Eating disorders and the pandemic

By Amanda Turco, Therapist

As I reflect on the past year and the clients that have come to work with me, I can’t help but notice a trend. “When did you start noticing this become a problem?” I ask. “During the pandemic” is the most frequent answer. The pandemic has caused all types of mental illness and emotional distress to increase. COVID-19 brought a whole year of uncertainty, anxiety, and confusion about the world and our future. A shut down that was supposed to last for two weeks continued for over a year. We were forced to adapt to a stay-at-home order and stripped away of all routine and normalcy. Schools shut down and the world of zoom began. Hours confined to our rooms or home office forced to see our friends, and ourselves, through a tiny little box on the computer. Sports and clubs cancelled. The social connection that we depend on and find joy in were limited. Loneliness and boredom set in. This loss of control can feel extreme.

It’s not just anecdotal that eating disorders increased during the last year and a half with the pandemic. The National Eating Disorders Association reported increases as high as 70-80% in calls to the helpline throughout the last year. In addition, the International Journal of Eating Disorders published a survey of people who had already been diagnosed with anorexia showing that many were experiencing worsening symptoms. When looking at binge eating, just under ⅓ reported an increase in episodes. 

The pandemic created a perfect scenario for eating disorders to thrive. A loss of routine and stability, isolation, disruption to our entire lives, more time on social media, and general distress are all perfect storms for an eating disorder to grow and for people to lose connection to their values and worth. Compared to the average person, people with eating disorders predominantly base their self worth on body shape, weight, and control of food. In treatment, we work on helping clients find other areas and avenues to find self worth; to re-allocate some of the emphasis they have had on their body and food. We often find this through friendships, school, extracurricular activities, community engagement, etc. But when faced with a pandemic, many of these other things were completely stripped away, leaving people with immense external stress from a constant and uncontrollable stressor (the pandemic), and less avenues for external support. This left space for the focus to become (or return to) the eating disorder behaviors. 

“ I am not doing anything right now, I should be dieting and exercising…”  Research shows that dieting increases your likelihood to have an eating disorder at some point in your life. The National Eating Disorders Association reports that 35% of “normal dieters” progress to pathological dieting and that 20-25% of those individuals develop eating disorders. This is because eating disorders grow and develop from societally deemed “normal” behavior. What begins as seemingly small changes quickly leads to a mindset consumed by eating disorder thoughts. During the pandemic, we spent more time on social media than ever, allowing these images and perceived perfect lives of others on Instagram and TikTok to inaccurately form a baseline of social comparison. Additionally, body checking – constantly looking in the mirror or body checking and focusing on “flaws” – keeps body image and control of shape and weight at the forefront of our minds. 

Initially, it might have felt “good.” Strict dieting, restriction, and exercise start to become adaptive as it initially improves mood, provides a distraction, and reinforcement as the body shrinks and the number on the scale gets smaller. For others, emotional or binge eating could become the primary way to cope with uncertainty and distress as it leads to emotional numbing. The immediate consequence is that it feels good, initially, releasing dopamine, some of the ONLY release that is simple to find in a state of global shut-down. But quickly, the eating disorder behaviors become habitual and lead to the long term, often negative consequences. A deep obsession with food/the body/and all things related becomes the primary focus of an eating disorder brain. And without anything to balance or challenge this, it can become even harder to shift out of this mindset and take control of these thoughts and behaviors. This is why we always encourage people to reach out for help as soon as they notice the voice or behaviors picking back up (or beginning)! The sooner you work on it, the sooner you can move toward a recovery mindset again. 

So, for a variety of reasons, the pandemic was a prime growing ground for eating disorders. This is not a small thing. Eating disorders have the second-highest mortality rate of any psychiatric diagnosis and they require therapists and treatment providers who specialize and understand this particular illness. It is critically important that those who are suffering reach out and receive appropriate care. As restrictions start to loosen and we are working towards a new normal, I see a glimmer of hope. We have more opportunities to set goals in these areas and establish old routines that previously made us happy. Eating disorders are very treatable, and relapses don’t have to last as long, but you DO need and deserve support in order to get back to a healthy baseline. Remember, you are more than your body and your thoughts are not facts. You can and will find yourself again.