthy. (3)

Some cultures even actively encourage disordered eating patterns during pregnancy. For example, in China, food restriction in pregnancy is common, with the belief that it will protect the unborn child from complications such as stillbirth, miscarriage, and newborn “imperfections.” (10)

Furthermore, as their body changes, pregnant people may feel pressure from their family members, peers, and partners to gain a minimal amount of weight and remain “healthy” throughout their pregnancy.

These societal and cultural pressures can cause pregnant people to become overly focused on their weight. In an attempt to stay as thin as possible, the symptoms of pregorexia may develop. (3)

Low socioeconomic status

The Norwegian Mother and Child Cohort Study (MoBa), which studied the disordered eating behaviors of mothers both prior to pregnancy and throughout, discovered that those with a lower socioeconomic status, were more likely to develop binge eating disorder (BED) during pregnancy. (11)

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Treatment of pregnancy-related eating disorders

While there is no standard treatment for pregorexia, intervention from a multidisciplinary team of physicians, dieticians, nutritionists, and psychotherapists provides the best chance at recovery from the condition.

The primary aim of treatment is to understand what drives disordered eating behaviors, as well as identify and address the root causes of pregorexia. Treatment methods used may include:

  • Individual Therapy: Cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT) can help patients develop healthier coping mechanisms to the stressors of pregnancy, explore unresolved emotions, and discover potential triggers for disordered eating behaviors.
  • Group Therapy: A group environment gives people an opportunity to talk to others in a similar situation, which helps them feel less alone. Family therapy and couples therapy may also be useful so loved ones know how to provide the right support.
  • Nutritional Counseling: Provided by a registered dietician, nutrition counseling can help a person with pregorexia work through their misguided beliefs about food and develop healthier food habits.

Partners and family members of those with pregorexia can benefit from attending support groups, where they, too, can discuss their concerns and better understand the condition.

Additionally, once pregorexia is out in the open, an OB/GYN can monitor the health of the mother and baby, and provide interventions if necessary, to ensure the best possible outcome for the pregnancy.

Asking for help for an eating disorder is hard. Being pregnant can compound the desire to hide behaviors, as someone who may have symptoms of pregorexia may feel additional shame about their perceived inadequacies. Seeking help for an eating disorder can be daunting. Each individual will need support, compassion, and empathy.

Within Health offers compassionate care for anyone struggling with an eating disorder, including pregnancy-related eating disorders like pregorexia. Reach out to our team today to learn about our virtual care programs.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Easter A, Bye A, Taborelli E, Corfield F, Schmidt U, Treasure J, et al. Recognising the symptoms: how common are eating disorders in pregnancy? Eur Eat Disord Rev. (2013) 21:340–4.
  2. Lo Sauro C, Ravaldi C, Cabras PL, Faravelli C, Ricca V. Stress, hypothalamic-pituitary-adrenal axis and eating disorders. Neuropsychobiology. (2008) 57:95–115.
  3. What is pregorexia? Eating Disorder Hope. (2021, December 3). 
  4. Raina Delisle (2021, October 1). Pregnancy is the eating disorder trigger that no one ever talks about. Today's Parent. 
  5. Lauren Muhlheim, P. D. (2021, October 7). Eating disorders during pregnancy: What you need to know. Verywell Mind. 
  6. Koubaa, S., Hällström, T., & Hirschberg, A. L. (2008). Early maternal adjustment in women with eating disorders. The International journal of eating disorders, 41(5), 405–410.
  7. Fogarty, S., Elmir, R., Hay, P., & Schmied, V. (2018). The experience of women with an eating disorder in the perinatal period: a meta-ethnographic study. BMC pregnancy and childbirth, 18(1), 121.
  8. Coker, E., & Abraham, S. (2015). Body weight dissatisfaction before, during and after pregnancy: a comparison of women with and without eating disorders. Eating and weight disorders: EWD, 20(1), 71–79. 
  9. Eating disorders, trauma, and PTSD. National Eating Disorders Association. (2018, February 20). 
  10. Cecile C. Exterkate, Patricia F. Vriesendorp, Cor A.J. de Jong, (2009) Body attitudes in patients with eating disorders at presentation and completion of intensive outpatient day treatment: Eating Behaviors, Volume 10, (1): 16-21,

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