Some mothers suffering with eating disorders are tempted to starve their children, according to forthcoming research from City University. Katherine Kalinowski, a clinical psychologist, also found that the fear of sharing a family meal led some women to lie to their children – even preparing fake dirty plates in order to fool them.
The number of people diagnosed and needing treatment for eating disorders increases by seven per cent year on year on average. There have been plenty of medical and psychological studies of the problem – but too little is known about its effect on mothers.
Estimates of the number of people suffering from anorexia and bulimia vary. Research by the Kings Fund claims that around 600,000 people in the UK suffer from eating disorders, while the National Institute for Clinical Excellence found that it was closer to 725,000. These numbers are important for commissioning services but they only tell us part of the story.
Kalinowski is one of the first psychologists to look at the lives of mothers suffering from these awful and baffling illnesses. ‘I wanted to show their experiences, to be able to present an ethnology of their lives and to look for patterns. After all, they are the experts,’ she says.
One reason there has been little research into this area is that relatively few mothers are affected. Women with eating disorders often find it hard to get pregnant in the first place. Also, eating disorders in pregnant women also increase the chance of miscarriage.
Already, sufferers struggle to eat for one, let alone ‘eat for two’. Enduring food cravings, on top of medical pressure to eat more healthily, can be an absolutely traumatic experience.
Anorexia is an obvious threat during pregnancy – but so is bulimia. Repeated vomiting and low body mass index mean that both mother and baby can become malnourished.
This isn’t a straightforward phenomenon. Pregnancy can have a positive effect on some mothers with eating disorders. The BabyCentre website tells women that coping with food or weight issues may become temporarily easier during pregnancy.
Or it may not. To quote the BabyCentre article:
When you’re pregnant, it’s natural and healthy to put on weight. Even so, many women don’t like the idea of it. If you have an eating disorder, the idea of gaining weight during pregnancy can be much harder to accept, and can be very worrying, even frightening. The idea of being weighed may be quite scary to you.
There’s also a risk that an eating disorder that subsides during pregnancy may get worse afterwards.
Kalinowski looked at mothers’ attitudes to food and feeding – and tried to assess whether any of her interviewees were at risk of malnourishment. ‘Fortunately no particular problems occurred,’ she says, ‘though some of the conversations raised during our interviews did leave us concerned.’
One mother told Kalinowski: ‘I guess that, if you could, you wouldn’t feed them,’ referring to her own children.
That’s a chilling prospect – though the interviewee quickly added that she would never act on this thought and indeed felt guilty for having had it.
Guilt was a ‘terribly frequent’ emotion, says Kalinowski. She talked to mothers with eating disorders who already had children, and were ‘going to great pains trying not to expose them to the problem’.
Several women spoke about the fear of ‘transmission’ and their frequent ‘white lies’. A mother might tell her children that she would eat after they had gone to bed – or create the impression that she had already eaten by dirtying a clean plate and conveniently leaving it by the sink.
Transmission can happen. This harrowing article by Abby Norman describes the experience of growing up with a severely bulimic mother:
I grew to resent my mother because of her addiction. Whenever I would get sick, with a stomach bug or anything else that would make me vomit, her disgust was palpable. By the time I was 10 years old, I had developed a debilitating fear of vomiting (called Emetophobia) that persists to this day. I am also plagued with flashbacks to the sounds and smells of my childhood. I figured out several years ago, during an acute illness, that I too share my mother’s ‘high’ from starvation and vomiting.
Now, I am terrified of throwing up because it makes me feel amazing and I don’t want to end up like her: addicted to it.
There’s also this article in the New York Times, which describes a male patient with an eating disorder. In therapy, it emerged that ‘an obsession with thinness went back at least to both of his grandmothers, who could never be too thin and always seemed to be angry and demanding’.
Unfortunately, it’s easier to recognise the problems of mothers with eating disorders than to cure them. Kalinowski found that whole-family interventions seemed to work well – but more work evaluating how effective they can be is needed.
Mothers with eating disorders often hide their problem from doctors. They didn’t hide them from Kalinowski. Let’s hope that her research will contribute to more effective treatment of women whose problems threaten their children as well as themselves.