Bulimic Symptoms During Pregnancy

Reprinted from Eating Disorders Review
March/April 2003 Volume 14, Number 2
©2003 Gürze Books

It’s one of the many mysteries of bulimia nervosa—why symptoms improve during pregnancy but return or even worsen during the postpartum period. In one study of 94 women, Morgan and colleagues found that pregnancy alleviated a sense of responsibility for body weight and shape. Other studies have shown that changes in taste and smell and changes in satiety associated with altered leptin levels may affect feeding behavior (Psychosom Med 1992; 54:665).

A case where symptoms worsened during pregnancy

For some women, symptoms worsen during pregnancy. A recent case of a ballet dancer with bulimia nervosa provided some clues to psychological factors that may have contributed to her increasingly disordered eating during pregnancy (Psychosomatics 2003:44:76).

The 37-year-old dancer had a dramatic worsening of eating problems during the first trimester of her third pregnancy—she reported up to 10 episodes of binge eating and vomiting weekly before pregnancy, and exercised excessively three times a week. When she was admitted to the hospital in the 20th week of gestation, her binge eating and vomiting had increased to more than 30 episodes per week, and she had begun exercising and jogging daily for at least 2 hours. She had extensive dental caries and iron deficiency anemia.

Behind the scenes

The dancer’s eating disorder had started when she was 17 and planning to become a dancer—once she began her dancing studies, the desire to become thin had increased to a point where she reported up to 10 binge eating and vomiting episodes a week. During her first two pregnancies, however, she completely stopped binge eating and vomiting.

She reluctantly became pregnant for a third time, after her husband convinced her that this would stabilize their marriage. When a sonogram showed a possible malformation of her fetus, she became overwhelmed with feeling of fear and guilt and was afraid she couldn’t cope. At some level within or outside of her awareness, one might also imagine that she may have been attempting to induce a spontaneous abortion.

Comment

The authors note that even more important than understanding improvement of bulimic symptoms during pregnancy is the need for insight into the reasons for lack of improvement or even worsening of symptoms that can occur during pregnancy. This information is crucial not only because of the health risks to the fetus and mother but because bulimic patients seem to have a higher risk of affective disorders, including postpartum depression, after delivery.

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