title: The reciprocal effects of eating disorders and the postpartum period: a review of the literature and recommendations for clinical care.
abstract: This paper examines the areas of psychological and physiological concern when working with patients who have eating disorders as they move through the postpartum period. These concerns include infant feeding, maternal-child bonding, and postpartum adjustment. The combination of psychological stressors of new motherhood and body image concerns intensified by the residual bodily changes of pregnancy may predispose women to have an exacerbation in eating disordered symptoms as well as the development of postpartum mood disorders. Depression can lead mothers to be nonresponsive, inconsistent, or rejecting of the infant, placing the mother-baby attachment at risk. The added existence of an eating disorder compounds these risks, with medical and psychological risks becoming increasingly apparent. Healthcare providers (e.g., primary care physician, obstetric provider) are more likely to have contact with women during the postpartum period, making such providers instrumental in the screening and referral process. A multidisciplinary approach is recommended for treating eating disorders and related conditions. Unfortunately, there is little information about the efficacy and appropriateness of standard eating disorder treatments for women in the postpartum period. In addition to reviewing the literature, guidance is offered on how to assess and treat patients with eating disorders in general as well as considerations specific to the postpartum period.
authors.affiliation: Department of Psychiatry, College of Medicine, University of Illinois, Chicago, Illinois 60612-7327, USA. efletcher@psych.uic.edu
authors.forename: Ellen
authors.initials: E
authors.lastname: Astrachan-Fletcher
authors.forename: Cindy
authors.initials: C
authors.lastname: Veldhuis
authors.forename: Nikki
authors.initials: N
authors.lastname: Lively
authors.forename: Cynthia
authors.initials: C
authors.lastname: Fowler
authors.forename: Brook
authors.initials: B
authors.lastname: Marcks
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D015897:Comorbidity; D019052:Depression, Postpartum / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D019317:Evidence-Based Medicine; D001068:Feeding and Eating Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008425:Maternal Behavior; D009034:Mother-Child Relations; D010353:Patient Education as Topic / Q000379:methods / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D011788:Quality of Life; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index