There’s no doubt about it — 2020 has been one of the most traumatic years in modern history, for so many different reasons. And for people with eating disorders or those who have struggled with them in the past, it's been especially hard. That's not surprising, say mental health experts. Emotional and psychological issues in general are on the rise — one study in JAMA Network Open, for example, suggests that depression symptoms among adults in the U.S. more than tripled during the novel coronavirus pandemic compared to the pre-COVID era. And many mental health problems, including anxiety, can exacerbate eating disorder behaviors or even prompt a relapse.
We're not talking about stress-eating or mindlessly snacking because you're bored while trapped inside. Sometimes soothing with comfort foods like ice cream or pizza when you're feeling stress, boredom, or anxiety like many are experiencing living through the pandemic, is a perfectly natural response. If you're the type who loses her appetite when she's stressed or anxious, forgetting to eat occasionally is also normal. The problem arises when these every-so-often responses become more and more frequent, your go-to soother, and you start to overeat or restrict excessively—that's disordered eating.
On the far end of the spectrum are full-blown eating disorders—when your dieting or overeating and excessive concern about weight and calories and grams of carbs disrupt your everyday life. There are specific symptoms that doctors use to diagnose these, and the National Association of Anorexia Nervosa and Associated Disorders reports that nearly 29 million Americans (9% of the population) will have an eating disorder at some point during their lifetime. Furthermore, these complex psychological conditions are among the deadliest mental illnesses.
And because eating disorders are often inflamed by extreme life changes—like all of a sudden not being able to go to school or the office—what we are seeing makes sense: Results from a June 2020 survey conducted by mental health professionals in Australia revealed that people with a history of eating disorders reported an increase in restricting, binge eating, purging, and exercise behaviors since the start of the global pandemic.
So what constitutes an official eating disorder? According to the National Library of Medicine (a part of the National Institutes of Health) these are the definitions for three of the most widely-known types of eating disorders:
Binge eating, which is characterized by excessive eating, beyond the point of feeling full. This is the most common eating disorder in the U.S.
Bulimia nervosa, which begins with binging, followed by purging, laxative abuse, or compensatory exercise. People suffering from bulimia can be either underweight, a healthy weight or overweight.
Anorexia nervosa, which can include avoiding food, severely restricting food and/or eating very small quantities of certain foods. Someone battling anorexia may view themselves as overweight, regardless if they are dangerously underweight.
How eating issues are being intensified during the pandemic:
Eating disorders and other mental health conditions often hold hands. “Depression and anxiety have very high comorbidity rates with eating disorders,” explains Ellen Astrachan-Fletcher, Ph.D., a psychologist and regional clinical director of the Eating Recovery Center, a Denver-based treatment center. “Plus, one of the things we know about eating disorders is they have a high rate of relapse. In fact, people typically relapse multiple times before finally finding recovery — and there are a lot of people suffering these days.”
And with the holiday season underway, emotions are likely to be at all-time high. “Last year at this time, everything was ‘normal,’ but hundreds of thousands of people have died from COVID and numerous homes will be suffering from a loss,” Dr. Astrachan-Fletcher says. Plus, it's not safe to gather with loved ones indoors.
Here, three additional stressors related to the pandemic that can worsen eating disorders, as well as other types of eating disturbances, and how you can take good care of yourself.
Potential trigger: Stay-at-home orders
Eating disorders thrive in isolation. “COVID enhances isolation, and not feeling connected to anyone can contribute to a person relapsing,” says Dr. Astrachan-Fletcher, who prefers the term "prompting event" to "trigger" because it implies that you can take steps to interrupt harmful eating behavior and that it's not inevitable. “I recently had a patient who said to me, ‘I feel like I’m in no one’s close social pod.’” Dr. Saltz has heard similar sentiments, and adds that being forced to work from home — and having easy access to the kitchen — can cause people to spiral into unhealthy habits. “It’s not about being physically near the fridge that makes someone have to eat, but it’s the thought of being the near the fridge unfettered that makes someone feel at risk. As a result, they may start the cycle of needing to restrict in order to manage that feeling.” And if you're prone to bingeing, not having anyone there to notice can be disinhibiting.
How to cope: Reach out to a trusted friend or relative and be completely honest. “Be open, be vulnerable and tell them how isolated and disconnected you’ve been feeling,” Dr. Astrachan-Fletcher suggests. “It’s one thing to say, ‘Hey, what are you doing tonight?’, but it’s another thing to say, ‘Can you talk? I’m really feeling depressed.’ These two questions will get very different responses.” If a social distance get-together is not possible, then she suggests chatting over video (FaceTime, Zoom) or phone — and giving the keyboard a rest. “Texting is the least intimate way of communicating.”
Potential trigger: Those empty grocery shelves
Seeing bare shelves in your local supermarket or not being able to count on a timely food delivery—or hearing about food shortages on the news—can have a lasting psychological affect. “Even seeing the aisle without toilet paper can make someone feel as if they aren’t going to get the food they want, and that trips off this whole sense of I-will-be-denied-so-I-need-to-hoard,” Dr. Saltz states. “Hoarding food makes some people feel like eating, which can turn into a vicious cycle.”
Also, people in recovery may not be comfortable with breaking their routine of acceptable foods, which can cause a spiral of symptoms, adds Dr. Astrachan-Fletcher. “Often times when people struggle with eating disorders, they will only eat a specific brand of food, but if that brand is not available, they may decide not to eat at all. It can be an overwhelming experience.”
How to cope: Dr. Astrachan-Fletcher advises working with a dietitian to discuss alternative options. “And if possible, go shopping with a support person — someone who knows what you are going through. This person can help you relax, along with encouraging you to be a little more flexible.”
Potential trigger: Scrolling through social media
There's a name for the phenomena you're experiencing this year: Doomscrolling, or the act of spending endless time on Facebook/Instagram/Twitter reading a stream of dreadful, scary posts in your feed. This can be harmful in two ways: it adds to anxiety, and people with eating disorders use food or restriction to cope with those unsettling feelings, and certain accounts (say, influencers who focus physical appearance or promote an unrealistic body ideal) can make it worse for people with eating disorders. “In general, social media accounts that are discussing food, calories, dieting and exercise can be difficult for those who have body dysmorphia as part of their eating disorder,” Dr. Saltz explains.
And don't forget about the nationwide obsession with gaining the quarantine 15 (or 19), which means the online conversation is often a panicked one about weight and exercise and dieting. “Some people suffering from an eating disorder can think, ‘I cannot gain weight!’ and begin over-restricting,” Dr. Astrachan-Fletcher states. “Meanwhile, others may see workout posts and think, ‘This is the perfect time to get in shape!’ and start exercising for hours a day — or someone may go to the other extreme and think, ‘I could never achieve that goal, so I’m going to console myself in a box of cookies.’”
How to cope: Block, hide or unfollow those accounts that leave you distressed or bring up disordered thoughts, along with disabling news alerts on your phone. You can even delete the most egregious apps from your phone—you can always put them back when you're feeling calmer.
When you should seek help:
If you’re wondering when is the "right" time to reach out for professional help, now is the time, says Dr. Astrachan-Fletcher. If you even had the thought, “This means there’s an inkling inside of you that knows your desire to control food is out of control. Relapse is a slippery slope. Once a couple of steps are taken on that slope, it can get away from you very quickly.”
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