Pregnancy, birth, and early postpartum are often described as joyful and connecting—but for many women, the perinatal period can also be psychologically complex and deeply vulnerable, particularly for those with a history of eating disorders.
Even when an eating disorder has been in remission for years, the profound physical, emotional, and identity changes of the perinatal period can trigger a return of disordered eating thoughts or behaviours.
Why the perinatal period is a high-risk time
The perinatal period places extraordinary demands on both body and mind. Rapid physical changes, loss of control over appetite or body shape, heightened medical monitoring, and major identity shifts can activate old vulnerabilities.
Common contributing factors include:
- Rapid and visible body changes that challenge body image and sense of control
- Weight monitoring and increased medical focus on the body
- Hormonal fluctuations that affect mood, appetite, and emotional regulation
- Increased anxiety around feeding, nourishment, and responsibility for another lif
- Sleep deprivation and emotional overwhelm postpartu
- A strong desire to “get back to normal” after birth
How eating disorders can re-emerge (sometimes subtly)
Re-emergence doesn’t always look identical to past illness. In the perinatal context, eating disorder symptoms may present subtly and can be overlooked or minimised.
Some common patterns include:
- Restriction under the guise of “healthy eating”
- Heightened anxiety about weight gain or postpartum body changes
- Compulsive exercise urges after medical clearance
- Binge–restrict cycles triggered by exhaustion or emotional distres
- Increased preoccupation with food, calories, or body checkin
- Shame, secrecy, or fear of disclosure due to pregnancy/parenting expectation
- Importantly, many people experience significant internal distress even when outward behaviours appear “controlled.”
Identity, motherhood, and the emotional load
The perinatal period involves a profound identity shift. For those with an eating disorder history, the body may have been central to self-worth, control, or emotional regulation—so pregnancy and postpartum can feel like a loss of autonomy over one’s body, evoking grief, fear, or anger alongside joy.
Many clients describe feeling disconnected from their body, conflicted between caring for themselves and caring for their baby, guilty for having eating disorder thoughts, and afraid of judgement if they disclose symptoms.
What’s happening in the brain (and why it’s not about willpower)
Eating disorders are not about vanity or willpower—they are neurobiological coping responses to threat and distress. In the perinatal period, stress can activate the brain’s threat system, increasing anxiety and rigid thinking.
When the nervous system feels overwhelmed, familiar eating-disorder behaviours can resurface as an attempt to regain safety or predictability. Therapy focuses not on “eliminating thoughts,” but on restoring nervous system regulation, flexibility, and self-compassion.
Evidence-based treatment options during pregnancy and postpartum
Support needs to be gentle, collaborative, and developmentally informed.
Common evidence-based approaches include:
- Perinatal-informed CBT-E (CBT for eating disorders) to understand triggers, challenge rigid beliefs, and re-establish nourishment safel
- Compassion-focused and parts-based approaches (including IFS-informed work) to reduce shame and build internal safet
- Nervous system regulation strategies (grounding, mindfulness, somatic tools) to reduce urges and improve emotional regulation
- Multidisciplinary care integrated with GP, obstetric, dietetic, and midwifery support
When to seek support
Early intervention is protective—for both parent and baby. Consider reaching out if you notice persistent body image distress, restriction/bingeing/compensatory behaviours, high anxiety around food/weight/feeding, guilt or shame interfering with bonding, or fear of disclosure/managing alone.
Support at Happy Minds Psychology
At Happy Minds Psychology, we provide compassionate, trauma-informed care for individuals navigating eating disorder vulnerability during pregnancy and postpartum. Our clinicians understand the complexity of perinatal mental health and work collaboratively to support recovery, safety, and long-term wellbeing.
