Eating Disorders
by Sarit Shatz
Eating Disorders and Pregnancy
This is in response to a question by Vicky
Your question and the issue in general, are very important. Although it's well known that many of the patients suffering from eating disorders, particularly those with anorexia nervosa, have a primary or secondary amenorrhea and are infertile (meaning that they do not ovulate), the reproductive aspects in women suffering from eating disorders and disordered eating, have not been studied much.
Starkey and Lee, in a very early study (1969), found that in most anorexic patients, menses and fertility can return with successful treatment. Other research suggest the fecundity of women who recovered from anorexia and wanted to have children, is no different from that of the general population.
Occasionally pregnancy may occur during the active phase of anorexia nervosa if the weight gain is sufficient. Or it may follow hormonally induced ovulation. Women who didn't restore their weight and eating patterns to a normal level, didn't experience menstrual return or conception.
Additionally, investigators found that a significant proportion of women with amenorrhea or infertility who are seen in infertility clinics, actually have undisclosed eating disorders or are on very restricted eating patterns. In the case of bulimia, 50%-70% of the women experience secondary amenorrhea that lasts for more than 12 months. As the majority of the patents suffering from bulimia, have BMI more than 19, the amenorrhea is most probably related to the weight control behaviors they are engaged in. During the course of the illness, these women suffer from infertility at twice the rate of the general population. With remission of the eating disorder and recovery, over 80% will achieve pregnancy.
The course of pregnancy in patients suffering from eating disorders is a very large and important AND complex issue. but I won't discuss it now.
You can read more in the following articles :
Infertility and eating disorders. by D. Stewart, et al, Am. J. of Obstetr. and Genecology, . vol. 163, no.4. (1990).
The influence of dieting on the menstrual cycle of healthy young women, by Pirke et. al.. J. of Clinical Endocrinology and Metabolism, vol.60, no.6 (1985)
Anorexia Nervosa, Bulimia and Pregnancy. Stewart et. al, Am. Jour. Obstetr. and Gynecology, vol. 157, n. 5 (1987)
Hope that the information helps.
Sarit Shatz RN
Israel
Eating Disorders As a Continuum
The field of eating disorders is a very dynamic one. Today we know more about these complex health problems than we did just ten or twenty years ago. The criteria for bulimia nervosa, for example, was defined only in 1979. Binge eating disorders is a relatively new, being mentioned in DSM IV in 1994. Today, with the growing body of knowledge, we have such new disorders as nocturnal binge eating, anorexia athletica, etc. The complexity regarding the diagnosis and definition of an eating disorder, is tremendous and challenging. It includes components such as gender, developmental period, age and the ability to draw the line between normal and pathological characteristics. We should think of eating behaviors as being on a continuum, not as distinct entities.
Eating disorders are psychiatric entities with declared criteria, as defined in the DSM. However, there are many eating PROBLEMS which don't have strict definitions, but still have to be dealt with therapeutically. For instance, eating problems among infants are common. But in many cases we find it very difficult to distinguish between normal and pathological eating patterns. Young children tend to eat differently than adults and change their eating habits and preferences as they mature. The differences between eating problems and disorders in infants vis-à-vis adolescents and adults, are in the characteristics and the components of their eating. However the underlying issues are very similar, in general. It is believed that the origin of eating disorders in infancy are in the infant, his parents or in the interaction between the infant and his parents.
Chatoor et al (1985) divided eating disorders in infants into 4 major types:
- Disturbance in the physiological balance (0-3 months)
- Depression of infancy
- Power struggles around issues regarding control and independency
- Eating disorders as a result of traumatic feeding process or relationships
More information about those issues can be found in :
Chatoor et. al. "A developmental clarification of feeding disorders associated with failure to thrive (FTT)" : in : Drotar D. (ed). New directions in FTT ; implication for research and practice. New York. Plenum. 1985 pp - 235-258.
Sarit Shatz RN
Israel
