Eating Disorder Recovery during COVID-19

The collective trauma of the COVID-19 pandemic is far-reaching and difficult to quantify.  In recent months, many have experienced disruptions to daily life, work-life balance, access to healthcare, and access to many necessities.  A great many individuals are struggling from the direct effects of the COVID-19 as well as the psychological effects of social distancing (Brooks et al., 2020; Williams et al., 2020).  Individuals with pre-existing mental health challenges may be especially vulnerable to the effects of social distancing (e.g., loneliness, depressed mood, increased use of social media, anxiety/intrusive thoughts, dysregulated sleep patterns, and dysregulated eating patterns).  The collective toll on mental health as we cope with the COVID-19 pandemic could lead to “a historic wave of mental-health problems” (Wan, 2020, para 2).

The perfect storm for eating disorder patients

Individuals with eating disorders may face significant and unique challenges during this time.  In keeping with public health guidelines, families are encouraged to limit trips to the grocery store to once a week.  People may buy in bulk or have a greater quantity of food at home to limit more frequent trips to the grocery store.  For a person in recovery, having access to a lot of food at once can trigger thoughts of bingeing.  On top of increased access to food, being home with food all day can bring an unwanted or unhelpful amount of attention to food.  For many, meals may be one of few touchstones during the day to provide structure, as many forms of habits/schedule have been upended by the pandemic.  During this time of uncertainty, a need to feel in control could trigger cravings or an urge to return to disordered eating.

In addition to these stressors, individuals who are responsible for grocery shopping may have encountered food shortages or lack of access to certain products.  Seeing empty shelves or being unable to place orders for groceries online can be triggering and can lead to scarcity mindset (a belief that you will “run out of food”).  Vulnerable patients will switch to panic-buying if they believe food resources are scarce.  In addition, the human body naturally craves sugar and fat during times of stress, either as a way to keep energy levels high to escape stress or to counteract the effects of stress hormones.  Many individuals, with or without eating disorders, turn to food for comfort during times of stress and uncertainty.  These cravings for sugar and fat can promote binge cycles.  In many ways, the current pandemic represents a “perfect storm” for individuals with disordered eating, in terms of the scarcity mindset, excess food in the home, and the stress-triggered cravings.  

Implementing simple gestures can be the solution to disorder eating

To counteract this “perfect storm,” a balance of structure and flexibility is needed.  Structure could entail list-making and written meal plans (to stave off impulse purchases at the store).  A written grocery list, made a day or two in advance, can provide grounding while shopping.  It can also help with feelings of guilt if you find yourself buying “the last” of an item available at the store.  This list can also include coping statements or “reframes”: “It is not your responsibility to feel guilty about any shortages.  You are allowed to buy what you need for your recovery and your family.” Alternatively, perhaps this is a time to ask someone else to help with the shopping if it is too overwhelming.  Flexibility is also needed in case certain foods are not available.  For some, cooking and meal prep can be helpful to prevent emotional eating.  Many individuals struggle with choosing “what to eat” in a time of emotion, and having ready-made containers can help you to move forward with the meal. 

Family can be a great deal of help to a loved one

Another unique source of stress for individuals in recovery could be moving home to their families or spending more time at home with family.  Family members can represent sources of support, accountability, and encouragement in the recovery process; however, family involvement in recovery can also be challenging and lead to feelings of loss of control and being monitored.  When possible, flexibility and validation should be cornerstones of family dialogue about eating/food.  Some find comfort in the routine of their established meal plan, which may be difficult with all family members eating together or having different schedules.  A first step can be an open and validating conversation about what could be helpful at mealtimes for the individual in recovery.  This conversation, ideally, should take place privately, with everyone having the time/space to lean into the moment of the conversation. For in the individual in recovery, being able to speak up and assert wishes/desire (without demanding) shows flexibility and understanding; for example “I understand that you are very busy and need to get back to work, but I would prefer to not feel rushed to finish my plate.”  Having your needs met by family members can be very stabilizing.  If you are struggling through a meal, having someone there to distract you or help through a coping skill can validate the difficulty that meals can present.  If you are in recovery, take some time to check in with yourself and voice your needs (for a hug, for the opportunity to vent, or for encouragement).  Beyond validating and having an open dialogue about stresses, limiting body talk and comments about dieting/nutrition/exercise during meals could be helpful.  

Finally, and most importantly, reach out for help if you need it.  Many individuals have experienced a relapse in symptoms or urges during this difficult time.  Recovery is always possible, and reaching out for new support or extra support is the first step toward freedom and hope.  Telehealth access to treatment is improving, free resources are available on line, a treatment center is only a click away to get help!