Like many key workers, Jessica, a grocer and graduate student in Atlanta, is “extremely overworked” during the coronavirus pandemic. Overwhelmed with stress, she has reverted to bad habits dealing with it.
Jessica, who is identified by her first name only to maintain her anonymity, has struggled with bulimia for over a decade.
‘I eat binges so I don’t break like a tight rubber band. I know I can’t cleanse because it’s unhealthy, ”Jessica said. “So I find myself halfway through this cycle, I’ve been trying for years to break through.”
The pandemic has increased stress among many Americans, compounded only by isolation and lack of frequent social contact. It has been the perfect storm of negative factors for those with eating disorders or those in recovery.
“I think in many ways it has been disastrous,” said Cynthia Bulik, the founder and director of the UNC Center for Excellence in Eating Disorders, of the pandemic. Bulik co-authored a study published in July analyzing the early effects of the pandemic on people with eating disorders in the US and the Netherlands. The study found the side effects of living in lockdown, including ‘a lack of structure, more time spent in a triggering environment, lack of social support’, resulted in worsening symptoms in people with eating disorders and a higher risk of relapse . for those who recover.
“This is just one of the tragedies that followed the COVID crisis,” said Bulik of the increase in eating disorders, which can affect anyone regardless of race, gender, age or weight.
Chelsea Kronengold, the communications manager for the National Eating Disorders Association, said the NEDA helpline has had 40% more contacts since March 2020.
“During the pandemic, NEDA is seeing an increase in phone calls targeting suicidality, self-harm and even the need for child protection services,” Kronengold told CBS News in an email. Kronengold explained “eating disorders thrive in isolation,” and the isolation imposed by working from home, social remoteness, and a break from the routine “can put an extreme strain on those suffering from eating disorders.”
Many people who work from home have lost the structure of their days that helped them establish better eating patterns, Bulik said.
“Time has lost its meaning in the pandemic and everything is just so amorphous, so it’s much more difficult to put a recovery structure on an amorphous life,” said Bulik.
Greater isolation also leaves more time for checking social media, which can be incredibly triggering for people with eating disorders. Meredith, who lives in Washington, DC and works in marketing, told CBS News that she was overwhelmed with ads for fasting apps.
“January and February are particularly difficult months to be locked up at home, as every social media user is inundated with fitness and diet ads,” she said. Meredith, in his mid-twenties, explained that the “boredom” of the pandemic era “leaves more time to aimlessly scroll through Instagram and TikTok,” teeming with influencers with certain body types.
Marita Cooper, a postdoctoral researcher at Johns Hopkins University School of Medicine, said social media could be a serious trigger for people with eating disorders, especially given the prevalence of weight gain memes during the pandemic era. Cooper was the lead author of a July study that found “the potential impact of the pandemic on individuals with EDs is staggering and requires coordinated intervention efforts.”
“The weight gain discussion about COVID has been really problematic,” Cooper said, referring to the so-called “COVID 15” or “quarantine 15,” a play on the often derisive phrase the “freshman 15,” which refers to 15 pounds. freshmen in college.
Food insecurity also increased in the US during the pandemic as millions of people lost their sources of income, which could be a trigger for those prone to binge eating and purging. Bulik noted that most of the cheapest foods available are also unhealthy, which can lead to a greater risk of binge eating or guilt about what they eat.
“That ends up being a horrible perpetual cycle,” said Bulik, where people eat unhealthy foods all the time and then react in inappropriate ways.
Particularly at the start of the pandemic, many Americans began hoarding food, believing that they would be quarantined for a few weeks or months. This has been problematic for people who relied on eating certain foods as a way to manage their eating disorders, and now had more difficulty accessing these foods.
“Many people with eating disorders feel safe with a certain range of foods, and they have those foods on their meal plan,” Cooper said. “If there is limited access to that type of food, it can really trigger it.”
Stockpiling can also create an unsafe environment for people with bulimia or binge eating disorder, who are now trapped in a place where the temptation to overeat is pervasive. People who are food insecure can often binge eat because they don’t know when to eat their next meal, says Erin Parks, a clinical psychologist, researcher and co-founder and chief clinical officer of Equip, a virtual eating disorder program.
“That’s going to be a survival behavior when you’re food insecure,” Parks said.
However, the news isn’t entirely bleak for those struggling with eating disorders. The study co-authored by Bulik found that a positive consequence of the pandemic was “perceived increases in social support that helped challenge their eating disorder behaviors and increase motivation to recover.”
Thy Vo, a 29-year-old journalist living in Colorado, said her disordered eating habits were “much better” in the face of the pandemic. She has been struggling with binge eating and especially purging behavior for seven years.
At the start of the pandemic, she struggled to eat in front of her boyfriend because she couldn’t hide her behavior when they were both at home all the time. While it initially strained her relationship, the circumstances forced by the pandemic ultimately helped her, including joining an online group for people with eating disorders.
“In the end, always being at home helped me normalize my eating habits, which has blunted all my ED thoughts significantly,” said Thy Vo. “Being forced to sit down with my boyfriend three times a day and eat all my meals was torture, but it helped in the end.”
The increased time at home has also helped some adolescents with eating disorders, who have been able to receive support from their families and be held accountable. It is more difficult for young people to fall into disordered eating habits when they are constantly surrounded by family members.
Parks said children and adolescents are “more likely to recover” if they have adults in their lives who support them. She added that a greater reliance on telecare had made it easier for family members to attend multiple sessions of counseling per week, rather than having to physically travel to different appointments.
“The benefit of telecare is that anyone can come,” Parks said, encouraging people to “really bring in their entire town” to deal with an eating disorder. Equip offers virtual family treatment, using what Parks described as the “radical idea that families are best equipped to help their loved one recover from an eating disorder.”
But even with greater use of telecare and family support options, the pandemic is likely to cause long-term damage to those with eating disorders. Bulik said she looks forward to a year-long follow-up study into how respondents got through the pandemic for several months, and to see if people still reported stronger will to recover or closer ties with their families.
“I think pandemic fatigue could erode those positive effects,” said Bulik.
People can recover from eating disorders with support and treatment. But the road to recovery has been derailed for many by the pandemic, and getting back on track can be difficult.
“It is believed that EDs may disappear after life returns to normal,” Cooper said. “But this is not something that will magically disappear.”
Resources:
National Association for Eating Disorders
If you or someone you know is struggling with body image or eating issues, the NEDA free and confidential helpline can be reached by phone or text message at 1-800-931-2237 or click-to-chat at nationaleatingdisorders.org/helpline . For 24/7 crisis support, text “NEDA” to 741-741.
The NEDA has also compiled a list of free or low-cost COVID-19 resources: https://www.nationaleatingdisorders.org/help-support/covid-19-resources-page.
National Institute of Mental Health
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FEAST is a non-profit organization that provides free support to health care providers with loved ones suffering from eating disorders.