Breast & Ovarian Cancer

The shock of the diagnosis. The uncertainty of treatment, results or mortality. The feeling of everything being out of our control.  

But first… 

What is Breast Cancer? 

A kind of cancer that begins as a growth of cells in the breast tissue. Abnormal breast cells grow out of control and form tumours.  

Breast cancer usually occurs in older women above 50 but can also affect men and younger women. In Singapore, breast cancer is the most commonly occurring cancer among women, accounting for 29.7% of all cancers diagnosed in females. 

What is Ovarian Cancer? 

It occurs when abnormal cells in ovaries or fallopian tubes grow and multiply out of control. It may originate from the ovary or more commonly from nearby structures such as fallopian tubes or the inner lining of the abdomen.  

Ovarian cancer usually occurs in older women above 60 who are in the menopausal stage but can also affect younger women. In Singapore, ovarian cancer was 4.4% of all cancers diagnosed in women from 2016-2020. It is the 5th most common cancer in Singaporean women. 

Mental Health Challenges 

Here are the moments that women may struggle the most in the cancer journey:  

6. Awaiting follow-up results  

  • Waiting for the outcomes of follow-up tests 

7. Survivorship phase (Life after diagnosis or treatment) 

  • Persistent guilt (about family, children, responsibilities) 

  • Fear of recurrence 

  • Diminished self-esteem 

  • Problems with social acceptance and body image 

  • Difficulty in re-entry into previous life 

  • Perceived and actual loss of employment and insurance discrimination 

  • Concerns about infertility 

8. Symptom recurrence 

9. Facing end of life 

As treatment goes on, distress heightens (with all the physical and social impacts too). It is then no surprise that these can culminate into anxiety, depression, PTSD, or other conditions. 

1. Before diagnosis  

  • Noticing a concerning symptom  

  • Anxiously awaiting test results 

2. Initial diagnosis  

  • Receiving the news of the diagnosis for the first time 

3. Anticipating treatment 

  • Waiting to learn about the recommended treatment plan  

4. Leaving the hospital  

5. Completion or adjustment of treatment  

  • Fear of finishing a treatment course   

  • Adapting to a change in the plan 

How to Cope, Psychologically 

Receiving a diagnosis is never easy. The shock and distress can be overwhelming, and we might not know how to cope with such complicated emotions and thoughts.  

Yet, how we feel, think and cope with the diagnosis and treatment can greatly affect our physical health, treatment progress, adherence and recovery. So let’s take time to prioritise ourselves – physically and mentally.

Here are some ways to cope better: 

1. Find your support pillars 

Lean on those trusted friends and family, they tend to be the reasons we keep going even in tough times. 

Many have also gone through the same journey, and we do not need to fight cancer alone. Consider the links below to find communities of like-minded individuals who may share the same struggles as you:  

How are you feeling? What emotions can you pinpoint exists? Was it fear, anxiety, shock, anger, regret, or hopelessness?  

What about your thoughts about this journey – from diagnosis to treatment? What do your thoughts tell you about… 

  • Cherished things and people 

  • Personal hopes and dreams 

3. Stay engaged, moment-to-moment 

We know we bring up mindfulness often, but bear with us. When time seems limited and more precious than ever, we often want to capture and “stay” in the moments we cherish the most.  

This speaks to a part of us that wants more presence, and connection to what is going on around us. To do so, we need pause, observe and engage.  

Here’s our guide to being more mindful (general tips are at the bottom of the article). 

4. Show kindness to yourself 

Your pain and suffering is valid. Your feelings are valid. The journey is not easy, and there is little that others can do to make it easier on us.  

 Yet, how do we respond to our pain and emotions? What our pain and emotions often need is soothing. Like a mother soothing a child in pain, aim to soothe the pain and emotions within you. Here are some ways to soothe and be kind to yourself: 

  • Cry it out 

  • Calming music or smells  

  • Visualise a place that is calming to you  

    • Sunsets, starry night sky, pet café, comforts of a bed or bath 

    • Focus on your 5 senses  

  • Repeat personal mantras  

    • “I can do this” 

    • “I got this” 

    • “Take it easy” 

    • “This will pass” 


People differ in how they cope with difficult emotions and painful situations. There is no “best” method here, so find ways that you are comfortable with and personalise your recovery journey in your own way.  

“It is during our darkest moments that we must focus to see the light.” – Aristotle 

Understanding Disordered Eating and Mental Health

Misconceptions of Disordered Eating
Credit: TEDx Talks

Wait! Disordered eating or eating disorder? Aren’t they the same?

Not exactly! While they share some similarities, they are different.

An “eating disorder” is a clinical diagnosis, with specific criteria for conditions like anorexia or bulimia.

On the other hand, “disordered eating” refers to unhealthy eating behaviours or patterns that don’t meet the full criteria for an eating disorder.

Someone with disordered eating may not have an eating disorder, but people with eating disorders often exhibit disordered eating behaviours. Disordered eating is quite common and can often go unnoticed, as it may show up in small actions you might do daily without realising.

How do I know if I have disordered eating and not an eating disorder?

While there is no single, perfect guideline on what constitutes “normal eating” as each of our bodies is different, healthy eating is about nourishing our body in a balanced and flexible way. Not overly restrictive, preoccupied, or obsessed (binging, excessive calorie counting).

The golden rule: eat when hungry and stop when satiated (not when you’re about to unbutton your pants).

Whether it’s 3 regular meals a day, or smaller portions but more frequently, our food intake should have all the necessary nutrients our body needs.

In contrast, disordered eating can fly under the radar because its signs are usually more subtle. In contrast, eating disorders are generally more severe and easier to spot. For more information, read more about eating disorders here.

But when it comes to disordered eating, here are a few behaviours to take note of:

Ψ     Eating when stressed or for comfort
Ψ     Eating when not hungry or not for nourishment
Ψ     Following restrictive diets
Ψ     Fasting for extended periods (more than 24 hours)
Ψ     Regularly skipping meals
Ψ     Episodes of binge eating
Ψ     Using diet pills to control weight
Ψ     Misusing diuretics, laxatives, or enemas
Ψ     Feeling guilty after eating or for eating certain foods

If any of these sound familiar, it may be time to reflect on our relationship with food.

Here’s a short summary of the differences between disordered eating and eating disorders:

Disordered Eating

Eating Disorders

Eating for emotional reasons

Frequently thinking about food

Eating to cope with distress

Extreme calorie concern

Rigid rituals or routines around food and exercise

Fixation on weight and body shape

Occasional calorie restriction or bingeing

Disruption in daily life

Selective eating

Significant weight changes

Disordered Eating and Mental Health: The Connection

While disordered eating might seem less severe than an eating disorder, it can still impact both physical and mental health over time.

Disordered eating often stems from emotional reasons, particularly to cope with distress. This distress may come from feeling heightened stress in our lives, or anxiety about our weight, health or appearance.

For example, finding ourselves rummaging through the office pantry right after lunch because we’re feeling stressed or skipping dinner because we’re already full from snacks, telling ourselves, "I need to lose weight.”

Soon after, feelings of regret and guilt may arise, whether from eating or restricting food. This can lead to anxiety, low self-esteem, or feeling unsatisfied, prompting behaviours like skipping meals or overeating. This cycle of stress, eating, guilt and restriction can create a pattern that’s hard to break.

If you notice the signs, it might be time to check in on your emotional needs.

disordered eating image

Okay, I think... I might have it. So, what should I do now to stop it?

The key is to start from within. Addressing disordered eating isn't just about changing eating habits – it's also about understanding the emotional and mental factors that drive these behaviours. Here are some steps you can take:

Ψ    Gather knowledge and check in with yourself often

Start by learning the signs of disordered eating and eating disorders, just like you’re doing now! Recognising these patterns early can help you catch them before they become more ingrained.

Mindfulness plays a big role here. Stay grounded and present and be aware of your emotions and physical cues. Eat when you’re hungry and try to differentiate between physical hunger and emotional hunger.  

Ψ    Try alternative coping mechanisms

If you’re using food to deal with emotions like stress or sadness, or even binge eating when you’re feeling happy, try adopting healthier ways to manage your emotions and eating, such as:

  • Exercise: Physical activity can help relieve stress and improve mood.

  • Creative hobbies: Engage in activities like painting, writing, or crafting to channel your emotions in a productive way.

  • Heathy snacks: Opt for nutritious options like fruits.  

Ψ    Avoid fad diets

Fad diets often promise quick results but can harm your body and disrupt healthy eating habits.

Focused on balanced, long-term changes (choosing healthier options, or preparing your own meals) instead of drastic restrictions that can lead to disordered eating behaviours.

Ψ    Self-positive encouragement

Celebrate small victories! Even the tiniest steps toward healthier behaviours, deserve recognition. Use positive self-talk to motivate yourself. You could say things like:

  • “Good job to me! I didn’t overeat, even though I loved the food!”

  • “I made it! I didn’t skip any meals this week!”

Sometimes, enjoying a good meal can be a form of celebration – just remember to enjoy it in the right portion and be aware of when you feel satiated. 

Okay, but what is the right portion?
There’s a Chinese saying, “qi (7) fen bao, gang gang hao,” which means “eat until you’re 70% full.” This could be the balanced portion your body needs.

Ψ    Set realistic goals

Don’t expect to change everything overnight. Set achievable, small goals that focus on improving your relationship with food and your body. This could be as simple as:

  • Eating 3 regular meals per day

  • Reducing emotional eating from 5 times a week to 3 times

Lastly, if you’re struggling to manage disordered eating on your own, reaching out for professional support is a great next step. Therapists, dietitians, or counsellors specialised in eating behaviours can guide you toward healthier coping strategies and a balanced relationship with food.

Make an appointment

Perinatal OCD: When Intrusive Thoughts Feel Scary

What if I harm my baby?

 

What is Perinatal Obsessive-Compulsive Disorder (OCD)?

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterised by obsessive thoughts, and behavioural compulsions.

Ψ Obsessions are intrusive, unwanted and persistent thoughts and mental images.

Ψ Compulsions are repetitive acts, including avoidant behaviours, that aim to reduce the distress associated with the obsessive thoughts. They could look like cleaning rituals, repeated checks, counting, saying a particular word or phrase, or avoiding certain places or activities.

Perinatal OCD occurs during pregnancy or a year after childbirth. It could be another manifestation of existing OCD or a sudden onset of a new condition.

Find out more about Obsessive-compulsive disorder

Symptoms of the condition often centre around the baby. They are associated with fears that the baby would be harmed, such as through contamination, inappropriate handling, etc. While individuals with perinatal OCD probably recognise that their obsessive thoughts and compulsive behaviours are irrational, they feel consumed by those thoughts and unable to break free from the rituals.

Often Undetected and Unspoken

Having a baby is stressful and overwhelming. As parents, it’s normal to feel anxious about caring for a young child, and worried that they will harm the child. This anxiety, at manageable level, could actually be helpful in ensuring that you avoid potential risks to your pregnancy and child. 

While many parents have that fear, people who suffer from perinatal OCD give undue importance to those thoughts, and believe that they are capable of causing harm.

These parents may be reluctant to disclose their anxious thoughts for fear that they may be regarded as the potentially dangerous and harmful parent.

Parents may also not be aware of the condition or recognise it as an illness. They may see themselves as an unreliable and unfit parent, or attribute their fears as “going crazy”. 

Failure to detect and address perinatal OCD can result in persistence of the distressing thoughts, and affect the relationship the parent has with the child and their family members. New fathers and mothers (or even those without children) with perinatal OCD may struggle to enjoy moments and bond with the child.

Depending on the severity of your condition, it can also impact your confidence in caregiving and overall quality of life as you spend the day worrying about your child being harmed.


How can I Cope with Perinatal OCD?

Ψ Learn more about OCD

Find out more about the condition. Understand that it is not your fault, and that you are not going mad.

It is often comforting to find an explanation for what you are going through. With better understanding of the condition, you could also make sense of the consuming thoughts and compulsions that you have.

Ψ Learn about your symptoms

Everyone’s triggers and symptoms would look different. It is always a good idea to note how your symptoms present and when they present. This give yourself and ideally your therapist a clearer idea of your presenting difficulties and how to manage them.

Ψ Talk to someone

Reach out to a loved one and share with them what you are going through. It can be relieving just to tell someone your feelings. It could be helpful to first write down your thoughts and feelings before you bring this up with someone.

It can be also reassuring to hear that similar anxious and distressing thoughts are experienced by other people too. Connect with support groups online or in your local community (e.g, OCDNetwork) to receive the emotional support much required in this journey.

Ψ Get practical support

Your anxiety may make you unavailable to care for your child for the time being. Reach out to your family and friends to help with the caregiving tasks.

Let them know how they can help (e.g., could you help to change the baby’s nappy)

Ψ Seek professional help

OCD can be managed with psychological therapy, and sometimes with the additional help of medication. Typically, Exposure and Response Prevention Therapy (ERP) and Acceptance and Commitment Therapy (ACT) are used to help individuals with OCD. They involve exposure to anxiety-provoking situations and accepting the intrusive thoughts while engaging in value-aligned behaviours respectively.

Your therapist will work with you to develop a management plan that best supports you. Things would get better, however overwhelming they seem now.

 

Supporting a Loved One Who is Struggling with Perinatal OCD

Many individuals who experience perinatal OCD worry that they get ostracized when others find out. Do not criticise their compulsions. Assure them that you are there to support them if they ever need it. 

Learn about the condition. With greater understanding of the condition, it may be easier for you to see why your loved one is acting the way they do. You would also realise that providing assurance (e.g., “I’ve sterilized the milk bottle”, “the baby is still breathing”) might not be the best form of support for them – counterintuitively it may sound. Instead consider staying by their side as they experience the discomfort rather than reinforce their rituals.

If you are concerned that you or someone you know is struggling with perinatal OCD, seek professional help. Feel free to reach out to us for support with coping with OCD.

Losing a Baby to Miscarriage or Stillbirth

Both miscarriage and stillbirth refer to the loss of a baby during pregnancy. Whereas miscarriage occurs before 20-24 weeks of gestation, stillbirth is when a baby is born dead after 20-24 weeks of pregnancy.  

Statistics in Singapore

In Singapore, about 20% of pregnancies end up in a miscarriage while stillbirth happens in 0.5%-1% of pregnancies. In most cases, the cause cannot be established. Some known causes include infection, umbilical cord accidents, and placental complications.

A word from our clinical psychologist:

Perinatal loss is a term broadly used to describe losses before, during and after pregnancy. There are different types of losses during pregnancy, including miscarriage, stillbirth, ectopic pregnancies and medical termination for various reasons. No matter when or how the pregnancy loss happened, losing a baby has been described by some of the clients I have worked with, to be the worst kind of pain. Their loss experience defied their assumptions and expectations of a "normal" course of pregnancy through the trimesters until the smooth delivery of their healthy baby, just like everyone else! A "typical" path towards parenthood, towards forming a family (with children) is all that they had hoped for. Given this, a range of emotions - anger, sadness, grief, shock, guilt amongst others may result, as a part of the grieving parents' mourning process. 

For there is so much to mourn - the loss of their "healthy" baby, the loss of sense of "normalcy" in their lives, the loss of that anticipated future with baby as a part of the new family, and the loss of the new identity, hopes, dreams as soon-to-be parents. Instead of celebration of their baby's arrival, some grieving parents may find themselves confronted with the starkest reminder of their loss, in the form of a symbolic farewell ritual, or funeral ceremony and burial event for their baby. For some families who choose these practices, they shared that it can be very helpful for their grieving process and closure. But, there is no one way to grieve, so honour your own needs, beliefs, emotional and physical capacity to decide what is best for your unique situation. 

What can complicate perinatal grief is also in part due to the "invisible" nature of pregnancy loss, especially in the early stages. This can make it very hard to talk about it with others and for loved ones to fully acknowledge the deep, emotional and psychological impact of such losses. Hence, it is necessary to remind all that perinatal losses are as worthy of care and compassion as other types of relationship losses. This is because attachment relationship bonds has already formed between conceiving parents and baby, as soon as they learn about being pregnant. 

Given the tough, unbearable pain of perinatal losses, much compassion is needed all around. Grieving mothers/fathers need to learn to be more self-compassionate and manage their own harsh self-talk, especially those about failure and being unworthy as parents. Given that the nature of perinatal losses are often unexpected, resulting in a big sense of loss of control, it can be beneficial to find little ways of taking charge, for instance, of daily routines, or setting of boundaries about what you are comfortable discussing. This can assist with restoring some sense of normalcy and control as you navigate grief. 


A journey shrouded by shame and silence

Given that pregnancy losses are common, some women may feel that they do not deserve to grieve. On the other hand, despite the substantial occurrence rate, resources to support these women are scarce.

There has also been stigma and blame attached to pregnancy loss, where mothers are implied to have failed to take good care of their babies. Even well-intentioned advice could come across as insensitive and dismissive. This unspoken roller-coaster journey can feel unforeseeably lonely and difficult. 

 

An unimaginable pain

The loss of a child, no matter how brief they have been in your life, is profound. It goes against the natural order of life and no parent can ever be prepared for it. The loss of a child is also the loss of an imagined future with them – the hopes and dreams that cannot be fulfilled.

With the devastation, there may also be guilt that you could have been more attentive to your diet and body, and anger that it had to happen to you. Mothers may also feel alone thinking that their partner does not understand their pain since their partners are not the one who carried the child.

 

How can I cope with a miscarriage or stillbirth?

Everyone grieves differently – in different ways and on different timelines.

Here are some ways we hope can help with your grief.

Ψ Make room for your feelings

Allow yourself to feel all that you feel – guilt, anger, confusion, panic. Observe where you are feeling these emotions in your body – aches in the stomach, tightness in chest? Let yourself be where you are at the moment. There is no prescribed timeline which states the stage of grief you should be at at any point of time.

Ψ Be compassionate to yourself

Understand that it is not your fault nor a personal failure.

As mentioned earlier, there is no timeline for grief; you will move along with your grief rather than moving on from it. Do not expect yourself to forget. Instead, expect yourself to feel triggered on the anniversaries or when you see other families with children. When that happens, allow yourself to take short breaks to grieve – it can be in a toilet cubicle or in a corner of a park. This place should be somewhere you feel safe and comfortable to express your emotions. 

Ψ Pay attention to unhelpful thoughts

Certain narratives may start playing in your head: “My life is worth nothing if I do not have children”, “I am not complete without children”, “It is all my fault”, “I’m a useless mother”. When played enough times in your mind, these thoughts may seem convincing. But they are not true.  

You could challenge these thoughts by asking these questions.

  • What's the evidence for and against these thoughts?

  • What would I tell a loved one who is going through the same situation? 

Ψ Grieve with your partner

An event like the loss of a child could bring a couple closer to each other or lead them to drift apart.

You and your partner may respond to the death of the baby differently – one may turn to crying, one may turn to work to avoid thinking about the pain. Some couples may not want to burden their partner with their anguish so they choose to keep their feelings to themselves. When you are unsure of how your partner feels about the loss, there is a chance that you feel that they are less affected by the loss. And this, will lead to emotional distance and tension in the relationship. 

Recognise that this is uncharted territory for both of you. Seek your partner to grieve as a team. Communicate with each other your sorrow, and try to understand how both of you will grieve in different ways, but together. 

Ψ Consider a grief ritual

For some, a grief ritual gives some form of closure to the episode. The symbolic ritual could be in the form of a scrapbook, memory box, journal entry or even a remembrance trip. 

Ψ Look after yourself

The miscarriage or stillbirth takes a toll on your physical body. The grief and emotional pain may take hold of your life, leaving you with no mental capacity to plan for your day. A routine may be helpful to ensure that your physical well-being is taken care of. You need your sleep, food and physical activity.

Ψ Seek support

Reach out to your family and friends. Be with your loved ones even if you do not feel like talking about the loss; their company in itself may be comforting.

To ease your return to work, we encourage you to speak with your bosses to let them know how you want your return to be managed (e.g., shorter hours, work-from-home arrangement, inform your colleagues to not broach the topic).

The pain of grief could be overwhelming. But you are never alone. Consider seeking professional psychological help in the forms of support group and therapy. Some support groups include:

  • Child Bereavement Support (Singapore)

  • Angel Hearts

  • Miscarriage, Stillbirth, & Child Loss Support Group

  • Pregnancy and Infant Loss Support Group Singapore

  • Pregnancy After Loss Support (PALS)

Speak to a psychologist

 

How family members can support their loved ones

This key idea should underlie all of your efforts to support them: Acknowledge and validate their pain.

Understand that the loss hurts them deeply, and it will take time for the pain to feel more bearable. Some may feel comforted by phrases like “I’m so sorry it happened”, “I cannot imagine your pain but I’m here for you”.

The aim is never to cheer them up – you would be disappointed if you want to do that because you cannot take their pain away; rather, it is to join them in their pain as they struggle with their intense and painful emotions.

On anniversaries or in situations where the parents may be reminded of their loss, you could check in on them gently by asking how they are feeling or if they want to spend time together.

If you notice that their grief has affecting their daily life for a concerning amount of time, let them know why you are concerned (i.e. what did you notice and explain why it is concerning), and encourage them to ask for professional help. You could also go the extra mile and accompany them to visit a psychologist.