As if eating disorders themselves weren’t hard enough to manage, patients have been handed a whole new challenge in the form of a pandemic requiring social distancing. The COVID-19 pandemic is changing our entire way of living. For those with eating disorders and disordered eating, it creates new stressors and disruptions to treatment plans.
How Treatment May Be Affected During This Time
Because of the risk of contagion, it appears that all but a few providers of the lower levels of care—individual outpatient, intensive outpatient, and partial hospitalization programs—are moving to virtual treatment models, meaning that patients have video sessions from home. Some of these programs usually provide up to 11 hours per day of programming along with meals. Patients in such programs will now be living at home and have greater responsibility for their own meals.
At higher levels of care, most residential treatment centers and medical hospitalization units for eating disorder patients are still operating but might be reducing the number of admissions to prevent the potential transmission of the virus.
Preliminary reports suggest that the criteria for admission are becoming more stringent in the face of COVID-19. Thus, it may become harder for people with eating disorders to access these levels of care, with only those with significant medical complications being able to obtain residential and inpatient treatment.
With in-person sessions restricted or no longer available due to appropriate social distancing, a major concern for many is whether insurance companies will cover comparable coverage for telehealth. While many states and companies have announced telehealth coverage for behavioral health services, this does not fully answer the question.
Many patients may still have employer plans that do not cover telehealth—it is not clear when or whether these policies will be amended. The speed at which this transition has occurred means that it is taking time for programs and providers to adapt. There may be temporary disruptions in treatment.
The COVID-19 crisis is a time of heightened stress for everyone, with a lot of unknowns. Routines are disrupted. People with busy lives are now stuck at home with much less to do. The loss of structure can be challenging.
Social distancing is necessary to help prevent the rapid spread of COVID-19, but it also comes with added difficulties. It separates many people from the supports on which they rely; in other cases it may confine them at home in a relatively small space, sometimes with people with whom they may have had conflict. People are also restricted from activities which they may have successfully used to cope: exercise, support groups, and treatment providers.
While most people have difficulty with extended periods of uncertainty, for people with eating disorders, who tend to be more rigid and can have trouble with flexibility, the difficulty is greater. During times of stress, people automatically tend to revert to their past coping strategies. For those with eating disorders, these often include eating disorder behaviors.
For a person with an eating disorder, grocery shopping can already be an overwhelming experience. Add the long lines and frenzied behavior of “stocking up”, and it becomes even more fraught.
Food shortages in the supermarket can bring up a lot of anxiety for people who have experienced food deprivation in the form of dieting. They may trigger an urge to binge or hoard food.
People who can only comfortably eat a narrow range of foods may face anxiety if they can’t find their preferred foods or subsist solely on low energy fresh foods for long periods of quarantine. They may have to tackle their fear of higher-calorie, energy-dense, shelf-stable foods such as rice and pasta to get through this. Conversely, large stockpiles of energy-dense food at home can increase anxiety and be a trigger for binge eating.
Strategies for Coping
Accept your feelings and know that you are not alone—Remember that it’s okay to feel overwhelmed and unmoored. We all feel this way. This is an unprecedented time that none of us have dealt with before.
Allow space to mourn your losses—Whether you are a high school senior whose prom has been canceled, a college student whose senior spring semester and graduation activities have been canceled, a parent who will not see your child graduate, a person who has lost a job, or a spouse whose partner is a healthcare worker treating people with the illness, we are all facing enormous losses right now. Allow yourself space to grieve and experience the whole range of emotions that ensue.
Ask for help—If you’ve been putting off getting help for your eating disorder or are experiencing increased anxiety, now is a good time to reach out. There are numerous therapists, dietitians and treatment centers providing services through telehealth. In addition, many treatment centers have added virtual support groups and many providers are offering meal support via Facebook live or Instagram live.
Recognize that online therapy works—If viewing your therapist, doctor, or dietitian over the computer is new to you, recognize that there is a long and good history of treatment being provided this way. The first video telepsychiatry link occurred in 1997. Research indicates that telehealth is appropriate for many populations and can be as effective as sessions delivered in person. It may just take a little adjustment.
Eating disorders thrive in isolation, so stay connected to your support system. Now more than ever, we need our supports. Even though we’re social distancing, we are social beings who need connection. Use the internet to connect with family, friends, and people in your professional life. Don’t just text but do facetime and video chats. Have a video meal with a friend. Many people are having online cocktail parties, Netflix watch parties, and the like.
Create a Routine
Most people do better with structure. Create a routine that involves getting up, getting dressed, and doing something every day that feels productive. Your new routine should include your mealtimes—this is very important for everyone, but also people with either current or past disordered eating behaviors.
Find activities that bring you joy or develop a skill. Engaging in such activities is a way to prevent depression.
Try to incorporate as many activities of your “former” life into your shelter in place life. If there was something you were doing before, see if you can find an online equivalent. There is an incredible and increasing number of online activities in which you can participate from home, including Broadway shows, new movies, museum tours, classes, and so on.
Plan Your Meals
An eating disorder recovery plan includes 3 meals a day and 2 to 3 snacks evenly spaced throughout the day. You should always have a general idea of what and when your next meal or snack will be. This applies to everyone, but especially those struggling with disordered eating behaviors.
Having a structure and a plan to prevent grazing will help you to regulate your hunger and satiety cues, reduce binge eating, avoid undereating, and manage your food supply on the sparsest number of shopping trips. Make sure to plan meals that are satisfying physically and emotionally.
Depriving yourself of adequate nutrition and enjoyable foods is not going to keep you safe from a virus. On the other hand, staying emotionally satisfied and nourished will help stabilize your blood sugar levels, mood, and emotional coping.
Face Your Fear foods
The foods you will need during the pandemic may be the very foods you fear and have avoided. Those sustaining shelf-stable foods like pasta and rice, potatoes, bread, crackers, and chips are easiest to stock up on and keep for a long time. Canned and frozen foods and processed foods are all fine.
Foods like pizza and macaroni and cheese and baked goods are comforting and provide needed energy. Now is the time to face them and start incorporating them. Just plan them into your regular meals and snacks. All food is good.
It’s not surprising that you are feeling overwhelmed and soothed yourself with food. Accept that eating to self-soothe can be a wise way to cope. But, if it’s your only coping skill, it can be helpful to learn to utilize some other coping skills too. Try to resist urges to compensate.
If you eat something you didn’t plan to, accept that it happened and move on. You are not a failure! Don’t perpetuate the cycle by restricting; instead get back on track with your next scheduled meal.
Consider Moderate Exercise
This is where it gets personal. If exercise was a part of your eating disorder this may be a perfect time for a planned break. Take it! You are not required to exercise. If you are far enough along in recovery and your team has said it is okay to reintroduce exercise or exercise has not been a part of your eating disorder, then you may continue with some moderate exercise as you wish.
Although you may be separated from your gym, it is still safe to walk or run outside, hike away from crowds, and do an online workout. Try to keep it fun. But please monitor this and make sure it does not become excessive or compulsive.
Addressing Body Image
Time at home may provide a temporary respite for those who feared being judged about their appearance. You may want to just hang out in your pajamas all day and not get dressed. That’s okay. But if you find that it makes you feel worse about your body, then consider getting dressed and primped as you would normally. Limit body checking.
Challenge Diet Culture
Do not make jokes about how much weight you are going to gain during social distancing. This is fat-phobic, adds unnecessarily to people’s worries, and honestly should be the least of our collective concerns at this time. Weight stigma is a health risk factor that doesn’t need to be added to the pile.
We must work together to make the world a safer place for all bodies. Your body weight is not something that you can control—attempting to do so only backfires. Work on intuitive eating which relieves you from weight fluctuations.
If you are a parent and your teen or young adult has come home from treatment or has moved home with you, you can play an important role. Parent-assisted treatments such as Family-Based Treatment can be effective.
Take Extra Precautions
People with eating disorders may be at increased risk from the virus so please take extra precautions to protect yourself or those people with eating disorders in your life.
Practice or Learn New Coping Skills
Try to get regular sleep. Try to get some time outdoors when you can. Do some meditation or relaxation. Take time to rest. Be patient with yourself. Having a toolkit of healthy coping skills can help you better manage the stress you feel.
A Word From Verywell
These are indeed challenging times. We don’t necessarily have all the answers. But we are all in this together and we will get through it.