A Disturbing Rise Of Anorexia During Pregnancy

A first-of-its-kind study last year found that one in 15 pregnant women is anorexic. Gaunt women are even posting cringe-worthy photos of their baby bumps on pro-anorexia forums.

Experts on eating disorders have traditionally overlooked pregnancy as a vulnerable time
Experts on eating disorders have traditionally overlooked pregnancy as a vulnerable time
Lara Fritzsche

MUNICH — Louisa Bartel* still remembers the first thought that ran through her head when she found out she was pregnant: “Now I’ll have to eat more. I won’t be able to go running every day. I’ll get fat.”

Louisa suffered from anorexia as a teenager, reacting to a difficult home situation with a depressed mother and absent father. She spent years in therapy, including six months in a specialist clinic, before she was able to articulate this. When she was released, the doctors thought she was cured, but she says she had simply found a way to live with her disease. Then when she fell pregnant in her thirties, the panic set in again.

Louisa’s pregnancy was full of ups and downs. Some days she managed to eat everything on her plate without feeling guilty about it. Other days the thought of food made her feel sick, and she would go to bed with an empty stomach. She can cope with that, though. It’s how she lived for years.

You wouldn’t know it to look at her. Louisa is a management consultant, a career that relies on convincing others to trust your judgment. She can’t afford to let clients see any shred of self doubt. Friends and colleagues know an open, friendly woman who enjoys life and has everything under control.

But that is precisely the problem. Eating disorders are an attempt to regain control, often when physical or emotional changes threaten to overwhelm. That is why they often appear during puberty, a time of significant biological changes. After puberty, pregnancy is the next most significant period of upheaval in a woman’s life, with considerable changes to both body and lifestyle, all under the influence of intense hormonal shifts.

Despite the similarities between the two stages, psychologists and experts on eating disorders have traditionally overlooked pregnancy as a vulnerable time, probably because the idea of a pregnant woman intentionally endangering her unborn child by not eating was simply unthinkable.

A quantifiably real problem

It wasn’t until last year that a group of British scientists began to study the problem. The results, carried out by researchers at the Institute of Child Health and the psychiatric department at the University of London, were clear. Of the 739 women who participated, 25% admitted being afraid of weight gain and the changes to their body during pregnancy. One in 10 women was already exhibiting signs of an eating disorder and one in 15 fulfilled all the criteria.

“We found that many of the women’s concerns had to do with the public perception of pregnant women,” explains lead researcher Nadia Micali. In the past, pregnancy was treated with discretion, but that has changed and the media play a role in shaping our idea of how pregnant women should look. “Celebrities show off their baby bumps, and a few days after giving birth they’re very slim,” Micali says. “We see that on TV, in magazines, on the Internet. These images give women unrealistic expectations of their bodies.”

Heidi Klum modeled in her underwear only five weeks after the birth of her son Henry. One week after giving birth to daughter Harper, designer Victoria Beckham was wearing a U.S. size 4. New mothers are bombarded with diet and exercise tips, as if their most pressing concern should be losing their baby weight. Some magazines even calculate how much weight is lost through sweat during labor.

And it’s not just traditional media promoting these ideas. The pressure is only intensified by the many selfies posted on social media sites by proud new mothers showing off their flat stomachs. There is also a troubling number of pregnant women participating in online “pro-ana” forums, where anorexia sufferers post extreme weight-loss tips and “thinspiration” photos. Pictures of skeletal women with tiny baby bumps have begun appearing on the sites. Like many of the thinspiration images, some have been photoshopped: It’s impossible to maintain a pregnancy at certain very unhealthy weights. But anorexia sufferers have distorted perceptions of their bodies and see these images as aspirational.

A disease only recently acknowledged

The growing prevalence of anorexia cases during pregnancy cannot be blamed entirely on the media. It may be partly explained by the fact that the medical profession officially recognized the disease only a few decades ago. Now the first generations of diagnosed teenage anorexia sufferers have grown up and are having children.

The problem is so great that some clinics, such as Inntal in South Germany, have reacted by creating therapy rooms for mothers with nursing babies. Andreas Schnebel, director of the Anad clinic in Munich, believes that the cause of anorexia during pregnancy goes beyond desire to conform to an ideal of beauty and is more about people’s changing relationship with their bodies. “All people, not only women, are afraid of losing control over their bodies,” he says. “Sport, nutrition and sex are all seen as a means of self-improvement or fulfilment. It’s very rare to find someone who just enjoys their body.”

During pregnancy, women have less control over their bodies than ever, and they are no longer the reliable machines they once were. Women are also subject to intense and contradictory pressures during this period. They are expected to regularly visit the doctor and attend birth classes, read the right books, paint the nursery, tell their boss when they plan to return to work, research kindergartens, etc. But most importantly, they should find the time to celebrate the miracle of their femininity.

“For women who need to be in control, this pressure can be very harmful,” says Schnebel. It may sound counter-intuitive, but an eating disorder gives sufferers the impression of being able to control at least one thing in their lives.

Louisa Bartel ultimately gave birth to a daughter. Although she was sometimes overcome by panic as she watched her belly grow, she returned to her therapist and got through her pregnancy with the support of her husband. Her healthy baby daughter was born in the fall, but Louisa is still regularly attending support groups to try and overcome her eating disorder. She needs to get better, if not for herself, then for her child. Because, as she says, “What kind of role model would such a mother be?”

*The woman’s name was changed to protect her identity.

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Paying tribute to the victims of the attack in Kongsberg

Terje Bendiksby/NTB Scanpix/ZUMA
Carl-Johan Karlsson

The bow-and-arrow murder of five people in the small Norwegian city of Kongsberg this week was particularly chilling for the primitive choice of weapon. And police are now saying the attack Wednesday night is likely to be labeled an act of terrorism.

Still, even though the suspect is a Danish-born convert to Islam, police are still determining the motive. Espen Andersen Bråthen, a 37-year-old Danish national, is previously known to the police, both for reports of radicalization, as well as erratic behavior unrelated to religion.

Indeed, it remains unclear whether religious beliefs were behind the killings. In an interview with Swedish daily Dagens Nyheter, police attorney Ann Iren Svane Mathiassens said Bråthen has already confessed to the crimes, giving a detailed account of the events during a three-hour interrogation on Thursday, but motives are yet to be determined.

Investigated as terrorism 

Regardless, the murders are likely to be labeled an act of terror – mainly as the victims appear to have been randomly chosen, and were killed both in public places and inside their homes.

Mathiassens also said Bråthen will undergo a comprehensive forensic psychiatric examination, which is also a central aspect of the ongoing investigation, according to a police press conference on Friday afternoon. Bråthen will be held in custody for at least four weeks, two of which will be in isolation, and will according to a police spokesperson be moved to a psychiatric unit as soon as possible.

Witnesses have since described him as unstable and a loner.

Police received reports last year concerning potential radicalization. In 2017, Bråthen published two videos on Youtube, one in English and one in Norwegian, announcing that he's now a Muslim and describing himself as a "messenger." The year prior, he made several visits to the city's only mosque, where he said he'd received a message from above that he wished to share with the world.

Previous criminal history 

In 2012, he was convicted of aggravated theft and drug offenses, and in May last year, a restraining order was issued after Bråthen entered his parents house with a revolver, threatening to kill his father.

The mosque's chairman Oussama Tlili remembers Bråthen's first visit well, as it's rare to meet Scandinavian converts. Still, he didn't believe there was any danger and saw no reason to notify the police. Tlili's impression was rather that the man was unwell mentally, and needed help.

According to a former neighbor, Bråthen often acted erratically. During the two years she lived in the house next to him — only 50 meters from the grocery store where the attacks began — the man several times barked at her like a dog, threw trash in the streets to then pick it up, and spouted racist comments to her friend. Several other witnesses have since described him as unstable and a loner.

The man used a bow and arrow to carry the attack

Haykon Mosvold Larsen/NTB Scanpix/ZUMA

Police criticized

Norway, with one of the world's lowest crime rates, is still shaken from the attack — and also questioning what allowed the killer to hunt down and kill even after police were on the scene.

The first reports came around 6 p.m. on Wednesday that a man armed with bow and arrow was shooting inside a grocery store. Only minutes after, the police spotted the suspect; he fired several times against the patrol and then disappeared while reinforcements arrived.

The attack has also fueled a long-existing debate over whether Norwegian police should carry firearms

In the more than 30 minutes that followed before the arrest, four women and one man were killed by arrows and two other weapons — though police have yet to disclose the other arms, daily Aftenposten reports. The sleepy city's 27,000 inhabitants are left wondering how the man managed to evade a full 22 police patrols, and why reports of his radicalization weren't taken more seriously.

With five people killed and three more injured, Wednesday's killing spree is the worst attack in Norway since far-right extremist Anders Breivik massacred 77 people on the island of Utøya a decade ago.

Unarmed cops

As questions mount over the police response to the attack, with reports suggesting all five people died after law enforcement made first contact with the suspect, local police have said it's willing to submit the information needed to the Bureau of Investigation to start a probe into their conduct. Police confirmed they had fired warning shots in connection to the arrest which, under Norwegian law, often already provides a basis for an assessment.

Wednesday's bloodbath has also fueled a long-existing debate over whether Norwegian police should carry firearms — the small country being one of only 19 globally where law enforcement officers are typically unarmed, though may have access to guns and rifles in certain circumstances.

Magnus Ranstorp, a terrorism expert and professor at the Swedish Defence University, noted that police in similar neighboring countries like Sweden and Denmark carry firearms. "I struggle to understand why Norwegian police are not armed all the time," Ranstorp told Norwegian daily VG. "The lesson from Utøya is that the police must react quickly and directly respond to a perpetrator during a life-threatening incident."

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