COVID-19 Sheltering Can Make Things More Difficult for People with Eating Disorders

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  • Experts say shelter-in-place orders during COVID-19 can make life more difficult for people with eating disorders.
  • They say lockdowns can produce isolation as well as temptations that are close at hand that can disrupt coping strategies.
  • They add that food scarcities can also trigger both overeating and undereating issues.

Many people have fallen back on comfort food to help cope with the stress of COVID-19 lockdowns.

For people with eating disorders, however, it’s created a “perfect storm” of unhealthy, emotional eating triggers, from social isolation to anxiety over perceived shortages of food supplies, experts say.

Officials at the National Eating Disorders Association (NEDA) Helpline said their chat queries increased 83 percent between April 2019 and April 2020.

Doctors specializing in treating eating disorders say they’ve also observed a sharp uptick in problem reports from their patients.

“I had a full schedule this morning,” said Dr. Harry Brandt, medical director for the Eating Recovery Center in Maryland.

He’s been meeting patients via telemedicine.

“People are really struggling,” Brandt told Healthline. “I’m very concerned, because even when you can meet patients in person, this can be a difficult illness to [recover] from.”

Eating disorders include issues with both overeating and restricting food. The most common diagnoses include anorexia nervosa, bulimia, and binge eating.

Anxiety plays an outsized role in each diagnosis, experts say.

“Oftentimes, eating disorders are related to control,” Jennifer Pepper, a holistic psychotherapist in Guelph, Ontario, told Healthline.

“When we feel that we cannot control what is happening to us, we cling to that idea that at least we can control what or how we are eating. Due to COVID-19, the loss of control over one’s life feels heavier to everyone, so for someone who has already been dealing with a sense of lacking control, this feeling is most likely amplified right now.

“If a person was using an eating disorder to feel more stable and in control before this pandemic, it would make sense that they would be triggered and perhaps be struggling with the disorder more right now as an unhealthy way to cope with the pressures,” Pepper said.

The extent to which COVID-19 has tossed the rule book on what “normal life” looks like can be interpreted by people with eating disorders as “nothing counts, so I can just do whatever I want,” Krista Scott-Dixon, PhD, curriculum director for Precision Nutrition, told Healthline.

“People with disordered eating tend not to think of in-betweens or gray zones or moderation. It’s very much on or off. If I can’t be on, if I can’t have the strict rules, and if I can’t follow my strict routines, then it’s off,” she said.

Food scarcity can be a trigger

Food shortages brought on by hoarding and supply chain issues during the pandemic may hit especially close to home for those with eating disorders.

Stocking up due to perceived scarcity, for example, can become a dangerous trigger for those who binge eat, according to Ariel Johnston, RD, LD, of The Tasty Balance LLC.

“Just having excess food in a pantry at home can make those struggling revert to old behaviors, or exacerbate behaviors like bingeing on the foods because they are available,” Johnston told Healthline.

“Most people with eating disorders have a scarcity mindset when it comes to food,” Lindsay Ronga, an eating disorders recovery and life coach with OutshiningED, told Healthline.

“‘Will there be enough?’ ‘What if I run out?’ COVID magnifies these fears. Someone with anorexia might buy very little food [when] hearing eating disorder thoughts, such as ‘There’s not enough food for everyone and you don’t deserve to buy it.’ In addition, if their ‘safe foods’ aren’t available at the store, this can be a huge trigger,” Ronga said.

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Coping behaviors are disrupted

Shelter in place also can disrupt routines established as coping mechanisms for eating disorders, including when and how to eat, as well as exercise regimens.

Psychologist Rebecca B. Skolnick, PhD, a co-founder of MindWell NYC, tells Healthline that popular discussions about “quarantine 15” weight gain can be “particularly challenging for someone with an eating disorder who already spends a great deal of time focusing on weight and shape.”

Such messages “have resulted in many clients relapsing into overexercising, purging, bingeing, and food restriction,” added Mallory Hepp, a licensed psychotherapist in the Los Angeles area specializing in treating eating disorders, body image issues, and exercise addiction.

“We recommend that people with eating disorders be very intentional about who they follow on social media and not engage with those who can be triggers,” Claire Mysko, CEO of NEDA, told Healthline.

Temptations close at hand

Environmental factors are also shelter-at-home stressors for people with eating disorders.

“You are always near your kitchen, which makes it especially hard not to eat more than you normally would, particularly if you already struggle with binge eating or overeating,” Skolnick said. “Though many people who do not have eating disorders are struggling with this, too.”

“That food is much closer now and available to use it for coping. It’s a lot more seamless,” Scott-Dixon said. “Your stress is up. Your boredom is up. That feedback loop is a lot tighter now.”

“For example, at work, if you’re in an office or on a job site, maybe you can’t deal with workplace stress immediately until you get home. If you’re already home, it’s a really quick trip between workplace stress or other stress and coping with it [with food],” she explained.

Overcoming isolation

Even without the mandates of a lockdown, “people with eating disorders are already good at isolating themselves,” Mysko said.

“Eating disorders thrive on secrecy and isolation,” Ronga explained. “They get stronger when no one knows what you’re up to. You feel like you can ‘get away with it’ without anyone knowing. This is a top reason why those with eating disorders are struggling even more in COVID environment.”

“At a time when we are being encouraged to isolate, it makes it that much more difficult to reach out for support, and many end up feeling deeply shameful about their struggles and behavior,” Johnston said.

Mysko urges people with eating disorders to maintain their connections with their personal support network, and to utilize resources like the NEDA Helpline at 800-931-2237, where volunteers are available for live chat sessions.

In addition to telemedicine consultations via videoconferencing, programs like the Eating Recovery Center are offering “virtual partial hospitalization” to their most at-risk patients — essentially daylong online group therapy sessions.

“Finding productive, engaging, and potentially pleasurable activities is also important,” advised Arlene B. Englander, author of “Let Go of Emotional Overeating and Love Your Food: A Five-Point Plan for Success.”

“Read books online. Pick up that instrument in the corner and play it. Learn to knit. Walk to fun music. Ditch your perfectionism and just do stuff,” Englander told Healthline. “The endorphins — yes, even from knitting — will kick in to soothe you sans food.”

“We can overcome emotional overeating — even in quarantine,” she added. “Awareness, self-compassion, and active engagement are crucial components of an action plan to protect our mental and physical health.”