Worsening of Symptoms of Bulimia Nervosa During Pregnancy

Abstract

Score indicates clinically significant symptoms. Clinically significant change (greater than one standard deviation). Received Jan. 4, 2002; revised May 20, 2002; accepted June 11, 2002. From the Department of Psychosomatic Medicine and Psychotherapy, University of Bonn. Address reprint requests to Dr. Conrad, Department of Psychosomatic Medicine and Psychotherapy, University of Bonn, Sigmund Freud Str. 25, 53105 Bonn, Germany; cr.bonn@t-online.de (email). Copyright 2003 The Academy of Psychosomatic Medicine. Bulimia nervosa in pregnancy has been the subject of several studies. Most studies evaluating the course of eating disorder symptoms during pregnancy have reported a substantial improvement in bulimic symptoms and, in the majority of cases, a return to prepregnancy symptom levels or even a worsening of symptoms in the postpartum period. However, the reasons for improvement of bulimic symptoms during pregnancy are not fully understood. Morgan and colleagues reported on 94 women for whom phenomenological descriptions of pregnancy suggested an alleviation of a sense of responsibility for body weight and shape. Furthermore, physiological changes in the course of pregnancy, such as changes in taste and smell and changes in satiety associated with an altered leptin level, may have important influences on feeding behavior. Even more important than understanding improvement of bulimic symptoms during pregnancy is the need for insight into the reasons for lack of improvement or even worsening of symptoms during pregnancy. Such research is important not only because of the health risk for the fetus but also because patients with bulimia seem to have a higher risk of affective disorders after delivery, including postnatal depression. This case report discusses a woman with worsening bulimic symptoms during her third pregnancy.