Eating Disorders and COVID-19

**Trigger Warning: Eating Disorders**

I would like to preface this blog post by mentioning that I am not a person with lived experience with an eating disorder of any form, and I am writing this as an ally to people in recovery. I cannot speak from personal experience, but I speak as an ally to all those who have been personally affected. Additionally, I recognize that much of the media coverage and research that’s been done on eating disorders has often focused on white, upper-class folks, and I want to emphasize that eating disorders can impact people of all socioeconomic backgrounds, gender identities, sexualities, races, ethnicities, abilities, and body shapes/sizes. 

Given the onset of the novel virus COVID-19 over the past few months, quarantine and isolation have been trying times for many. For those facing racial/ethnic violence and discrimination due to COVID-19 (and in general), those with preexisting mental health conditions and/or substance use disorders, those living in unsafe home environments, students home from college, and more ― the virus has proved especially troubling. In addition to these topics I’ve explored throughout this blog, I want to highlight the challenges COVID-19 has forced upon folks in recovery or who are currently battling eating disorders. Eating disorders have the highest mortality rate of any psychiatric illness. 

As defined by the National Eating Disorders Association (NEDA), eating disorders are “serious but treatable mental and physical illnesses that can affect people of all genders, ages, races, religions, ethnicities, sexual orientations, body shapes, and weights. National surveys estimate that 20 million women and 10 million men in America will have an eating disorder at some point in their lives. While no one knows for sure what causes eating disorders, a growing consensus suggests that it is a range of biological, psychological, and sociocultural factors.” 

Video from NEDA to give a better look into disordered eating.

There are different types of eating disorders, which vary in how they impact the mind and the body. As listed and described on the NEDA Website, there are several eating disorders that can have serious mental health implications, including:

  • Anorexia Nervosa
    • Characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many individuals, distorted body image. People with anorexia generally restrict the number of calories and the types of food they eat. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives, and/or binge eat.
  • Bulimia Nervosa
    • Characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.
  • Binge Eating Disorder (BED)
    • Characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterward; and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating. 
    • It is the most common eating disorder in the United States.
  • Orthorexia
    • An obsession with proper or ‘healthful’ eating; people with orthorexia become so fixated on so-called ‘healthy eating’ that they actually damage their own well-being
    • Studies have shown that many individuals with orthorexia also have obsessive-compulsive disorder.
  • Other Specified Feeding or Eating Disorders (OSFED)
    • The category was developed to encompass those individuals who did not meet strict diagnostic criteria for anorexia nervosa or bulimia nervosa but still had a significant eating disorder
  • Avoidant Restrictive Food Intake Disorder (ARFID)
    • Similar to anorexia in that both disorders involve limitations in the amount and/or types of food consumed, but unlike anorexia, ARFID does not involve any distress about body shape or size or fears of fatness
  • Pica
    • Involves eating items that are not typically thought of as food and that do not contain significant nutritional value, such as hair, dirt, and paint chips
  • Rumination Disorder
    • Involves the regular regurgitation of food that occurs for at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out.
  • Unspecified Feeding or Eating Disorder
    • Applies to presentations in which symptoms characteristic of a feeding and eating disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functions predominate but do not meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class.
  • Laxative Abuse
    • When a person attempts to eliminate unwanted calories, lose weight, “feel thin,” or “feel empty” through the repeated, frequent use of laxatives
  • Compulsive Exercise
    • Extreme, excessive exercise that significantly interferes with areas of one’s life

Among the types of eating disorders and those not yet classified, it is no question that they can pose significant implications on the person. In addition to the challenge of seeking help and living in recovery, COVID-19 has created unique circumstances that may put people in recovery at risk of relapse. Furthermore, many individuals struggling with eating disorders may also suffer from other mental health conditions such as anxiety, depression, substance use disorder, or obsessive-compulsive disorder. Quarantine may trigger disordered eating thoughts as well as the symptoms of other mental health conditions in a variety of ways. With a routine that has become a “new normal” for many, the stay-at-home orders might pose risks to people in recovery:

  • Limiting contact with grocery stores and restaurants could trigger both restrictive and bingeing behaviors for people in recovery
  • Being surrounded at home in a stocked-up kitchen of food can feel threatening
  • Foods good for quarantine are often “fear” foods for those with an eating disorder (e.g., pasta, rice, peanut butter, frozen meals, etc.)
  • Lack of structure in the day and working from home can lead to more time for thinking about food and eating patterns
  • Less communication with friends and family members could lead to greater social isolation and feelings of wanting to relapse

As I have presented above, there are unique challenges the pandemic will pose on this part of the population. With that being said, I want to pose useful tips from the University of Michigan Department of Psychiatry for managing eating disorders during these trying times. Even if you have not been diagnosed with any sort of mental health condition or an eating disorder, it’s likely that COVID-19 has caused some disruption in the life of someone you know and may coincide with their recovery. 

  • Remain connected to your providers.
    • Most providers are offering telehealth via phone or video so that you can continue to receive treatment
  • Create a schedule for regular meals and snacks.
    • Enlist your providers, virtual support communities, or family and friends to help you stick to your schedule
    • Given current challenges around the pandemic, you may need to alter your typical diet to consume food that you would otherwise not be comfortable with. This may cause some anxiety and it is okay to acknowledge that.
  • Connect with a support system virtually.
    • Use Zoom, FaceTime, or Skype to stay connected to friends and family
    • Or, implement a system to connect with others after eating
    • Virtual communities can also be a great resource

Whether you are an ally to people in recovery or have experienced an eating disorder yourself, reading articles like this one, and caring for your loved ones can be emotionally draining. Focusing on your self-care is as important as ever right now during times of social isolation, and remember to set boundaries on caring for others and take breaks when you need them.

For anyone seeking eating disorder support and resources, I have created a list of support groups, services and information below. For more in-depth information for allies and people looking to learn more about eating disorders, I have provided resources for you as well. Please feel free to share these resources to help protect people struggling with eating disorders during COVID-19 and beyond.

Direct Care, Hotlines, and Support Groups

National Suicide Prevention Lifeline: 24/7, confidential, and free

  • Call 1-800-273-8255 for distress, prevention and crisis resources for you or your loved ones, and best practices for professionals or online chat here 

National Eating Disorders Association (NEDA) Helpline: free, confidential; M-R 11am-9pm EST & F 11am-5pm EST

  • Call 1-800-931-2237 for support, resources, and treatment options for yourself or a loved one or access live online chat here

National Association of Anorexia Nervosa and Associated Disorders Helpline: free, confidential; 9am-5pm CST

  • Call 630-577-1330 to access the ANAD Eating Disorders Helpline

National Eating Disorders Association (NEDA) Support Groups:

  • Click the NEDA website here to find support groups, online forums, virtual support groups, recovery mentors, and peer support for eating disorders

Mental Health America:

  • Free online screening tools for mental health conditions here
  • General resource list for COVID-19 and mental health here
  • For Virginia constituents:
    • The Mental Health America of Virginia Warm Line is available at 1-866-400-MHAV (6428) for mental health resources and referrals in Virginia

Crisis Text Line: 24/7, confidential, and free

  • Free texting service that can be accessed by texting HOME to 741741 for free, 24/7 crisis counseling

Eating Disorder Hope Therapists Directory:

  • List from Eating Disorder Hope of therapists specializing in eating disorders, registered dietitians, eating disorder psychiatrists, and specialized physicians, organized by state that can be accessed here

Center for Discovery Leading Eating Disorder Treatment:

  • 3 locations in Virginia that can be found here

The Alliance for Eating Disorders Awareness: available during standard business hours

The Recovery Village:

  • Call 352-771-2700 if you are experiencing an eating disorder in addition to a substance use disorder, to learn more about treatment for substance use and co-occurring disorders

Recovery Record App:

  • iPhone or Android app is your smart companion for eating disorder recovery. Recovery Record will help you to stay motivated, remain connected, and achieve your recovery goals – download here

Dominion Hospital Eating Disorder Treatment in Virginia:

  • HCA Virginia Health System eating disorder treatment locations can be found here or you can call the Intake Coordinator at 703-538-2886.

Half of Us:

  • Text START to 741-741 or call (800) 273-TALK (8255) to get support for your emotional health, including body image issues and eating disorders 
  • More resources can be found here

Health Brigade

  • Virginia’s oldest free clinic located in Richmond with medical, mental health, community outreach, and care coordination services for low-income and uninsured persons
  • Call 804-358-6343 to speak to the medical clinic and check your eligibility to access services here

Men To Heal:

  • An initiative that encourages men to pay more attention to their overall wellness, mental and physical health, to communicate effectively and increase their knowledge of self, especially African American men who face additional stigma
  • The founder, James Harris, hosts quarterly sessions within the local community in Virginia or virtually in other states through The Healing Hub

Black Emotional and Mental Health (BEAM) Collective:

  • Dedicated to the healing, wellness, and liberation of Black and marginalized communities, with a Black Virtual Therapist Directory tool here

Trans Lifeline Peer Support Hotline: 24/7, confidential, and free

  • Call 877-565-8860 to speak with an operator who identifies as trans or gender non-conforming/questioning
  • More information on the Trans Lifeline and its services are available here

Therepeasy:

  • Help get matched to an online mental health provider here
  • Totally free, accessible, and instant matching with a therapist

American Psychological Association Help Center:

  • List of national and statewide hotlines for support here
  • Search tool to find a psychologist near you for longer-term help here

Additional Resources for People in Recovery

Useful Articles, Links, and Resources for Family & Friends of People in Recovery

Anna Marston, Intern

Mental Health America of Virginia

anna.marston@mhav.org