One year ago, the World Health Organization declared COVID-19 a global pandemic and with it came government lockdowns, social distancing, and an upheaval of life as we knew it. The early weeks of the pandemic triggered anxiety and uncertainty among many, prompting questions about how the pandemic may impact various aspects of mental health, including difficulties surrounding eating. Now, one year later, what does research tell us about the impact of the COVID-19 pandemic on individuals with eating disorders?
Research suggests that COVID-19 has had varied effects on individuals’ self-reported eating disorder symptoms. For example, some reports indicate that people with eating disorders experienced a worsening of symptoms during the pandemic, with one study showing that 83% of participants with a range of self-reported eating disorder diagnoses experienced an increase in related symptoms and an online-based survey of adolescents and adults with anorexia nervosa found 41.5% percent of individuals reporting a worsening of symptoms. A study surveying the early impact of COVID-19 found that some symptom changes might be specific to disorder type — those with anorexia nervosa increased the restrictiveness of their eating, while those with bulimia nervosa and binge-eating disorder reported an increased frequency of binge eating.
While many people reported an increase in the frequency and intensity of eating disorder-related thoughts during the pandemic, there was some good news: the emergence of new symptoms was uncommon and the majority of individuals actually maintained their weight. Also, some research indicates that the pandemic had actually led to positive changes in the lives of individuals with eating disorders. Positive changes include a decrease in eating disorder symptoms due to more daily structure, increased social support at home, and improved coping skills in the face of persistent adversity. Another positive common theme found across individuals was that the pandemic strengthened their motivation to recover, with some experiencing it as a wake-up call.
So what might explain these differences? Why does there appear to be a worsening of eating disorder symptoms in response to the pandemic in some individuals, but not others?
The factors identified as having negatively impacted eating disorder symptoms the most include:
- changes to routine
- changes in physical activity
- difficulty coping with emotions such as fear and uncertainty
- significant increases in social isolation
- decreased satisfaction with social relationships and support
- increased difficulty accessing in-person treatment
Notably, neither how long an individual had been ill (i.e., duration of illness) nor type of treatment were predictive of outcome.
Four Effective Coping Strategies
Those who experienced positive responses to the pandemic reported engaging in a wide range of coping strategies that were effective and directly challenged some of the previously mentioned risk factors for worsening symptoms. These strategies are worth considering if you are experiencing increased difficulty with eating disorder-related thoughts and behaviors:
- Daily Structure: a predictable schedule and routine can be instrumental in maintaining mental health. Planning out your day the night before with tasks that need to be completed the following day can help boost productivity and feelings of accomplishment, though it’s also important to pencil in time for self-care habits to prevent feelings of burnout.
- Yoga: yoga has been shown to not only improve balance and flexibility, but also levels of stress and anxiety. Practicing yoga can range from a 3-minute breathing exercise to a longer, gentle yoga flow practice focused on flexibility depending on your goals.
- Mild Physical Exercise: mild physical activity can help reduce stress and improve mood. Short walks outside, for example, while mindfully focusing on nature and other elements of the environment, can help ease physical and mental tension. A walk can also be a good activity to plan with a friend, making it a great way to maintain your social connections during these difficult times, and to make sure that the activity level does not become inappropriate for your particular recovery needs.
- Maintaining Social Contact: reaching out to friends, family, and colleagues for support in times of stress is critical. While our casual daily interactions with friends have been significantly reduced due to COVID, connecting virtually with friends and family has become easier than ever with video platforms. Try scheduling a weekly get-together with friends at the end of the work week to check in and have some shared wind-down time.
Treatment During the Pandemic
As with all aspects of our lives in the past year, the treatment landscape changed as well. Access to in-person care declined, but with this came an associated increase in virtual therapy, with one survey indicating that 26% of respondents with anorexia nervosa utilized video conference therapy during the pandemic. A separate online survey, which included individuals with anorexia nervosa, bulimia nervosa, binge eating disorder, purging disorder, avoidant/restrictive food intake disorder, as well as other specified eating disorders, found that 45% of their U.S. sample had transitioned to telehealth services. Despite this change, only one in five patients indicated that their treatment was strongly impacted by the pandemic. Treatment outcomes research supports these findings, indicating that it was the quality of therapeutic relationships that predicted the improvement of symptoms, rather than treatment modality or delivery.
Overall, research has found that the COVID-19 pandemic has posed not just a physical threat, but a psychological one as well, especially for people vulnerable to eating disorders. The good news: even in these trying times, there are several strategies that have been found to help minimize – and in some cases, even improve – eating disorder symptoms.
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