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with purpose, and then is no longer pregnant. It all feels so purposeless.”

• • •

Another patient, Grace, had a history of disordered eating that played a large part in the shame, guilt, and self-hate she felt following her first trimester miscarriage. In her teens, she developed both anorexia and bulimia. After years of keeping it a secret, she eventually confided in her mother, telling her she was forcing herself to purge what little food she would consume. But instead of comfort and support, her mother dismissed Grace’s concerns, telling her she did not have a problem.

“She told me it was a ‘white girl’s disease,’” Grace explained. “And because we’re Black, there was simply no way I could have had any issues surrounding food, let alone issues that might have required treatment.”

While eating disorders are often billed as a “young white woman’s problem,” like many mental health issues, Black women are actually more likely to develop eating disorders. But a lack of access to mental health services and the trope of the “strong Black woman” make it that much more difficult for those suffering from mental health conditions like disordered eating to seek and receive treatment.20

From there, Grace’s disordered eating proliferated unchecked. For fifteen years, she starved herself, binged, purged, and then, she told me, she would enter into imperfect recovery for a few months, sometimes a year or two, then relapse and begin the cycle once more. After repeating this pattern a few times, she became open about her eating disorder, finding comfort in friends, coworkers, and love interests; the same comfort her mother could not give her as a young adult.

Grace found out she was pregnant when she was five weeks along, and by week seven her nausea was so intense that her only respite came through consuming poppy-seed bagels, buttery pasta, and salty potato chips around the clock. Invariably, she began gaining weight, and the feeling of not having control over her body only deepened her longstanding inability to trust it. She wrestled with the inescapability of watching her body slowly but steadily grow, knowing she wanted the result of the pregnancy but loathing the physical and psychological process it takes to get there. As her discomfort grew, suddenly, at thirteen weeks along, she lost the pregnancy. And in the wake of her miscarriage, all her previous openness about her struggles with food came back to haunt her, as colleagues and friends voiced concerns about whether her history of low weight and disordered eating had caused her to miscarry.

This is, of course, extremely unlikely. But that doesn’t change the fact that pregnancy can provoke myriad feelings for those with disordered eating habits, and may contribute to and expand upon complicated feelings about body size, shape, and self-worth that existed long before a pregnancy test showed a positive result. Eating disorders are often caused by a deep desire to maintain a semblance of ownership over one’s life. And what is pregnancy if not an utter lack of control? We are at the mercy of our bodies and our hormones. Weight gain, an impending life change that can feel insurmountable, and frequent comments on a pregnant person’s size all work against those who struggle with disordered eating. Grace, and others like her, find themselves ill-equipped to adequately deal with the loss of bodily autonomy that comes with pregnancy and an eating disorder’s need to maintain it.

There were other factors working against Grace too. Her mother’s comment—that disordered eating was a white woman’s problem—continued to come up in our sessions as she waded through the guilt she felt for having miscarried. “You’re stronger than this” was the underlying message. “You don’t have the luxury of having these kinds of problems.”

In my office, Grace was compelled to navigate the painful ramifications of the idea that her problems were miniscule at best. Her eating disorders weren’t real enough for her mother to take seriously, and she had people around her suggesting that it may have even ended her pregnancy. She spoke at length about her feelings that her miscarriage was her fault, and any grief she felt as a result was superficial and self-imposed. As she parsed these emotions, we also discussed the fact that she was at the mercy of conflicting societal expectations: maintaining a certain body shape, but being “strong” enough to rise above unhealthy beauty standards or be negatively impacted by them, and being able to relinquish a long-held way of relating to food, control, and her body in service of a pregnancy.

Like so many of us—some far more than others—she felt as though she had been imprisoned by her body: what is expected of it, how people view it, how to maintain it, and how we are unable to completely control it.

• • •

And after a loss, we’re struggling with more than just what we see when we look in the mirror. Research has found that after a miscarriage, women often report feeling a sense of alienation from their bodies. Sometimes they even report feeling “defective” and like “less of a woman.”21 Add to that the possibility of not feeling at home in your skin from hormonal changes that began when pregnancy commenced, and you’re looking at one of the more challenging situations a woman can face when it comes to how she feels in her own body. For some women, this discordance is so intense that they begin feeling that their body has committed a betrayal.

Phoebe is one of those women. She responded to me on Instagram as well. She wrote that since 2016, she has had four miscarriages, and has no children.

“I used to think I was very attuned with my body. The first time I got pregnant, I felt very in touch with every little change, every tiny fluctuation,” she wrote. “All my losses have happened before twelve weeks, so I’ve never had the opportunity to celebrate that my body can make and sustain a pregnancy into the so-called safe zone. Honestly, I can’t think of

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