A Case of Anorexia Nervosa Triggered by Early Pregnancy

Pregnancy and parenthood at an early age may help precipitate anorexia nervosa, according to Stanford researchers. In what is believed to be the first reported case of anorexia nervosa directly linked to pregnancy, a 17-year-old girl developed the eating disorder after an unplanned pregnancy (Int J Eat Disord 24:223, 1998).

After her infant was delivered, the girl weighed 68.2 kg (121% of ideal body weight, or IBW). She breast-fed her baby for a year, then began a self-imposed daily regimen of 700 kcal and 2 to 3 hours of walking. Within 2 months, she had lost 29.2 kg.

Improvement, then a turn for the worse

When she was admitted for treatment, the teen weighed 39.0 kg (69.6% of IBW) and had 4.7% body fat. With the help of a team of psychiatrists, nutritionists, and adolescent medicine specialists, she slowly recovered. After 5 weeks she was eating all of her food and began to have some insight into her illness. She also underwent group, individual, and family psychotherapy. When she was discharged, she weighed 46.6 kg (83% IBW), and had 13% body fat.

However, 4 weeks later, the picture was very different. She began to lose weight and was rehospitalized. After 4 more weeks, and a hospital course similar to the first, she was discharged and then was enrolled in the university’s day treatment program for 2 more weeks.

What factors were at work?

Dr. James Lock and Lisa Renee Benton-Hardy found several underlying clues, including the physical changes that came with pregnancy, changes that apparently posed a significant challenge to the teen’s self-image. In addition, the disorder enabled her to avoid becoming an independent adult. Before she became pregnant, the girl was the only child at home and enjoyed a close relationship with her mother. After her child was born, and before the disorder developed, the girl and her mother began to battle for control. The development of anorexia nervosa eased these battles: The mother could once again be primary caregiver, and instead of losing a daughter and a grandchild, in effect she now had 2 daughters.

The girl’s peer group also had an effect. She reported feeling uncomfortable around her friends and peers and no longer wanted to date or go out, but preferred to stay home with her child. Her parents wanted her to resume a normal life, but the disorder allowed her to avoid peer relationships, dating, or even looking for a job.

Thus far, the teen has not required further treatment. According to the authors, the young mother’s ability to recover will depend upon successful integration of her physical, psychological, and social self.