JOURNAL OF WOMEN’S HEALTH Volume 17, Number 2, 2008 © Mary Ann Liebert, Inc. DOI: 10.1089/jwh.2007.0550 The Reciprocal Effects of Eating Disorders and the Postpartum Period: A Review of the Literature and Recommendations for Clinical Care ELLEN ASTRACHAN-FLETCHER, Ph.D., 1 CINDY VELDHUIS, M.S. 2 NIKKI LIVELY, L.C.S.W., 1 CYNTHIA FOWLER, M.D., 3 and BROOK MARCKS, Ph.D. 4 ABSTRACT This paper examines the areas of psychological and physiological concern when working with patients who have eating disorders as they move through the postpartum period. These con- cerns include infant feeding, maternal-child bonding, and postpartum adjustment. The com- bination of psychological stressors of new motherhood and body image concerns intensified by the residual bodily changes of pregnancy may predispose women to have an exacerbation in eating disordered symptoms as well as the development of postpartum mood disorders. Depression can lead mothers to be nonresponsive, inconsistent, or rejecting of the infant, plac- ing the mother-baby attachment at risk. The added existence of an eating disorder compounds these risks, with medical and psychological risks becoming increasingly apparent. Healthcare providers (e.g., primary care physician, obstetric provider) are more likely to have contact with women during the postpartum period, making such providers instrumental in the screening and referral process. A multidisciplinary approach is recommended for treating eating disor- ders and related conditions. Unfortunately, there is little information about the efficacy and appropriateness of standard eating disorder treatments for women in the postpartum period. In addition to reviewing the literature, guidance is offered on how to assess and treat patients with eating disorders in general as well as considerations specific to the postpartum period. 227 INTRODUCTION A NOREXIA NERVOSA (AN) AND BULIMIA NERVOSA (BN) are the two best known and established eating disorders. AN is characterized by re- stricted food consumption and refusal to main- tain normal weight (85% of what is expected), intense fear of weight gain, negative self-evalua- tion that is overly influenced by weight or shape, and in postmenarcheal females, amenorrhea (ab- sence of three consecutive menstrual cycles). 1 Prevalence estimates of AN in women range from 0.1% to 1%. 2,3 BN involves recurrent binge eating episodes (uncontrolled eating of a large amount of food within a 2-hour period) and use of inap- propriate compensatory behaviors (e.g., vomit- ing, laxatives, fasting, exercise), both of which occur on average at least twice per week for 1 Department of Psychiatry, College of Medicine, University of Illinois, Chicago, Illinois. 2 Department of Psychology, University of Illinois at Chicago, Chicago, Illinois. 3 Student Counseling Resource Services, University of Chicago, Chicago, Illinois. 4 Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island.