Navigating the Challenges of Disordered Eating During a Pandemic: Identifying People at Risk

Psychiatrist & JED Subject Matter Expert

When much of the US–and the world–went into lockdown this spring, most of us were forced into new relationships with food. Grocery shopping took on an aura of heightened risk, restaurants closed, and fears about food shortages encouraged hoarding behaviors–making us all  think about how and what we eat much more than usual. Online classes and remote work have caused us to “see” ourselves much more frequently than before. For those struggling with disordered eating or body image problems, COVID-19 conditions created a perfect storm of increased risk for worsened eating disorders. Identifying those most at risk is a critical first step in mitigating the damage that an eating disorder can cause.

Although it’s too soon to have clear evidence of how or if the pandemic has increased the incidence of eating disorders, many of my patients have demonstrated worsened or new eating disorder symptoms while under stay-at-home orders. Many other clinicians report similar concerns. The Journal of Eating Disorders published an editorial in April 2020 sounding the alarm about the pandemic’s impact on eating, which is also being documented by qualitative studies. But some people who were not struggling with food or body image before the pandemic are also experiencing new difficulties.

Disordered eating behaviors, from restricting to binge eating to binging and purging, often arise as attempts to manage significant anxiety or to exert control when a person feels life is out of control. Eating disorders often disrupt interpersonal relationships, but the reverse is also true: isolation can worsen eating problems. While anxiety is a universal and normal response to the disruptions caused by COVID-19, using disordered eating to cope leads to more problems. Finding other ways to manage anxiety is critical.

If you were in treatment for an eating disorder before the pandemic began, or if you’ve recovered from one but notice certain symptoms creeping in again–or if you’ve never been diagnosed but notice new eating rituals or food and weight fears emerging–it’s important to seek help right away, even during the pandemic, because eating disorders are among the most dangerous of mental health illnesses. And though there are challenges to evaluating and treating eating disorders by telemedicine, there are also some creative new opportunities for  support.

Some signs of disordered eating:

  • Routinely skipping meals. With the loss of an external reason to get up at a specific time for work or school, many people are experiencing erratic sleep schedules. It can be tempting–but problematic– to blame these for also missing meals.
  • Using fear of contagion as a justification for not procuring food. While it’s important to follow CDC guidelines to minimize risk, if you’re self-isolating to an extreme–for example, you are unable to leave the house to pick up groceries while also feeling fearful of getting food or meals delivered–you need extra support.
  • Finding the proximity of food a trigger. When we’re in the same place all day, every day and our kitchen is right next to our workspace, it can be tempting to graze or snack frequently. If you are eating so much that you feel out of control, or hiding what you eat from your family or roommates, or if you feel so sick after eating that you resort to throwing up, ask for help. If you notice conversations with a friend or relative revolving around complaints about always being near food, ask more questions. How/when/what are they eating?
  • Feeling so bothered by video images of yourself that you resort to behaviors above. It’s strange to face images of ourselves on the video platforms most of us use now to work, socialize, or attend classes. Some platforms allow us to turn the camera off, so we can focus on the people we’re virtually interacting with instead of on examining whether we’ve brushed our hair well enough that morning. But if you can’t stop scrutinizing what you consider your flaws in images of yourself, or if seeing yourself sets off an avalanche of negative self-talk or hatred of your body, this too can be a red flag.
  • Significant weight changes. It’s not helpful to obsess about numbers on a scale, but if you’ve noticed weight loss recently this can be a red flag. Binging and purging can also lead to weight fluctuations and dangerous changes in hydration and electrolytes. During the pandemic, it’s harder than usual to get regular weight checks or blood tests in a doctor’s office. However, these services are increasingly available again, as clinics adapt to safer re-opening.

Creative solutions:

  • Schedule meals with friends and family over video platforms. But be sure to also schedule social visits that do not involve a focus on food.
  • Set up daily routines, anchored by regular mealtimes. Make sure you get outside for walks, staying physically distant or wearing a face covering. Stick to a sleep schedule.
  • Be honest with those you live with when you find yourself struggling. If you live alone, let those you video-chat with know how it’s going. Secrecy strengthens isolation and can strengthen eating-disordered thoughts.
  • Get treatment. Therapy and nutritional counseling help. Sometimes medicines are necessary. Many therapists are eating meals virtually with their patients or providing support during grocery trips via screen-sharing to help challenge fears around certain foods. Telehealth may allow new kinds of support. And residential and inpatient programs continue to be available for those who experience high medical risk or need more support than virtual options can provide.
  • Check out the resources compiled by the National Eating Disorders Association (NEDA) to help during the time of Covid-19, including a hotline here.
Doris Iarovici, MD, has provided psychiatric care to university students for over 20 years. The author of Mental Health Issues and the University Student, she has also written about college mental health in the New York Times, The Guardian, and elsewhere. She has been a subject matter expert with The Jed Foundation since 2016.
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