Biological factors of pregnancy-related eating disorders
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)
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
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
- Unhealthy and abusive relationships
- Conflict within the childhood home
- Alcohol or drug use within the home
- Death of a loved one
- 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.