“Our bodies are beautiful in every shape, size, and color. We cannot allow ourselves or others to begin a cycle of self-hatred over the bodies that are our lifelong homes.”
Healing Bodies, Healthy Babies is designed to be a resource for clinicians and healthcare professionals, patients, and family and loved ones to help navigate the complex issue of pregnancy and eating disorders.
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Thoughts & Insights
February 2020 Sensitivity Training
By: Malerie Razzis
West Virginia University
This past February, the Healing Bodies, Healthy Babies research team was able to conduct their very first sensitivity training. There were months of preparation prior to the first session with considerable work from team members including Zoya Khan, Caterina DeFazio, Taylor Shultz, Oghenerukeme Asagba, and Hattie Rowe. During Summer 2019, the team worked in the WV STEPS lab to film examples of patient-clinician interactions. These videos have been made available for the public to view on Youtube. Prior to the first sensitivity training, all members of the Healing Bodies, Healthy Babies team also underwent the sensitivity training.
The sensitivity training that was developed for the clinicians provided various clinical strategies that would be reasonable to integrate into their daily treatment of patients, particularly those with eating disorders and pregnancy. Previous studies have laid some groundwork about the prevalence and characteristics of eating disorders in pregnancy, indicating a greater need for clinical understanding of eating disorder symptomatology and appropriate screening tools to be incorporated into prenatal and postpartum care. Pregnant women with a history of eating disorders or an active eating disorder have a greater risk of giving birth to a child with lower birth weight, smaller head circumference, microcephaly, and small for gestational age (Kouba, Hällström, Lindholm, & Hirschberg, 2005). Due to these health risks, it is important for clinicians to learn how to properly treat patients with eating disorders.
A questionnaire was administered prior to the sensitivity training, as well as after the completion of the sensitivity training. Prior to training, only 76% of clinicians indicated that a patient’s eating disorder history would be extremely relevant to their treatment. Upon the end of training, this number increased to 96% of clinicians indicating that it would be extremely relevant to their treatment. When asked about their comfort when treating patients with eating disorders, 61% of clinicians expressed being less than comfortable providing treatment. After undergoing the sensitivity training, this number shifted to 84% of clinicians indicating that they were either somewhat comfortable or extremely comfortable with treating patients with eating disorders. These results were promising to the Healing Bodies, Healthy Babies team.
Since this was the first sensitivity training, the results are preliminary. “I am hopeful that once we conduct more trainings, we will have more data to analyze! This will allow us to investigate the significance of our data and how the sensitivity training can be implemented to better aid clinicians,” reported Zoya Khan. Khan is an undergraduate student that is an active member of the Healing Bodies, Healthy Babies team. She would like to be able to administer the sensitivity training to a variety of clinicians including physicians, physician assistants, nurses, etc. in the future. “Every person has a unique insight to offer, which will allow us to determine how we can provide clinicians with resources to treat patients with eating disorders,” she says. Another goal that she has for the team is to continue developing free resources that are made available on the Healing Bodies, Healthy Babies website. “I look forward to continuing to work with Dr. Claydon and the rest of the Healing Bodies, Healthy Babies team!”
Khan, ZA, DeFazio, C, Claydon, EA. “An evaluation of weight sensitivity training for clinicians” Poster presentation at the Spring Undergraduate Research Symposium, Morgantown, WV, April 2020.
Kouba S, Hällström T, Lindholm C, Hirschberg AL. Pregnancy and Neonatal Outcomes in Women With Eating Disorders. Obstetrics & Gynecology. 2005;105(2):255-260. doi:10.1097/01.aog.0000148265.90984.c3.
A Perfect Storm
By: Hannah Meeks
Pregnancy, especially an unplanned one, can be a stressful time for women with eating disorders due to amplified feelings of body dissatisfaction and anxiety about gaining weight. This, coupled with a lack of support and screening from clinicians who may not understand the intersection of eating disorders and pregnancy, creates a perfect storm for women with eating disorders.
While these unpleasant feelings normally dissipate to that of women without eating disorders after 18 weeks’ gestation, they can be even more overwhelming for women whose pregnancy is unplanned. Easter, Treasure and Micali (2011), notes that rates of unplanned pregnancy for women with eating disorders are higher than that for women without eating disorders, with women who have anorexia being twice as likely and women with bulimia being 30 times as likely to experience an unplanned pregnancy.
Many women with eating disorders experience amenorrhea and oligomenorrhea and can incorrectly assume that also means they are infertile. Amenorrhea is characterized by the absence of a menstrual period for at least three months and is often seen in women with anorexia nervosa(Amenorrhea, 2019). Oligomenorrhea is characterized by infrequent menstrual periods and can be seen in women with both anorexia nervosa and bulimia nervosa. The belief that this reduces fertility is incorrect and can be one potential explanation for why rates of unplanned pregnancy are so high in these groups.
Another possible explanation for these high rates of unplanned pregnancy among women with eating disorders could be an increased participation in risk-taking behaviors. Women with eating disorders may be more likely to engage in risky sexual behaviors such as a lack of using contraceptives such as condoms (Tabler & Geist, 2016). This coupled with an assumption of infertility can lead to greater risk for unplanned pregnancy.
Eating disorders during pregnancy already pose health risks to both the mother and baby, and many women will often not disclose their ED status with healthcare providers. Therefore, it is necessary to become more aware not only of the signs of eating disorders in pregnant women but also how best to approach things like weight and weighing processes during visits in order to better support patients who may have an eating disorder. This is one of the reasons for establishing Healing Bodies Healthy Babies, to help provide resources to the women affected, clinicians, and even family members of women with eating disorders.
Amenorrhea. (2019, July 25). Retrieved from https://www.mayoclinic.org/diseases-conditions/amenorrhea/symptoms-causes/syc-20369299
Tabler, J., & Geist, C. (2016). Young Women with Eating Disorders or Disordered Eating Behaviors: Delinquency, Risky Sexual Behaviors, and Number of Children in Early Adulthood. SOCIUS, 2, 1-14. https://doi.org/10.1177/2378023116648706
Easter A, Treasure J, Micali N. Fertility and prenatal attitudes towards pregnancy in women with eating disorders: results from the Avon longitudinal study of parents and children. BJOG. 2011;118(12):149–8. https://doi.org/10.1111/j.1471-0528.2011.03077.x.
A Toxic Relationship: Eating Disorders and Violence
By Hattie Rowe
West Virginia University
*Trigger Warning. Discussions of Intimate Partner Violence, Sexual Assault, and Eating Disorders*
You may have heard of the nature vs. nurture debate. Some people say that our genetics and biology are what make us who we are. Others say that our environment shapes us to create the person we are. Researchers have applied this theory to the development of eating disorders.
The roots and causes of eating disorders are a widely debated and researched subject. While there is evidence that a person’s genes can predispose them to an eating disorder, there is also evidence that shows how disordered eating problems could occur as a response to sexual abuse (Chen, et al., 2010).
What is sexual violence? And what does it have to do with eating disorders?
Sexual violence means that “someone forces or manipulates someone else into unwanted sexual activity without their consent,” as defined by The Rape, Abuse & Incest National Network (RAINN) (rainn.org).
Studies have shown a relationship of eating disorders forming as a result of sexual violence. Sexual violence can happen to anyone, but most frequently occurs to women between the ages of 18 to 34 (rainn.org). This is a similar age bracket to the average population of people with eating disorders, which typically affects women in their early teens into young adulthood (National Institute of Mental Health, 2016).
What is Intimate Partner Violence (IPV)?
Intimate partner violence (IPV), sometimes known as domestic violence, is a common
threat to men and women. The Centers for Disease Control and Prevention in the United States defines Intimate Partner Violence as: “abuse or aggression that occurs in a close relationship.” An intimate partner refers to both current and former spouses and dating partners (CDC, 2019). IPV can vary in how often it happens and how severe it is. “It can range from one episode of violence that could have lasting impact to chronic and severe episodes over multiple years.” (CDC, 2019)
Crimes committed by intimate partners often go unreported. As for the information that has been contributed to our base of knowledge over the years, the statistics offer alarming insights. Over half of reported female rape victims said that an intimate partner was responsible (CDC, 2011). Nine percent of homicides are committed by intimate partners (NCRJS, 2018). The psychological and behavioral consequences of these experiences are numerous. One of these consequences is that victims of IPV have reported experiencing disordered eating patterns (Wong et al., 2016).
Eating Disorder Effects
Use of food is a common coping mechanism used by victims of sexual violence. Strictly managing food intake is a way that a victim can feel in control over their body. Or possibly bingeing on large amounts of food falsely eases psychological burdens for a brief moment. Obsessions with food and body become a problem that impedes on the everyday life of a victim.
Victims of sexual violence often undergo a process of healing physically and mentally. Due to the physical toll that eating disorders take on the body, eating disorders may cause a disruption in the healing process.
Physical consequences of eating disorders include, but are not limited to:
- Tooth decay
- Sore throat
- Sleep problems
- Lowered sex hormones
- Dropped body temperature
- Stomach rupture
- Esophagus rupture
- Bone loss
- Decrease in white blood cell count
The mental effects of sexual violence and IPV can include:
- Eating disorders
- Sleep disorders
- And more
Getting professional care for the psychological effects of abuse is just as important as
healing from physical abuse. This can help prevent the onset of eating disorders and other mental health problems that occur as a result of sexual abuse. Seeking helpful services can include receiving trauma informed care/practice and becoming aware of resources for eating disorders, IPV, and sexual violence available in your area.
Pregnancy and Abuse
A 2015 study found that women who have eating disorders are at an increased risk for IPV during pregnancy (Kothari, 2015). Further research is needed on this subject, but it is important to note that rates of perinatal IPV range from 3.7% to 9% and are associated with mental and physical problems for both the parent and child (Hahn, Gilmore, Aguayo, and Rheingold, 2019). Sometimes pregnancy may occur from reproductive coercion. For instance, if one partner wants to have a child and the other does not. Pregnancy can also occur as a result of sexual assault.
Whether it was an isolated event, or if your partner is currently or has a history of being abusive, it is important to have a plan moving forward. Making a plan for maintaining good physical and mental health during pregnancy is crucial. The changes happening to the body and healing after sexual violence are a lot to handle at once. Preparing helps keep you focused on your goals throughout and after your pregnancy and also can help keep you and your baby safe.
Visit https://www.thehotline.org/is-this-abuse/pregnancy-abuse/ for detailed information on safety plans during pregnancy.
Resources for help:
- National Sexual Assault Hotline: 1 (800) 656-HOPE (4673)
- National Domestic Violence Hotline: 1 (800) 799-7233
- National Eating Disorder Helpline: 1 (800) 931-2237
Black, M. C., Basile, K. C., Breiding, M. J., Smith, S .G., Walters, M. L., Merrick, M. T., Stevens, M.
- (2011). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010
summary report. Retrieved from the Centers for Disease Control and Prevention,
National Center for Injury Prevention and Control:
Brewerton, T.D., Alexander, J., Schaefer, J. (2018). Trauma-informed care and practice for eating disorders: Personal and professional perspectives of lived experiences. Eating and Weight Disorders, epub ahead of print.
Chen, L.P., Murad, H., Paras, M.L., Colbenson, K.M., Sattler, A.L., Goranson, E.N., … Zirakzadeh, A. (2010). Sexual abuse and lifetime diagnosis of psychiatric disorders: Systematic review and meta-analysis. Mayo Clinic Proceedings, 85(7), 618-629.
Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, National Crime
Victimization Survey, 2018 (2019).
Christine K Hahn, Amanda K. Gilmore, Rosaura Orengo Aguayo, Alyssa A. Rheingold. (2018).
Perinatal Intimate Partner Violence. Obstetrics and Gynecology Clinics of North America,
45(3): 535–547. doi: 10.1016/j.ogc.2018.04.008
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