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Having a baby is supposedly one of the most joyful times in a woman's life. So why is it that recentstatistics state that about 15 percent of women suffer from postpartum depression?

Now if you factor in that according to the American Pregnancy Association, approximately seven million American women every year suffer from eating disorders that appear to peak during childbearing years, it is not hard to understand that women with eating disorders can be at a high risk for developing postpartum depression.

The women I see with eating disorders struggle most commonly with issues of control, perfectionism, poor self-esteem and distorted body image. 

Becoming pregnant can feel like the height of being “out of control” with hormonal ups and downs and appetite changes ranging from increases to food aversions and nausea. On top of that, a woman must come to terms with the “reshaping” of her pregnant body. These physical aspects alone are extremely challenging.  But when you add in the natural fears, anxieties, concerns, and the juggling act of raising multiple children, it is easy to see how postpartum depression and eating disorders can go hand in hand.

While there’s no main cause of postpartum depression, it is widely believed that physical, psychological and lifestyle factors – as well as genetics – may play a role.  Given all the adjustments one needs to make to all the changes and responsibilities, women can feel overwhelmed and more vulnerable to dealing with the stresses of motherhood in old maladaptive ways.

Illustrating this point, I am reminded of my client, Kerry, a 39-year-old mother of two-year-old, Brianna, and married for six years to her husband, Michael, the owner of contracting company.  When I last saw Kerry she was a bright, attractive, meticulously coiffed, ambitious attorney, a rising star in a local law firm. She had a history of bulimia for which I had treated her and had been in remission since marrying Michael. Her career was all consuming and she prided herself on her Type A personality and abilities to effectively multi-task, traits that helped make her successful at her job. Kerry began to exercise daily and hired a personal trainer once a week, which were some of the many positive outcomes for our working together on her eating disorder.  She had never felt so good about her body and herself.  As a result, she had a new sense of confidence.

So I was somewhat surprised to receive a frantic call from her, informing me that she had had a second child three weeks earlier and was not coping well. When we met I was a bit stunned by the contrast between the woman I treated seven years ago who was so full of energy and promise and this depressed, anxious, and harried-looking mother of a toddler and newborn sitting across from me.

Complicating matters, this pregnancy was a difficult one, unlike the first through which she easily sailed.  Being nauseous most of the time, the only thing that helped was her old friend – food. The old urges to purge came back with a vengeance, though she was able to resist them, not wanting to put the baby’s health in jeopardy. But she desperately wanted to feel better and steadily ate her way through the pregnancy gaining 60 pounds.   

Now she was depressed, sleep deprived, full of self-loathing about her body, had no interest in sex, which upset Michael, and felt like her life was careening out of control.  Of course, she also had to take care of Brianna, who did not take well initially to the new addition of her brother to the family, which further added guilt to the mixture of Kerry’s emotions.  Ultimately, she admitted that since the birth of her son, she had purged once the previous week, which terrified her. She called me because she thought she was headed for a nervous breakdown.

Embodied in Kerry’s case are all the complexities of diagnosing postpartum depression.  As we continued to meet, she realized how emotionally and physically unprepared she was for being a parent.  Giving up her career as a successful lawyer where she could “make things happen,” for the role as a mother where she felt overwhelmed and powerless to control anything, left her feeling like she lost an important piece of her identity, her competent self.  Being a mother to two children only worsened her feelings of inadequacy and made her feel more out of control. 

Her body no longer felt like her own either, especially since she chose to breastfeed, which she felt good about, yet conflicted that she couldn’t lose the “baby weight” immediately. This weight issue made her feel sexually undesirable and only reinforced her lack of desire for lovemaking with Michael. 

Her exhaustion from sleep deprivation left her without energy to exercise or to do much else.  Even if she had the time, who would watch her children?  While Michael was helpful, he too, was exhausted from the stresses and strains of the downturn in the economy and its negative impact on his business, which added financial pressures.  She didn’t want to burden him even more.

Kerry’s Type A personality and skill at multi-tasking, which made her so good in her career, were not working in her life as a mother. She clearly had the belief that she should be able to do this all on her own and not ask for help.  Feeling ashamed, she never even discussed any of these feelings with her husband. 

In treating Kerry this time I had to first educate her about all the factors playing into her current state of being.  I explained that the hormonal changes that were no doubt going on in her body were likely contributing to her depressed mood. Her lack of sleep could easily cause her to feel overwhelmed and disinterested in sex.  And finally, given her personality type and history of bulimia, feeling out of control, yet still trying to “be perfect” (the perfect wife and mother), all probably triggered her single bulimic incident last week.  Her body was telling her it was all too much to handle alone.

We also discussed her loss of identity as lawyer and the competent feelings she had in her career.  But above all, she became aware that she was taking care of everyone else’s needs but her own. I could see her visibly relax.  Capitalizing on the opportunity I taught her some mindfulness practices using breath work and visualization of a calm, relaxing place so that she would have an “oasis” when her life felt chaotic.

As part of the treatment I invited Michael in to discuss what it had been like for him being the parent of two children and trying to juggle work, family and his own needs.  Facilitating the communication between Kerry and Michael brought everything out into the open.  Michael realized that he took for granted that, since Kerry was so competent at her career and with their daughter, that she didn’t need his help.  He expressed how sorry he was that he didn’t know she needed his help and that he felt sad that she couldn’t come to him with her pain. 

This conversation enabled Kerry to give herself permission to think about what she needed.  As her mood improved and she felt more like herself, she realized she felt isolated and joined a Mom’s group.  She and her husband agreed that they would get some help with their newborn so she could get some much-needed rest.

And they even got a babysitter one night a month for a “date night.”  Their sex life returned and as Kerry felt more rested, she began to use the exercise equipment they had at home and started losing weight.  Within the next few months, she had begun to feel happy and whole again.  She had found herself once more.

In this case, no medication was needed.  But had she not come in when she did, the circumstances could have ended very differently…

Kerry’s situation epitomizes the importance of thoroughly evaluating the whole complex system of a woman’s postpartum world and providing her with the necessary tools and support to get back into balance with herself.

With the gift of the Postpartum Blues, Kerry emerged strong and confident again, with a commitment to express her needs and feelings and a willingness to ask for help.

~Sometimes we have to lose ourselves to find ourselves again~

Allyn St. Lifer has been a therapist in private practice for over 30 years and specializes in teaching clients mindful eating to determine physical hunger and the point of satisfaction.  She is the founder and director of Slimworks, a mind/body, non-diet approach for managing weight and transforming one’s relationship with food, body and self.  To find out more about Allyn, please visit her website: www.slimworks.com.  She is a regular ShareWIK.com columnist. 

Read other Allyn St. Lifer columns here

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