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The perfect sleeping newborn lay innocently in my lap.  Only her third day of life, baby Rachel made sweet noises and smiled, dreaming happy dreams of clouds and stars.  Warm and comfy in her blanket, little did she know about the drama unfolding just outside of her awareness.

Her mother and father, Colleen and Rick, sat on the couch in my therapy office. Colleen’s face was pallid and her cheeks sunken.  The dark circles under her eyes signaled the hours she’d already spent crying.  Rick’s face was pained. He was as smitten with his new daughter as he was concerned for his wife.

But thankfully, this time we were all prepared.

Colleen, a 35-year-old successful businesswoman, had experienced lifelong struggles with anorexia, obsessive-compulsive disorder and body dysmorphic disorder.  She had been in therapy with me over the years, first for help with her eating disorder, later for support through her professional struggles and relationship issues. 

A bright, attractive and funny woman, she’d overcome many challenges in her life, developing a professional life and marrying a loving and compassionate guy.  She’d accepted the fact that she might need to be on anti-depressants forever in order to ameliorate the impact of her serotonin-starved brain.  And while the medicine helped her feel less anxious and depressed, no amount of talk-therapy or loving words from her husband could change her distorted self-perceptions.  Thin and attractive, she was convinced that she was fat and hideous. 

I joked with her that she was the craziest sane person I knew. 

Through years of therapy, she’d come to a truce with her body.  When it was time to start planning her first pregnancy, she allowed her weight to get to a place that was healthy for carrying a child.  She made the difficult decision to stop taking Prosac during her pregnancy, knowing it would be tough but worth it to eliminate the worry about the potential impact the medicine might have on her unborn child.  As we predicted, when Colleen gave birth to Josh, she was hit by the emotional tsunami known as postpartum depression. 

For the first six weeks of Josh’s life, Colleen was racked with angst, despair and frightening, negative feelings towards her new son. Her body dysmorphia transferred to her adorable baby and she was convinced that he was ugly.  (We even coined a new term: Baby Dysmorphic Disorder!) 

She refused to post pictures of him on Facebook or venture with him out in public.  Added to her deep depression and angst at having given birth to a “hideous” son was intense guilt that she was having these feelings.  She compared herself to other new moms who reveled in their babies and believed them to be “the most beautiful baby on the planet.”  So added to Colleen’s belief that she was crazy, was the idea that she was a horrible mother and a bad person.

Poor Colleen was miserable.  Even though her physician had told her that it was safe for the baby for Colleen to take Prosac while nursing, she was afraid that taking the meds would cause her to worry MORE, not less!  For weeks she sacrificed her mental health for her son’s physical health, hoping that nursing would alleviate some of the guilt she felt for the negative feelings that she was having towards him. 

After two months of emotional distress, Colleen made the excruciating decision to stop nursing and start taking Prosac again. (More guilt: all that research that nursing was superior to bottle feeding!)  She was simply too riddled with anxiety to do both.  

Almost immediately Colleen started to feel sane again.  She began to feel loving feelings towards her baby and to even delight in him.   And while she still wondered about his appearance (she still didn’t quite trust reports of his cuteness!) she comforted herself with this: “At least he’s a boy; he’ll be appreciated for his intellect and his humor.  If the baby had been an ugly girl, the world would eat her alive…”

Fast forward two years: when they decided to have a second child, they knew what to expect. She got pregnant and got off of her medicine.  When she learned she was having a girl, her obsessions grew stronger than ever. “What if she’s ugly? What if the girls are mean to her? What if she and her brother hate each other? I will be a terrible girl-mom! What if she inherits my eating disorder?” 

Every day for months she suffered with overwhelming obsessions and fears for her baby.  This torturous mental anguish and worry was only compounded by the shame of not feeling happy that she was having a girl.  She visited a psychiatrist who specialized in postpartum depression and learned that Zoloft was safe for nursing moms and their babies. This time, she agreed to take it as soon as the baby arrived. 

Sure enough, when Rachel was born, Colleen’s worst fears materialized.   She thought her baby was ugly; she did not feel attached.  Sitting in my office that day, she sobbed to her husband that they had made a terrible mistake and that she could not be a mother to this baby girl.  Rick said all the right things: “Colleen, don’t you worry.  You get yourself better, and I will take care of her until you are yourself again.”  Having been here before, he knew this was not his wife speaking; it was her brain NOT on drugs.  That afternoon Colleen started on Zoloft. 

One week later, Colleen came to see me, a completely changed woman.  She calmly smiled at her baby and nursed Rachel like an old pro.  She told funny stories of Josh adjusting to his new baby sister. 

By acting quickly and getting the right help, Colleen was actually going to enjoy these first few months of Rachel’s life.  We sighed and hugged; it was going to be okay.

Dina Zeckhausen is a nationally-known clinical psychologist and author who specializes in treating eating disorders and body image in both adults and adolescents. She is a weekly columnist for ShareWiK.com. You can visit her on the web at dinazeckhausen.com and MyEdin.org.