Stress and isolation have hit us all. Many of us are out of work, temporarily or not. Where we can go, how we can get there, and what we can do are severely restricted. Exercise options, whether indoor or outdoor, are limited. The virtual lifestyle, be it for receiving medical services, visiting family, or attending the dreaded Zoom meeting, is likely here for some time. We grumble, we complain, we carry on.

Many among us would consider carrying on just heaven.

For some of the 30 million Americans who will grapple with an eating disorder some time during their lives, the COVID-19 pandemic has triggered future struggles into the here and now. The National Eating Disorders Association (NEDA) witnessed a substantial surge in people reaching out to its helpline – as revealed by a 78% increase in traffic in March and April (relative to the same period in 2019), which has been sustained through the summer.

This is due to a number of factors, “but mainly that eating disorders thrive in isolation and during times of induced stress,” says Becky Mehr, a registered dietitian and director of Outpatient Nutrition at The Renfrew Center. The center has experienced a similar spike in its call volume.

Some illnesses warrant scarier names. Eating disorders, an umbrella term for a group of serious, sometimes fatal psychiatric illnesses, is one. Those with some types, like anorexia, restrict their caloric intake so much that bodily functions can be severely disrupted, including those involving the heart. One study that looked at mortality rates of women with eating disorders showed that of 7 deceased patients, 3 were about 60% of their recommended body weight. That same study discussed the other serious health issues going on in these people’s lives, including substance abuse and bipolar disorder.

For most of us, coping with the pandemic has tested our skills from every vantage point. We have learned our strengths, our capacity for doing. If we need a little boost, we seek out friends, listen to music, or if we’re lucky, take a nap.

But for people with eating disorders, they try to cope with food.

What’s an Eating Disorder?

“EDs are not about the food,” noted Ms. Mehr. They are emotional disorders that often go hand-in-hand with other issues such as anxiety or depression. They are emotionally driven behaviors “to either numb or decrease the physical sensations of uncomfortable emotions.”

A broad range of behaviors falls under the term eating disorder, explained Claire Mysko, CEO of the non-profit National Eating Disorders Association (NEDA). As mentioned, people with anorexia severely restrict their intake of food and calories. People with bulimia binge, then purge to compensate for what they have just eaten. Binge eating disorder – the most common eating disorder -- is bingeing without purging. There are others in the DSM [Diagnostic and Statistical Manual of Mental Disorders] as well that don’t get as much attention.

There might be differences between the disorders, but they have a common denominator. “We’re talking about people that use disordered eating behavior as a coping mechanism,” said Ms. Mysko.

Who are these people? Certainly young women, but there are men. In fact one-third of all ED patients are estimated to be men – and some in their teen years. Because, while there are certainly middle-aged and older people with eating disorders, data show that the demographics of those with EDs are getting younger.

Isolation a Factor

The strategy used to curtail the spread of COVID-19 is exactly what worsens eating disorders. “EDs [grow] in isolation,” said Ms. Mysko, echoing Ms. Mehr. Public health recommendations around quarantines, sheltering-in-place, social distancing, and the like “stand in stark contrast to what people in recovery learn, which is about connection and connecting with others.”

“Often ED symptoms happen in isolation, so there’s more opportunity to use the behaviors,” agreed Alison Pelz, a psychotherapist and registered dietitian in Austin, Texas. “And isolation causes us to have some anxiety and depression, and then the person that has an eating disorder, that has depression or anxiety, will use their ED behaviors to cope with that isolation.”

Food, Financial Insecurity

Early on in the pandemic, people panicked and emptied grocery store shelves. There was a fear of not being able to get food or certain types of food that they’re used to eating. “That can really cause ED clients to be anxious. Oftentimes they’re pretty ritualistic around their food,” Ms. Pelz said. On the flip side, people have been stockpiling and may not be on regular schedules, taking them away from school or work. “Now people are anxious and at home with lots of food, and that can be problematic for someone with an eating disorder,” she added.

Financial uncertainty was felt as well, and that was a fear well realized. A recent US Census Pulse survey showed that since March 13, half of the households in the US have experienced income loss.

Body Image, Social Media and Exercise

Cultural messaging around diet culture, fitness, the perfect body, “quarantine 15” (or “COVID-15”, plays on the “freshman 15” meme), has been a big trigger for these patients, said Ms. Mysko. “We are encouraging people to be very mindful about how they are consuming and interacting with media, and especially social media.”

People with heightened weight and shape concerns may be more distressed because their usual exercise regimens exist no longer, as gyms are mostly closed and social distancing curtails outdoor options. Many with eating disorders – especially anorexia nervosa – engaged in dysfunctional, compulsive exercise before the pandemic as a way of regulating negative emotions. It is feared that with this option removed, they may seek out other (perhaps unhelpful) coping mechanisms or adopt other unhealthy compensatory behaviors (such as greater caloric restriction or purging).

It’s Not All Bad

In a recent survey, some people with eating disorders said they noticed an increase in social support during the pandemic, helping them to challenge their problems. The lockdown also gave many more time for self-care, and increased their motivation to recover.

Resources

An eating disorder won’t go away on its own, noted Ms. Pelz. People should seek out “qualified providers that have experience in eating disorders.” During the pandemic, the Renfrew Center has provided mostly virtual counseling, but continues to operate in-person residential treatment facilities, said Ms. Mehr.

NEDA’s homepage (nationaleatingdisorders.org) greets visitors with a pop-up window that links to the organization’s COVID-19 resources page. That page includes links to the NEDA chat/phone/text Helpline, online support groups and forums, information about treatment centers and private practitioners, as well as free and low-cost support.

Josh P. Roberts is a PhD-level science writer and reporter, based in Minneapolis, whose work has appeared in Science, The Scientist, and many other publications.

Sources:

Cooper M et al., “Eating disorders during the COVID-19 pandemic and quarantine: an overview of risks and recommendations for treatment and early intervention,” Eat Disord. 2020 Jul 9;1-23. doi: 10.1080/10640266.2020.1790271. Online ahead of print.

Termorshuizen JD et al., “Early impact of COVID-19 on individuals with self-reported eating disorders: A survey of ~1,000 individuals in the United States and the Netherlands,” Int J Eat Disord. 2020 Jul 28. doi: 10.1002/eat.23353.

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