For Many People with Eating Disorders, Quarantine Is an Unexpected Trigger
Kat Cordio had a bulimia relapse in October. By January, she was solidly back in recovery. And then coronavirus happened — followed by social distancing, self-isolation, and shelter-in-place.
Cordio, 27, is hanging in there. But it’s not easy. “Staying at home has made it increasingly difficult to manage the stress-eating and binging,” Cordio says. “It’s been torture trying to resist as much as I can in the place where it’s the easiest to happen.” At times, it feels like her apartment is a beautiful prison, she adds.
She’s not alone. According to the National Eating Disorders Association (NEDA), approximately 20 million women and 10 million men in the U.S. have a clinically significant eating disorder. And recent research shows that disordered eating, a more general term that describes unhealthy behaviors around food (think: yo-yo dieting or feeling out of control around food) is significantly more prevalent. And it’s on the rise.
So the measures being taken to fight coronavirus and COVID-19, are likely to trigger “eating issues” in a lot of people — even those who just have a “complicated relationship” with food.
“It’s hard fighting a silent internal fight in normal times, and it’s definitely even harder now,” Cordio says. Being stuck at home is a big part of the problem.
Eating disorders thrive in isolation.
While physical isolation is necessary to help prevent the spread of COVID-19, it can be disastrous for those struggling with all types of mental health issues. Eating disorders are no exception.
“Personally speaking, social distancing, self-quarantining, and other measures involved in fighting COVID-19 provide the perfect environment for my eating disorder to thrive,” explains Ruthie Friedlander, co-founder of The Chain, a support group and community for those with eating disorders who work in fashion and media.
The reasoning is simple: “Eating disorders LOVE isolation. Eating disorders LOVE anything related to rules. And so some of these very real precautions that we’re needing to take — staying away from other people, restaurants closing, people hoarding food — can also be a perfect environment to re-engage behaviors you’ve worked to overcome.”
Friedlander’s co-founder, Christina Grasso, agrees. “Personally, the anxiety of being still and having large quantities of unstructured time can open the door to an increase in disordered thoughts, behaviors, and obsessions, which can be difficult to control, especially in the absence of distractions.”
What Friedlander and Grasso describe is common among those in recovery. “Everyone with an eating disorder is having a problem right now,” says Rebecca Scritchfield, RDN and author of Body Kindness.
People with eating disorders tend to be more rigid and have trouble with flexibility, explains Lauren Muhlheim, Psy.D., founder of Eating Disorder Therapy LA. Throwing a wrench in a carefully-constructed coping routine is a virtually guaranteed trigger. “People are restricted from numerous activities which they may have successfully used to cope, including exercise, support groups, and treatment providers.”
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Cleaned-out grocery stores and closed gyms are triggers, too.
Not being able to find toilet paper is inconvenient. But for those in recovery, empty grocery aisles can set off alarm bells.
“When toilet paper and hand sanitizer appeared to be scarce, what happened?” asks Jennifer Rollin, MSW, LCSW-C, therapist and founder of The Eating Disorder Center. “Some people started hoarding and stockpiling it. The same thing happens when we tell ourselves that a certain food is ‘off limits.’” For some, perceiving food as scarce can lead to compulsive eating and/or binge eating later on, she says.
Empty grocery stores can also make people with a history of extreme dieting feel anxious. “People’s eating disorders might latch onto the idea that food is scarce, and some individuals might use this to justify restrictive eating,” Rollin points out.
Lastly, many of the foods so many are stocking their pantries and freezers with are ones that some people with eating disorders fear: processed, packaged, and frozen foods. “People who have a narrow range of foods they are able to comfortably eat might face anxiety if they can’t find their preferred foods,” Muhlheim says. “They may have to tackle their fear of higher calorie, energy dense, shelf stable foods such as rice and pasta to get through this.” On the other hand, stockpiles of pasta, rice, and other packaged foods can increase anxiety and be a trigger for binge eating.
Plus, many people in recovery use movement as an outlet for stress and anxiety. So closed gyms just magnify the need to do something with those feelings. “The movement part is tremendously challenging, at least for me,” Grasso says. “Exercise has been a huge part of my life, both before and during my eating disorder. And especially as a New Yorker, I’m rarely just chilling in my apartment all day. The guilt and anxiety associated with stillness can be intense.”
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And all those memes about “getting fat”? They’re not helping, either.
You’ve probably seen them. Or maybe you’ve seen content geared at avoiding weight gain while cooped up at home, or even people talking about how they’re worried about getting fat while lockdowns go into effect.
Ready for some truth? “Getting fat in the face of a pandemic should be the least of people’s worries,” Muhlheim says. “We should be afraid of spreading the virus. It’s okay to eat and not exercise and comfort ourselves with food.”
Fear is a natural response to what’s going on in the world right now. But instead of worrying about gaining weight, Scritchfield recommends facing anxiety head-on by creating a self-care checklist based on practices that have inherent value.
Here’s what that might look like:
Get at least 8 hours of sleep
Fill up your water bottle several times a day to stay hydrated
Eat well to support energy and immunity
Do yoga at home
Walk or run outside daily, but keep your distance
Use a meditation app
Connect with family and friends on FaceTime, WhatsApp, etc.
Do something crafty or brainy, like a puzzle, game, knitting, coloring book, or any other screen-free hobby
Dance and sing to your favorite songs, or play an instrument
Other experts in the space have similar recommendations.
“I suggest bringing activities from your ‘former’ life into your shelter-in-place life,” Muhlheim says. If you would have gone to see a play, there are about 15 Broadway musicals you can watch from home. If you would have gone to a museum, there are virtual museum tours. “People are having virtual cocktail parties, virtual game nights, and Netflix watch parties,” she adds. Streaming workout classes are also a great option if you enjoy exercise and it’s safe for you to do so, Muhlheim says. “It’s important to keep up as much of our routines and previous life as possible.”
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If you’re still struggling, you have options.
If self care isn’t enough, consider reaching out for help. Not sure if you need help? “If most of your brain space is being taken up by thoughts of food, weight, or exercise, it’s time to seek help,” Friedlander says.
For people with eating disorders in particular, asking for help can be extremely difficult. “A classic belief of eating disorders is, ‘I have no needs, and I don’t want to bother anyone,’” Scritchfield says. Bottom line: “Your needs matter and people care about you.”
Here are a few ways to reach out: If you have a therapist or treatment team, keep in touch with them virtually. “If someone is in recovery, they should maintain contact with their treatment team. Most therapists and programs are continuing virtually,” Muhlheim says.
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If you don’t currently have a therapist, consider getting one. “Many treatment centers and providers are running virtual support and therapy groups right now,” Muhlheim says. If that’s not an option right now, services like Crisis Text Line and the NEDA Helpline can provide comfort and ideas for next steps.
Connect with others with shared experience. Friedlander and Grasso encourage people to reach out to them via Instagram DM on their account @thechain, or join them on their newly-added private Discord channel. “It’s not a replacement for therapy, but peer support can be so helpful,” Grasso explains.
Above all else, Scritchfield encourages people to be honest with themselves. “You have needs, and that’s okay. You’re human, and we are all in this together.”
The coronavirus pandemic is unfolding in real time, and guidelines change by the minute. We promise to give you the latest information at time of publishing, but please refer to the CDC and WHO for updates.
