Poor Body Image: Depression's Evil Twin

What is the worst possible question you could ask a woman with a history of an eating disorder (or any female, but especially a female with body-image issues)?

I'll give you a hint—it's three words long and ends with an eight-lettered word: "Are you pregnant?"

My mom taught me as a young girl to never, ever utter those three evil words to another lady, even if she looks like she's going to burst yesterday. Unless you've seen the sonogram with your own eyes, you don't go there, she told me and my three sisters.

But my mom was wrong. You don't even pop the pregnancy question to a woman who has shared her happy news with you. Leave it to me to make that mistake.

"So when are you due again, Shelly?"

"I had Tim two months ago."

Yikes. Sorry about that.

God makes sure we suffer the consequences of such carelessness.

Seven weeks ago (not that I'm counting) my spinning instructor (cycling class) at the gym asked me if I was pregnant.

I didn't want to make her feel bad, so I said, "No. The severe bloating is a side effect of my brain-tumor medication."

I don't think she'll ever ask that question again.

It's the truth. I have a bulge, thanks to the meds I'm on to shrink the growth in my pituitary gland. I retain ungodly amounts of water, so the bump swells throughout the day as I drink liquids (okay, and eat chocolate and bread and pasta). In the morning I look four months pregnant. As I pat my baby "Ed" (I named him) in the evening, I'm at least six months.

"Who cares?" Eric says. "What's your other option--surgery and a shaved head? I guess it looked okay on Demi Moore, but not so much on Britney Spears...."

He's right. It's really not a big deal. It shouldn't be, anyway.

And the ten pounds I've gained in the last two months shouldn't matter either...because this means I'm healthy now. My body has just figured out that it will no longer be shaking with anxiety, so it can hang onto the calories I eat. (The "shake" diet certainly had its perks--doing the equivalent of about 100 sit ups every minute meant that I could eat whatever I wanted. It was better than breastfeeding.)

I should be pleased that I can now start wearing my pre-depression clothes: two or three sizes bigger than the "shake" clothes. This means I'm happy (I eat when I'm content--my wedding pictures prove it.)

But the pregnancy question, ten pounds, and new wardrobe is very difficult for a person who at age 14 would have been classified as anorexic had she been forced to see a professional (my BMI or body mass index was at about 16--healthy being between 18.5 and 25).

At the time, my dream was to be a professional ballet dancer with a figure of a skeleton. I danced for several hours after school in an intensive ballet program. Then I came home, tried to skip dinner, and worked out for another hour (swimming, running, or aerobics). At supervised meals I dropped my food into a napkin and threw it away. I wore layers of long underwear underneath my pants to so that my pants didn't hang off my hips (and my mom wouldn't worry).

At my lowest weight--somewhere around 105 (so thin I stopped menstruating)--I looked into the mirror and still saw a chunky girl, a fat ballerina.

I worked like hell with my counselor at St. Mary's College to form a healthy body image. She helped me to commit to a regular diet of three well-rounded meals--at least 2000 calories a day--and to stop using laxatives and exercise as a way of purging calories. I was newly sober at the time, so I couldn't tuck away my pain in the bottle. I became extremely depressed--and started taking antidepressants for the first time.

All this is to say that I understand why Johns Hopkins combines its inpatient eating disorder clinic with its inpatient psychiatric unit on the fourth floor of the Meyer building of its hospital: poor body image is just another face of depression. In some ways, it is depression's evil twin, because while they are stuck in the Black Hole, depressives usually face all kinds of eating complications (losing weight, gaining weight, or fluctuating between the two).

At Hopkins, I roomed with anorexic woman who looked like she belonged in a biology lab (a skeleton with little flesh). The first night of my stay the nurses checked her vitals every two hours. I thought they should check them ever half-hour because I was truly unsure if she'd make it that long. Her clothes could have fit Katherine's dolls.

My eating-disordered voice (his name is Ed--short for eating disorder--and the name of my bump) is much more polite now than he used to be. My Saint Mary's counselor and I laid down some rules for the rowdy guy--like no skipping meals (even for a fast day like Good Friday). Together we learned how to distinguish his obnoxious opinions (you are ugly and fat) from the truth (so you gained a few pounds...no big deal).

For the most part, I have learned how to successfully tame him, and he isn't too problematic.

But every now and then Ed behaves like my two preschoolers--running around naked with a diaper on his head, or sheer panic without reasoning. (Apparently, I should call 911 because Little Mermaid's fishtails don't fit on Barbie, or summon the fire department because a drop of milk landed on someone's shorts.)

The last seven weeks--given the pregnancy question, ten extra pounds, and bigger clothes--Ed is back. Seeing all the evidence, he has sounded the alarm, and is screaming such things as, "You are widening more quickly than the ozone layer is thinning!"

Yesterday I climbed on the scale first thing in the morning and observed a round number that I haven't seen since I was pregnant with Katherine. I rushed to my computer and immediately calculated my BMI, which was in the normal range (but closer to overweight than to underweight, which threw me into a tizzy). I asked Eric to watch the kids for an hour plus so that I could run eight miles. When I returned I weighed myself again. Down two pounds. So I calculated my new BMI, which was the same number.

Does this sound like normal, reasonable behavior?

If you answered yes, click here to use Beliefnet's cool new tool, "Find a Therapist." If you answered no, then read my next post for the game plan.

Either way, know this: Never ask a woman if she is pregnant. It does bad things to her psyche.