Since every family situation is different and eating disorders are complex conditions, there is no one “right” way to reach out to your daughter during her pregnancy. Throughout this article, we have emphasized the importance of showing empathy; as with every other situation involving disordered behavior, you’ll want to communicate to her that you sense what she is going through and that you’re on her side. Chances are her eating disorder makes it difficult for her to see the size and shape of her pregnant body accurately. Her increased appetite, coupled with her misperception of her expanding body, may cause her distress. Statements such as the following are likely to be helpful:

•  “It must be so hard to eat healthy these days.”
•  “I’d imagine the last few weeks have been nerve-racking/overwhelming/scary for you.”
•  “I can understand why you feel conflicted about snacking/resting.”

Claudia, Sybil’s mom, describes how self-reflection increased her empathy for her daughter. “My weight-consciousness has followed me for a long time,” she admits. “When Sybil first developed her eating disorder, I was going through menopause. One part of me realized that it is normal and natural for women my age to put on some pounds as their metabolisms slow.

But another part of me felt that fat was bad and that if I gained weight, even just a few pounds, I would lose my value as a person. In a department store one day, I overheard the expression middle-age spread in a conversation between two women. My gut reaction-‘I’m doomed to be fat and bad’-may have been similar to how Sybil felt in the face of the freshman 15. My point is that becoming aware of how I feel about my own body has helped me understand my daughter’s experience on some level. My body image issue is not nearly as severe as an eating disorder. Since I find it challenging to cope with my body anxieties, I can only imagine how hard Sybil’s experience must have been for her, especially when her illness was in full gear.”

Moving Forward
Claudia and Sybil’s recollections illustrate some key points.

Anorexia and bulimia generally improve with professional treatment and, for some individuals, tend to reawaken later in life, especially in response to challenges that involve body image. In addition to those who are afflicted with the illness, many women teeter on the edge. Others, including now-60-year-old Claudia, experience body dissatisfaction for many years but don’t generally engage in extreme weight-loss practices.

Throughout this article, we have emphasized how hard it is for adolescents with anorexia or bulimia to seek help. This also holds true for adult patients who may be embarrassed to have what they perceive as a “teenager’s problem” or feel too swamped in day-to-day responsibilities-including a career, parenting, or caring for elderly relatives-to take time for their own health. In her first five years as a mom, Sybil has stayed physically healthy. Her part-time teaching job, in addition to child-care responsibilities, keeps her busy. To all outward appearances, she’s fine. Yet her struggles are not over. “My slips into abnormal eating behaviors have become shorter and less frequent,” she says. “Yet I still feel haunted by ‘I’m fat and bad’; it lurks in my mind. It’s not that my negative body thoughts are constant. They come and go, and some are more forceful and stubborn than others. Having people to confide in has been an enormous help.”

Whether your child is 15, 30, 45, or older-whether she’s living with you, in a college dormitory, in her own apartment, or with a significant other-try to encourage her not to suffer in isolation. Even patients who have had eating disorders for a long time can make progress and feel better with treatment. For individuals who appear fine on the outside but feel uncomfortable on the inside, therapy will often help cut through the loneliness of these disorders and pave the way to greater self-acceptance. In our final section, we will discuss future directions in research and explore how individuals in recovery, their families, friends, and professionals in the field are joining together to improve the lives of all sufferers.

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David B. Herzog, M.D., Debra L. Franko, Ph.D., Pat Cable, RN

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David B. Herzog, M.D., is the Harvard Medical School Endowed Professor of psychiatry in the field of eating disorders at Massachusetts General Hospital and the director of the Harris Center at Massachusetts General Hospital.
Debra L. Franko, Ph.D., is a professor in the Department of Counseling and Applied Educational Psychology at Northeastern University and the associate director of the Harris Center at Massachusetts General Hospital
Pat Cable, RN, is the director of publications at the Harris Center.