People with eating disorders are particularly vulnerable during the COVID-19 pandemic.
Social isolation and increased levels of anxiety are among the factors that may interrupt recovery.
In this article, we look at how the measures that authorities have introduced to combat the spread of the virus might be affecting people with an eating disorder (ED).
We also provide tips on how to cope, advice on supporting loved ones with an ED, and a list of organizations that can offer support.
According to the American Psychiatric Association, a person with an ED will experience severe disturbances in their eating habits.
These disorders also affect how people think and feel about eating and food.
Those with EDs tend to spend a disproportionate amount of time and energy thinking about food and how much they weigh.
The three main EDs are:
- anorexia nervosa
- bulimia nervosa
- binge eating disorder
There are also many other types of EDs and disordered eating tendencies that may not always fit into specific categories.
EDs are mental health conditions. Often, people with an ED will also experience other mental health issues, such as anxiety, panic disorder, obsessive compulsive disorder (OCD), or drug and alcohol use disorders. However, this is not always the case.
The COVID-19 outbreak and the measures that authorities have put in place to tackle it may affect people living with EDs in a variety of ways.
Emotional impact of lockdown
Many people are required to stay at home in a bid to stop the novel coronavirus from spreading.
Some people may feel isolated, which can lead to a range of feelings and emotions.
Quarantine, self-isolation, and physical distancing (also called social distancing) can cause anxiety, depression, and loneliness, all of which are common ED triggers.
ED triggers are factors that lead to people using certain behaviors and actions to cope with them. In response to a trigger, a person with an ED may binge eat, purge, take laxatives, or exercise excessively.
Some people with an ED experience social anxiety, meaning that they tend to isolate themselves. Physical distancing measures can make it harder for them to manage this symptom.
People with EDs have complex relationships with food. They might only eat a certain type or brand of food. They might only eat at a particular time of day or within a strict routine, even if they are recovering.
In fact, the routine may be an essential part of their recovery. It might outline when and what to eat, as well as when and how to exercise. Visiting friends and attending healthcare appointments may also be important parts of the routine.
The current situation has affected people’s ability to follow their usual routine and left them vulnerable to relapse.
People in therapy for an ED might be unable to attend appointments due to physical distancing measures, and they may find virtual sessions unappealing or less effective.
They may also be unable to stick to their usual exercise regimen due to the closure of gyms and other leisure facilities. Stockpiles of food may be problematic for people with binge eating disorder or bulimia.
People who live alone might feel as though they have no support, while those who live with their family might find it difficult to cope with feeling watched, monitored, or pressured to eat certain foods.
Impact on treatment
Policymakers have reorganized healthcare services in response to the COVID-19 crisis to free up capacity in critical care.
At the same time, physical distancing measures are making it difficult for doctors to see their patients face-to-face.
Some centers are seeing people remotely, using videoconferencing software. Doctors are not yet sure whether this new way of working is as effective as face-to-face appointments.
Physical impact of infection
The novel coronavirus, or SARS-CoV-2, causes the respiratory disease COVID-19. Most people who develop COVID-19 will have relatively mild symptoms that do not require treatment in the hospital, and they will recover in a few days or weeks.
Scientists need more evidence before they can be sure of this link, but they believe that emaciation and compromised physical health play a role in susceptibility.
People living with an ED may find that doing the following helps them manage their condition during the COVID-19 pandemic:
Making a plan
When someone with an ED experiences a trigger, there are several techniques that they can use to help minimize their likelihood of engaging in harmful behaviors.
One idea is to make an action plan based on the level of distress. For example, if the distress measures 3 out of 10, the person could call a friend for a chat, take a relaxing bath, or write in a journal.
If the distress is 6 or 7 out of 10, the person could ask an ED organization, trusted healthcare professional, or close family member for support.
People with an ED may wish to share their feelings with trusted friends and family members and keep these lines of communication going during lockdown measures.
Video and telephone calls, as well as social media, are all great ways to stay in touch.
Many people living with an ED also benefit from speaking to a therapist. Therapists and other mental health professionals may offer video calls or telephone appointments.
Setting a routine
Some people find that it helps to have a routine, which may include a regular meal plan, exercise schedule, and set times for work and hobbies.
Writing it down
Some people find it helpful to write down a list of the reasons why they want to stay in recovery.
They can keep the list somewhere easy to see, such as on a noticeboard or the fridge door.
What people find comforting varies among individuals, but some ways to self-soothe include:
- listening to music
- taking a warm bath
- speaking to a friend
- limiting social media intake
- going for a walk, if possible
- spending time with a companion animal, such as a dog or cat
- reading a chapter of a book
Many organizations are offering support to people with EDs, including during the COVID-19 crisis. These include:
A person with an ED may find it hard to talk about how they feel or how lockdown or other coronavirus safety measures are affecting them.
Friends and family members who want to help can try giving their loved one opportunities to open up.
They can also work with their loved one to avoid triggers. That might mean finding acceptable alternatives to unavailable food products or avoiding stockpiling food at home.
Help Guide recommend that families help by:
- setting a positive example by eating nutritious, balanced meals and avoiding language such as “dieting”
- encouraging the whole family — even if the person with an ED is not eating — to sit down to a meal and enjoy spending time together
- avoiding attempting to force someone to eat
- promoting self-esteem with encouragement and compliments that do not focus on a person’s weight
Living with an ED during the COVID-19 crisis can have significant effects on a person’s physical and mental well-being.
People with very low body weight may be more susceptible to developing COVID-19.
In addition, the emotional and practical elements of measures such as quarantining, self-isolating, and physical distancing can all affect recovery.
However, resources are available to help a person stick to their recovery plan and take care of themselves during the crisis.