A qualitative investigation of the factors influencing eating disorder symptomology during the postpartum period.

Abstract

Background: The perinatal period can be a challenging time for women with current or historical eating disorder (ED) experience. Maternal EDs are associated with risks to both the mother and the child. During pregnancy, women are more likely to disengage with ED behaviours for the good of their growing baby. However, the postpartum period is a particularly risky period for the re-emergence or worsening of ED behaviours, irrespective of women's pre-pregnancy ED status. Little is known about the factors which influence ED symptomology during the postpartum period. The aim of this study was to develop an understanding of the factors operating in the postpartum experience that influence ED symptomology.

Methods: Semi-structured interviews were conducted with 12 women who had experience of an ED before becoming pregnant. Interview took place during or after the postpartum period, with women reflecting specifically on the postpartum period. Interviews were analysed using Reflexive Thematic Analysis.

Results: Four themes were developed within the interview data; (1) Embracing the self, (2) Motherhood: an ED enabler or protector?, (3) ED as a 'plaster' for emotional distress, and (4) The influential voices of others. Theme 1 captures participants' reports of the primary ED recovery facilitator, with a focus on self-awareness, self-understanding, self-compassion, and self-identity. Themes 2-4 describe a 'triangle of powers' which interacted with one another to influence participants' ED symptomology both positively and negatively during the postpartum period.

Conclusion: A new model is proposed which predicts that ED symptomology during the postpartum period is influenced by a complex interaction between various internal and external factors. Health care professionals encountering women with EDs during the perinatal period should be aware of these factors, to provide attuned and individualised care and improve outcomes for mothers and babies. Increased awareness how EDs may present during the postpartum period is needed.