As a neuroscientist, one of the most fascinating topics I have encountered is the complex relationship between pregnancy and eating disorders (EDs). As someone with a 15-year-long history of anorexia, I am intimately familiar with the worries that many women with a current or past history of EDs have as they consider or become pregnant (see, for example, this opinion piece). Will they be able to carry the pregnancy through? Will the fetus develop normally? Will their child also develop an eating disorder?

But perhaps the most interesting and overlooked question is: how will the mother feel about her body during the pregnancy? It’s natural to assume that the physical changes induced by a pregnancy will be difficult to tackle for someone with a present or past ED. Yet, in my interviews, another pattern emerged: these women independently reported a ‘spontaneous’ improvement in their ED behaviors during pregnancy. Interestingly, scientific research supports this relationship, with both prospective and retrospective studies reporting that pregnancy is associated with an improvement in the symptoms of EDs (1, 2, 3, 4, 5. But see 6).

It’s important to note that women with EDs have an increased likelihood of developing postpartum depression and, unfortunately, their ED symptoms often start to re-emerge during the first six to 12 months after delivery (1, 7). This means that for women with active EDs, the pregnancy and early postpartum period are associated with a brief but significant reduction in their symptoms.

Why is that?

It’s easy to assume that sheer willpower and love for their unborn child is what carries these positive changes, but that’s not how EDs work. If you could recover by choice, most EDs would be very short-lived, yet they remain some of the most persistent and debilitating mental illnesses (8). Could a transcendent love for your child unlock new behaviors within you? Perhaps, but why then do the majority of these women relapse to their serious ED behaviors during the first year postpartum? (1, 7). It’s possible that this relapse occurs as a consequence of their newborn no longer depending on their physical support (breastfeeding and pregnancy). In other words, the women may no longer feel like the ED would “hurt” their child. While that makes sense, it forces us to return to the assumption that having an eating disorder is to some extent a choice. Is that the full story?

In my interviews, I learned that this spontaneous improvement occurred at a nonconscious level, happening naturally without effort or intention.

“I abstained [from purging and restricting] during the entire pregnancy. It was strange, none of the [ED] thoughts were there. Then, six months after having my baby, I started struggling again.” —Jessica Grenzy, 41, Florida

The lack of full awareness and reflection indicates that the women were not ‘choosing’ to improve, just as they did not choose to be ill. Likewise, the recurrence of ED symptoms during the first year postpartum suggests........

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