Abstract
The postpartum period may be a particular window of vulnerability for eating disorder symptoms given changes to body shape and weight that women experience. However, no quantitative studies have identified risk factors for postpartum eating disorder symptoms, and current psychosocial frameworks of risk may be missing key elements unique to this period. This manuscript reviews existing quantitative and qualitative literature regarding the developmental trajectory of eating disorder symptoms during the perinatal period and proposes an application of three psychosocial models of eating disorder risk (objectification theory, the tripartite influence model of body image and eating disturbances, and social comparison theory) to the postpartum period. Drawing on quantitative and qualitative literature, this paper identifies novel postpartum-specific factors that should be included for consideration in psychosocial models (e.g., self-oriented body comparison and pressure to achieve a prepregnancy weight and shape). This review is the first to theorize potential postpartum-specific risk factors for postpartum eating disorder symptoms. Prior models of eating disorder risk omit key psychosocial factors that are unique to the postpartum period. Other limitations of prior research relate to measurement and methodology. This critical window of vulnerability has been largely ignored in the quantitative literature and necessitates further research.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ahern AL, Bennet KM, Hetherington MM (2008) Internalization of the ultra-thin ideal: positive implicit associations with underweight fashion models are associated with drive for thinness in young women. Eat Disord 16:294–307. https://doi.org/10.1080/10640260802115852
Ashley-Martin J, Woolcott C (2014) Gestational weight gain and postpartum weight retention in a cohort of Nova Scotian women. Matern Child Health J 18:1927–1935. https://doi.org/10.1007/s10995-014-1438-7
Astrachan-Fletcher E, Veldhuis C, Lively N, Fowler C, Marcks B (2008) The reciprocal effects of eating disorders and the postpartum period: a review of the literature and recommendations for clinical care. J Women's Health 17:227–239. https://doi.org/10.1089/jwh.2007.0550
Atieno OP (2009) An analysis of the strengths and limitation of qualitative and quantitative research paradigms. Probl Educ 21st Century 13:13–18
Baker CW, Carter AS, Cohen LR, Brownell KD (1999) Eating attitudes and behaviors in pregnancy and postpartum: global stability versus specific transitions. Ann Behav Med 21:143–148. https://doi.org/10.1007/BF02908295
Benas JS, Uhrlass DJ, Gibb BE (2010) Body dissatisfaction and weight-related teasing: a model of cognitive vulnerability to depression among women. J Behav Ther Exp Psychiatry 41:352–356. https://doi.org/10.1016/j.jbtep.2010.03.006
Ben-Tovim DI, Walker MK (1991) The development of the Ben-Tovim Walker body attitudes questionnaire (BAQ), a new measure of women’s attitudes towards their own bodies. Psychol Med 21:775–784. https://doi.org/10.1017/S0033291700022406
Berg CK, Torgersen L, Von Holle A et al (2011) Factors associated with binge eating disorder in pregnancy. Int J Eat Disord 44:124–133
Birkeland R, Thompson JK, Phares V (2005) Adolescent motherhood and postpartum depression. J Clin Child Adolesc Psychol 53(34):292–300. https://doi.org/10.1207/s15374424jccp3402_8
Blais MA, Becker AE, Burwell RA, Flores AT, Nussbaum KM, Greenwood DN, Ekeblad ER, Herzog DB (2000) Pregnancy: outcome and impact on symptomatology in a cohort of eating-disordered women. Int J Eat Disord 27:140–149. https://doi.org/10.1002/(SICI)1098-108X(200003)27:2<140::AID-EAT2>3.0.CO;2-E
Bonne OB, Rubinoff B, Berry EM (1996) Delayed detection of pregnancy in patients with anorexia nervosa: two case reports. Int J Eat Disord 20:423–425. https://doi.org/10.1002/(SICI)1098-108X(199612)20:4<423::AID-EAT10>3.0.CO;2-Z
Cahill JM, Freeland-Graves JH, Shah BS, Lu H, Klohe-Lehman DM (2009) Development and validation of the eating stimulus index in low-income, minority women in early postpartum. J Am Diet Assoc 109:1593–1598. https://doi.org/10.1016/j.jada.2009.06.364
Carter SK (2010) Beyond control: body and self in women’s childbearing narratives. Sociol Health Illn 32:993–1009. https://doi.org/10.1111/j.1467-9566.2010.01261.x
Cashel ML, Cunningham D, Landeros C, Cokley KO, Muhammad G (2003) Sociocultural attitudes and symptoms of bulimia: evaluating the SATAQ with diverse college groups. J Couns Psychol 50:287–296. https://doi.org/10.1037/0022-0167.50.3.287
Clark A, Skouteris H, Wertheim EH, Paxton SJ, Milgrom J (2009a) My baby body: a qualitative insight into women’s body-related experiences and mood during pregnancy and the postpartum. J Reprod Infant Psychol 27:330–345. https://doi.org/10.1080/02646830903190904
Clark A, Skouteris H, Wertheim EH, Paxton SJ, Milgrom J (2009b) The relationship between depression and body dissatisfaction across pregnancy and the postpartum: a prospective study. J Health Psychol 14:27–35. https://doi.org/10.1177/1359105308097940
Coker EL, Abraham S (2015) Body weight dissatisfaction before, during and after pregnancy: a comparison of women with and without eating disorders. Eat Weight Disord 20:71–79. https://doi.org/10.1007/s40519-014-0133-4
Coker EL, Mitchell-Wong LA, Abraham SF (2013) Is pregnancy a trigger for recovery from an eating disorder? Acta Obstet Gynecol Scand 92:1407–1413. https://doi.org/10.1111/aogs.12256
Crow SJ, Agras WS, Crosby R, Halmi K, Mitchell JE (2008) Eating disorder symptoms in pregnancy: a prospective study. Int J Eat Disord 41:277–279. https://doi.org/10.1002/eat.20496
Earle S (2003) “Bumps and boobs”: fatness and women’s experiences of pregnancy. Womens Stud Int Forum 26:245–252. https://doi.org/10.1016/S0277-5395(03)00054-2
Easter A, Solmi F, Bye A, Taborelli E, Corfield F, Schmidt U, Treasure J, Micali N (2015) Antenatal and postnatal psychopathology among women with current and past eating disorders: longitudinal patterns. Eur Eat Disord Rev 23:19–27. https://doi.org/10.1002/erv.2328
Eisenberg ME, Neumark-Sztainer D, Haines J, Wall M (2006) Weight-teasing and emotional well-being in adolescents: longitudinal findings from project EAT. J Adolesc Health 38:675–683. https://doi.org/10.1016/j.jadohealth.2005.07.002
Eisenberg M, Berge JM, Neumark-Sztainer D (2012) Associations between hurtful weight-related comments by family and significant other and the development of disordered eating behaviors in young adults. J Behav Med 35:500–508. https://doi.org/10.1007/s10865-011-9378-9
Festinger L (1954) A theory of social comparison processes. Hum Relat 7:117–140. https://doi.org/10.1177/001872675400700202
Fitzsimmons-Craft EE (2011) Social psychological theories of disordered eating in college women: review and integration. Clin Psychol Rev 31:1224–1237. https://doi.org/10.1016/j.cpr.2011.07.011
Fitzsimmons-Craft EE, Bardone-Cone AM (2014) One-year temporal stability and predictive and incremental validity of the body, eating, and exercise comparison orientation measure (BEECOM) among college women. Body Image 11:27–35. https://doi.org/10.1016/j.bodyim.2013.09.003
Fitzsimmons-Craft EE, Bardone-Cone AM, Harney MB (2012) Development and validation of the body, eating, and exercise comparison orientation measure (BEECOM) among college women. Body Image 9:476–487. https://doi.org/10.1016/j.bodyim.2012.07.007
Fredrickson BL, Roberts TA (1997) Objectification theory: toward understanding women’s lived experiences and mental health risks. Psychol Women Q 21:173–206
Fuller-Tyszkiewicz M, Skouteris H, Watson B, Hill B (2012) Body image during pregnancy: an evaluation of the suitability of the body attitudes questionnaire. BMC Pregnancy Childbirth 12:91. https://doi.org/10.1186/1471-2393-12-91
Goldschmidt AB, Wall MM, Loth KA, Neumark-Sztainer D (2015) Risk factors for disordered eating in overweight adolescents and young adults. J Pediatr Psychol 40:1048–1055
Gow RW (2012) Representations of celebrities’ weight and shape during pregnancy and postpartum: a content analysis of three entertainment magazine websites. Body Image 9:172–175
Green K, Broome H, Mirabella J (2006) Postnatal depression among mothers in the United Arab Emirates: socio-cultural and physical factors. Psychol Health Med 11:425–431. https://doi.org/10.1080/13548500600678164
Harper EA, Rail G (2011) Contesting “silhouettes of a pregnant belly”: young pregnant women’s discursive constructions of the body. Aporia 3:5–14
Hartley E, Hill B, Bailey C, Fuller-Tyszkiewicz M, Skouteris H (2018) The associations of weight status and body attitudes with depressive and anxiety symptoms across the first year postpartum. Womens Health Issues 28:530–538. https://doi.org/10.1016/j.whi.2018.07.002
Hawkins LK, Gottlieb BR (2013) Screening for eating disorders in pregnancy: how uniform screening during a high-risk period could minimize under-recognition. J Women's Health 22:390–392. https://doi.org/10.1089/jwh.2013.4313
Heinberg LJ, Guarda AS (2002) Body image in obstetrics and gynecology. In: Body image. The Guilford Press, New York, pp 351–360
Hodgkinson EL, Smith DM, Wittkowski A (2014) Women’s experiences of their pregnancy and postpartum body image: a systematic review and meta-synthesis. BMC Pregnancy Childbirth 14:1–11. https://doi.org/10.1186/1471-2393-14-330
Huxley CJ, Halliwell E, Clarke V (2015) An examination of the tripartite influence model of body image: does Women’s sexual identity make a difference? Psychol Women Q 39:337–348. https://doi.org/10.1177/0361684314554917
Institute of Medicine (2007) Influence of pregnancy weight on maternal and child health: workshop report. National Academies Press
Jenkin W, Tiggemann M (1997) Psychological effects of weight retained after pregnancy. Women Health 25:89–98. https://doi.org/10.1300/J013v25n01_06
Keery H, van den Berg P, Thompson K (2004) An evaluation of the tripartite influence model of body dissatisfaction and eating disturbance with adolescent girls. Body Image 1:237–251. https://doi.org/10.1016/j.bodyim.2004.03.001
Knoph C, Von Holle A, Zerwas S et al (2013) Course and predictors of maternal eating disorders in the postpartum period. Int J Eat Disord 46:355–368. https://doi.org/10.1002/eat.22088
Krones PG, Stice E, Batres C, Orjada K (2005) In vivo social comparison to a thin-ideal peer promotes body dissatisfaction: a randomized experiment. Int J Eat Disord 38:134–142. https://doi.org/10.1002/eat.20171
Lacey JH, Smith G (1987) Bulimia nervosa. The impact of pregnancy on mother and baby. Br J Psychiatry J Ment Sci 150:777–781
Larsson G, Andersson-Ellström A (2003) Experiences of pregnancy-related body shape changes and of breast-feeding in women with a history of eating disorders. Eur Eat Disord Rev 11:116–124. https://doi.org/10.1002/erv.497
Lemberg R, Phillips J (1989) The impact of pregnancy on anorexia nervosa and bulimia. Int J Eat Disord 8:285–295. https://doi.org/10.1002/1098-108X(198905)8:3<285::AID-EAT2260080304>3.0.CO;2-P
Lin LF, Kulik JA (2002) Social comparison and women’s body satisfaction. Basic Appl Soc Psychol 24:115–123. https://doi.org/10.1207/S15324834BASP2402_4
Lin L, Soby M (2016) Appearance comparisons styles and eating disordered symptoms in women. Eat Behav 23:7–12. https://doi.org/10.1016/j.eatbeh.2016.06.006
Luce KH, Crowther JH (1999) The reliability of the eating disorder examination—self-report questionnaire version (EDE-Q). Int J Eat Disord 25:349–351. https://doi.org/10.1002/(SICI)1098-108X(199904)25:3<349::AID-EAT15>3.0.CO;2-M
Mills A, Schmied V, Dahlen HG (2013) “Get alongside us”, women’s experiences of being overweight and pregnant in Sydney, Australia. Matern Child Nutr 9:309–321. https://doi.org/10.1111/j.1740-8709.2011.00386.x
Morgan JF, Lacey JH, Sedgwick PM (1999) Impact of pregnancy on bulimia nervosa. Br J Psychiatry 174:135–140. https://doi.org/10.1192/bjp.174.2.135
Nash M (2012) Weighty matters: negotiating ‘fatness’ and ‘in-betweenness’ in early pregnancy. Fem Psychol 22:307–323. https://doi.org/10.1177/0959353512445361
Neumark-Sztainer D, Falkner N, Story M et al (2002) Weight-teasing among adolescents: correlates with weight status and disordered eating behaviors. Int J Obes 26:123–131. https://doi.org/10.1038/sj.ijo.0801853
Nunes MA, Pinheiro AP, Hoffmann JF, Schmidt MI (2014) Eating disorders symptoms in pregnancy and postpartum: a prospective study in a disadvantaged population in Brazil. Int J Eat Disord 47:426–430. https://doi.org/10.1002/eat.22236
Papp I, Urban R, Czegledi E et al (2013) Testing the tripartite influence model of body image and eating disturbance among Hungarian adolescents. Body Image 10:232–242
Patel P, Lee J, Wheatcroft R, Barnes J, Stein A (2005) Concerns about body shape and weight in the postpartum period and their relation to women’s self-identification. J Reprod Infant Psychol 23:347–364. https://doi.org/10.1080/02646830500273657
Pettersson CB, Zandian M, Clinton D (2016) Eating disorder symptoms pre- and postpartum. Arch Womens Ment Health 19:675–680. https://doi.org/10.1007/s00737-016-0619-3
Rallis S, Skouteris H, Wertheim EH, Paxton SJ (2007) Predictors of body image during the first year postpartum: a prospective study. Women Health 45:87–104. https://doi.org/10.1300/J013v45n01_06
Rodgers R, Chabrol H, Paxton S (2011) An exploration of the tripartite influence model of body dissatisfaction and disordered eating among Australian and French college women. Body Image 8:208–215
Rodgers RF, Paxton SJ, McLean SA (2014) A biopsychosocial model of body image concerns and disordered eating in early adolescent girls. J Youth Adolesc 43:814–823. https://doi.org/10.1007/s10964-013-0013-7
Rodgers RF, Donovan E, Cousineau T, Yates K, McGowan K, Cook E, Lowy AS, Franko DL (2018a) BodiMojo: efficacy of a mobile-based intervention in improving body image and self-compassion among adolescents. J Youth Adolesc 47:1363–1372. https://doi.org/10.1007/s10964-017-0804-3
Rodgers RF, O’Flynn JL, Bourdeau A, Zimmerman E (2018b) A biopsychosocial model of body image, disordered eating, and breastfeeding among postpartum women. Appetite 126:163–168. https://doi.org/10.1016/j.appet.2018.04.007
Schaefer LM, Thompson JK (2014) The development and validation of the physical appearance comparison scale-revised (PACS-R). Eat Behav 15:209–217. https://doi.org/10.1016/j.eatbeh.2014.01.001
Schaefer LM, Burke NL, Thompson JK, Dedrick RF, Heinberg LJ, Calogero RM, Bardone-Cone AM, Higgins MK, Frederick DA, Kelly M, Anderson DA, Schaumberg K, Nerini A, Stefanile C, Dittmar H, Clark E, Adams Z, Macwana S, Klump KL, Vercellone AC, Paxton SJ, Swami V (2015) Development and validation of the sociocultural attitudes towards appearance Questionnaire-4 (SATAQ-4). Psychol Assess 27:54–67. https://doi.org/10.1037/a0037917
Shloim N, Hetherington MM, Rudolf M, Feltbower RG (2015) Relationship between body mass index and women’s body image, self-esteem and eating behaviours in pregnancy: a cross-cultural study. J Health Psychol 20:413–426. https://doi.org/10.1177/1359105313502568
Shrewsbury VA, Robb KA, Power C, Wardle J (2009) Socioeconomic differences in weight retention, weight-related attitudes and practices in postpartum women. Matern Child Health J 13:231–240. https://doi.org/10.1007/s10995-008-0342-4
Stice E (2002) Risk and maintenance factors for eating pathology: a meta-analytic review. Psychol Bull 28:825–848. https://doi.org/10.1037/0033-2909.128.5.825
Thompson JK, Heinberg LJ, Altabe M, Tantleff-Dunn D (1999) Exacting beauty: theory, assessment, and treatment of body image disturbance. American Psychological Association, Washington, DC
Thompson JK, van den Berg P, Roehrig M, Guarda AS, Heinberg LJ (2004) The sociocultural attitudes towards appearance scale (SATAQ-3): development and validation. Int J Eat Dis 35:293–304
Thompson KA, Kelly NR, Schvey NA, Brady SM, Courville AB, Tanofsky-Kraff M, Yanovski SZ, Yanovski JA, Shomaker LB (2017) Internalization of appearance ideals mediates the relationship between appearance-related pressures from peers and emotional eating among adolescent boys and girls. Eat Behav 24:66–73. https://doi.org/10.1016/j.eatbeh.2016.12.008
Tiller J, Treasure J (1998) Eating disorders precipitated by pregnancy. Eur Eat Disord Rev 6:178–187. https://doi.org/10.1002/(SICI)1099-0968(199809)6:3<178::AID-ERV231>3.0.CO;2-Y
Trottier K, Polivy J, Herman CP (2007) Effects of exposure to thin and overweight peers: evidence of social comparison in restrained and unrestrained eaters. J Soc Clin Psychol 26:155–172. https://doi.org/10.1521/jscp.2007.26.2.155
Upton RL, Han SS (2003) Maternity and its discontents: “getting the body Back” after pregnancy. J Contemp Ethnogr 32:670–692. https://doi.org/10.1177/0891241603257596
van den Berg P, Paxton SJ, Keery H, Wall M, Guo J, Neumark-Sztainer D (2007) Body dissatisfaction and body comparison with media images in males and females. Body Image 4:257–268. https://doi.org/10.1016/j.bodyim.2007.04.003
Walker L (1998) Weight-related distress in the early months after childbirth. West J Nurs Res 20:30–44. https://doi.org/10.1177/019394599802000103
Walker LO, Gao J, Xie B (2015) Postpartum psychosocial and behavioral health: a systematic review of self-administered scales validated for postpartum women in the United States. Womens Health Issues 25:586–600. https://doi.org/10.1016/j.whi.2015.05.006
Watson B, Fuller-Tyszkiewicz M, Broadbent J, Skouteris H (2015) The meaning of body image experiences during the perinatal period: a systematic review of the qualitative literature. Body Image 14:102–113. https://doi.org/10.1016/j.bodyim.2015.04.005
Watson B, Broadbent J, Skouteris H, Fuller-Tyszkiewicz M (2016) A qualitative exploration of body image experiences of women progressing through pregnancy. Women Birth J Aust Coll Midwives 29:72–79. https://doi.org/10.1016/j.wombi.2015.08.007
Wisner KL, Scholle SH, Stein B (2008) Perinatal disorders: advancing public health opportunities. J Clin Psychiatry 69:1602–1605. https://doi.org/10.4088/JCP.v69n1010
Yamamiya Y, Shroff H, Thompson JK (2008) The tripartite influence model of body image and eating disturbance: a replication with a Japanese sample. Int J Eat Disord 41:88–91
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Thompson, K. An application of psychosocial frameworks for eating disorder risk during the postpartum period: A review and future directions. Arch Womens Ment Health 23, 625–633 (2020). https://doi.org/10.1007/s00737-020-01049-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00737-020-01049-5