Like many key employees, Jessica, a grocery store and graduate student in Atlanta, was “extremely overwhelmed” during the coronavirus pandemic. Overcome by stress, she returned to having bad habits to deal with the situation.
Jessica, who is being identified by first name just to preserve her anonymity, has struggled with bulimia for more than a decade.
“I’m on a spree just not to break like a stressed rubber band. I know I can’t purge, because that’s not healthy,” said Jessica. “So I find myself in the middle of this cycle that I spent years trying to break.”
The pandemic has increased stress among many Americans, which has only been exacerbated by isolation and a lack of frequent social contact. It has been the perfect storm of negative factors for individuals with eating disorders or for those who are recovering.
“I think it was disastrous in many ways,” said Cynthia Bulik, who is the founding director of the UNC Center for Excellence in Eating Disorders, on the pandemic. Bulik is a co-author of a study published in July that looks at the first effects of the pandemic on people with eating disorders in the United States and the Netherlands. The study found that the side effects of life in block, including “lack of structure, increased time spent in a triggering environment, lack of social support”, resulted in a worsening of symptoms for individuals with eating disorders and an increased risk of relapse for those in recovery.
“This is just one of the tragedies that followed the COVID crisis,” said Bulik of the rise in eating disorders, which can affect anyone regardless of race, sex, age or weight.
Chelsea Kronengold, communications manager for the National Eating Disorders Association, said the NEDA helpline has seen a 40% increase in contact since March 2020.
“During the pandemic, NEDA is seeing an increase in calls focused on suicide, self-harm and even the need for child protection services,” Kronengold told CBS News by email. Kronengold explained that “eating disorders thrive in isolation”, and the isolation imposed by working at home, measures of social detachment and a break in routine “can put extreme pressure on people suffering from eating disorders”.
Many individuals who work from home have lost to their day the structure that helped them to establish better eating patterns, said Bulik.
“Time has lost its meaning in the pandemic and everything is so amorphous, so it is much more difficult to overlap the recovery structure with an amorphous life,” said Bulik.
Increased isolation also leaves more time to check social media, which can be incredibly triggering for individuals with eating disorders. Meredith, who lives in Washington, DC and works in marketing, told CBS News that she was overwhelmed by ads for fast apps.
“January and February are particularly difficult months to be stuck at home because every social media user is inundated with diet and fitness ads,” she said. Meredith, who is in her early twenties, explained that the “boredom” of the pandemic era “leaves more time to roll aimlessly on Instagram and TikTok”, which are full of influencers with certain body types.
Marita Cooper, a postdoctoral fellow at the Johns Hopkins University School of Medicine, said social media can be a serious trigger for individuals with eating disorders, mainly due to the prevalence of memes about weight gain during the pandemic era. Cooper was the lead author of a July study that found that “the potential impact of the pandemic on individuals with erectile dysfunction is impressive and requires combined intervention efforts.”
“The discussion about COVID’s weight gain has been really problematic,” said Cooper, referring to the so-called “COVID 15” or “quarantine 15”, a joke with the often mocking phrase “freshman 15”, which refers to a 15 pound freshman college wear.
Levels of food insecurity also increased in the United States during the pandemic, as millions of people lost their sources of income, which can be triggering for individuals prone to binge eating and purging. Bulik noted that most of the cheapest foods available are also unhealthy, which can lead to an increased risk of binge eating or feeling guilty about what they eat.
“This ends up being a horrible cycle of perpetuation,” said Bulik, in which people continually eat unhealthy foods and then react inappropriately.
At the beginning of the pandemic in particular, many Americans began to accumulate food, believing that they would be quarantined for a few weeks or months. This was problematic for individuals who relied on eating certain foods as a way to control their eating disorders and now had more difficulty accessing those foods.
“Many people with eating disorders feel safe with a specific variety of foods and include those foods in their diet plan,” said Cooper. “When there is reduced access to these types of foods, it can be really triggering.”
Storing food can also create an unsafe environment for individuals with bulimia or binge eating disorder, who are now stuck in a place where the temptation to overeat is ubiquitous. People with food insecurity can start binge eating because they don’t know when they will be able to eat their next meal, said Erin Parks, clinical psychologist, researcher, co-founder and clinical director of Equip, a virtual eating disorder program company.
“These become a type of survival behavior if you don’t have food security,” Parks said.
However, the news is not entirely disheartening for individuals struggling with eating disorders. The study co-authored by Bulik found that a positive consequence of the pandemic was “a perceived increase in social support that helped to challenge their eating disorder behaviors and increase their motivation to recover”.
Thy Vo, a 29-year-old journalist who lives in Colorado, said her disordered eating habits were “much better” in light of the pandemic. She has been struggling with compulsive and especially purgative behaviors for seven years.
At the beginning of the pandemic, she struggled to eat in front of her boyfriend, as she was unable to hide her behavior when the two were stuck at home all the time. Although it initially damaged her relationship, the conditions forced by the pandemic ended up helping her, including joining an online group for individuals with eating disorders.
“Ultimately, staying at home all the time helped me to normalize my eating habits, which helped to significantly decrease all my thoughts of erectile dysfunction,” said Thy Vo. “Being forced to sit down and eat all my meals with my boyfriend three times a day was torture, but in the end it helped.”
The increase in time at home also helped some adolescents with eating disorders, who were able to receive support from their families and be held accountable. It is more difficult for young people to adopt 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 supporting them. She added that a greater reliance on telehealth made it easier for family members to attend several counseling sessions a week, instead of having to physically go to different consultations.
“The benefit of telehealth is that everyone can come,” Parks said, encouraging people to “really bring their entire village” to address an eating disorder. Equip offers virtual family-based treatment, which uses what Parks described as the “radical idea that families are better equipped to help their loved ones recover from an eating disorder”.
However, even with the increased use of telehealth and the potential for family support, there will likely be long-term damage to the pandemic for individuals with eating disorders. Bulik said he hoped to do a one-year follow-up study on how respondents had been dealing with the pandemic for several months and to see if people were still reporting a stronger determination to recover or strengthen ties with their families.
“I think pandemic fatigue may be eating away at these positive aspects,” said Bulik.
People can recover from eating disorders, with support and treatment. But the road to recovery for many has been hindered by the pandemic and it can be difficult to get back on track.
“There is this assumption that DEs can disappear after life is back to normal,” said Cooper. “But this is not something that will magically disappear.”
Resources:
National Eating Disorders Association
If you or someone you know is struggling with body image or dietary concerns, NEDA’s free, confidential helpline is available by phone or text at 1-800-931-2237 or by click to chat at nationaleatingdisorders .org / helpline. For 24/7 support, send “NEDA” to 741-741.
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
CELEBRATION
FEAST is a non-profit organization that offers free support for caregivers of loved ones who suffer from eating disorders.