“What size am I now?”
Source: Dedraw Studio/Shutterstock
Pregnancy is often celebrated as a transformative and joyous journey, but for people with body dysmorphic disorder (BDD), it can be a very difficult experience. Physical changes, societal expectations, and personal guilt combine to create difficulties that can be misunderstood or overlooked. These challenges often leave individuals feeling isolated with little acknowledgment of their experiences. By fostering open and realistic conversations about this complex condition, we can reframe the narrative around pregnancy, motherhood, and mental health to be more inclusive and compassionate.
BDD and pregnancy pressure
BDD is a condition characterized by a preoccupation with perceived physical flaws that may be trivial or unnoticeable to others (DSM-V). As we experience change, we often amplify these concerns. Physical changes such as weight gain, swelling, and stretch marks are often inevitable, but for people with borderline disorder, they can cause intense feelings of panic. The societal discourse that pregnancy is a time of glorious beauty complicates matters. Women are expected to embrace their changing bodies, marvel at the miracle of life, and exude happiness. When this ideal does not match reality, people with BDD often experience deep shame and inadequacy.
Adding to this pressure is the lack of representation of diverse pregnancy experiences in media and culture. Popular depictions rarely mention the self-image struggles that individuals face during this time. This lack reinforces the idea that having difficulty accepting one’s changing body is unusual or shameful, further alienating those who are suffering.
How is BDD different during pregnancy?
What sets BDD during pregnancy apart is the complex combination of mental, physical, and hormonal changes that increase distress. Hormonal fluctuations can amplify feelings of anxiety, making it more difficult for individuals to manage their emotions. Pregnant people with BDD are often highly conscious of medical interventions, ultrasounds, and frequent monitoring of their bodies. These experiences can increase attachment to perceived deficiencies (Veale & Neziroglu, 2010).
For many people, these changes bring a deep sense of sadness and loss. Pregnancy often symbolizes the loss of the body that you have worked so carefully to maintain to ideal standards. Whether or not this body was realistically achievable, it often formed a core part of their identity. Losing control over your appearance during pregnancy can lead to grief and despair over the loss of your former self. Research highlights that this sadness is not just about physical appearance, but also involves the psychological role played by the pre-pregnancy body in providing a sense of stability and self-esteem (BMC Pregnancy and Childbirth, 2024).
This fear of change often extends beyond pregnancy. Many people worry about the long-term effects on their bodies, such as weight maintenance and changes in skin elasticity, fueling anxiety about how they will be perceived postpartum. The grief surrounding their former bodies is deeply tied to both their physicality and the identity they represent. Pregnancy and the postpartum transition can be emotionally difficult experiences, compounded by uncertainty as individuals face what they perceive as permanent changes in self-perception (Veale & Neziroglu, 2010).
The intersection of infertility and BDD
For people struggling with infertility, the path to pregnancy is often accompanied by mental and physical challenges. Infertility treatments are invasive and physically taxing, and side effects such as bloating, weight gain, and fatigue can exacerbate body image concerns. The mental strain of repeated failures, combined with the physical changes caused by treatment, can worsen BDD symptoms (Zimmer-Gembeck & Skinner, 2016).
Additionally, infertility often comes with its own social pressures. Many people are told to “stay positive” or “trust the process”, creating even more stress. When this sense of security does not match the reality of setbacks and challenges, feelings of isolation and helplessness increase.
BDD adds an additional layer of complexity. For some, the process of infertility treatment can make them feel even more disconnected from their bodies, which they already perceive to be flawed. Constant medical testing can feel invasive and turn their body into an object of analysis rather than a source of strength.
Guilt and emotional complexity
Pregnancy often brings with it an increased sense of responsibility not only for oneself but for the life growing inside the body. For people with BDD, this sense of obligation can feel overwhelming, as they struggle with the fear that focusing on appearance will compromise their ability to fully embrace pregnancy. This inner conflict fuels feelings of guilt, and we often find ourselves caught between society’s expectations and our inner struggles.
Body image essentials
It’s not just the guilt. It can extend to how you perceive your future as a parent, including worries that your struggles with self-image will interfere with your ability to model healthy behaviors for your children. I am holding. For those undergoing infertility treatment, these concerns are often compounded by the added pressure to feel grateful and joyful after the arduous journey to conceiving. The weight of these expectations can make the already complicated emotions of pregnancy even more difficult to navigate.
Seek help and build resilience
Professional help can be invaluable for individuals who overcome BDD during pregnancy. Cognitive behavioral therapy (CBT), particularly forms tailored to BDD, has been shown to reduce symptoms and improve emotional well-being. Therapy provides tools to reframe negative thought patterns, deal with guilt, and build healthier coping mechanisms (Veale & Neziroglu, 2010).
Support groups are also helpful. Hearing from others who have experienced similar suffering provides validation and reduces feelings of isolation.
Practical steps can also bring about meaningful change (The Bump, 2022):
Focus on function over form: Change your perspective to understand the amazing work your body does to nurture life. Set realistic expectations: Challenge society’s ideals of what pregnancy should be like and set personal, compassionate goals for yourself. Take control of your environment: Avoid triggers such as social media accounts that promote unrealistic portrayals of pregnancy and instead look for body-positive content. Practice mindfulness: Engage in mindfulness and meditation to cultivate a deeper connection with your body and reduce anxiety. Seek help early: Don’t wait until the pain becomes unbearable. Seeking help early can make a big difference.
break the silence
BDD during pregnancy is a very isolating experience that is often overshadowed by society’s romanticized portrayal of this life stage. By creating space for honest conversations and raising awareness, we can begin to dismantle the unrealistic ideals that perpetuate prejudice and silence.
Pregnancy is not a one-size-fits-all experience. For some, it is a time of deep joy. For some, it comes with conflicting emotions, physical discomfort, and mental health challenges. Recognizing this complexity and supporting those who are struggling is not only compassionate, but necessary. Together, we can build a culture that values mental well-being alongside physical health, giving all parents-to-be the understanding and care they deserve.
To find a therapist, visit Psychology Today’s therapy directory.
