5 Things We Need to Know About Eating Disorders During COVID-19
These are unprecedented times for all of us. While COVID-19 has shown us glimpses of the best that we are capable of with tremendous stories of generosity and courage, it has also brought so many of our most inequitable social structures to the foreground. This virus hits us all in different ways, but as with many of the most destructive forces in our society, it is hitting some harder than others.
For one, this has been a particularly trying time for those without access to homes in which to social distance. Social distancing is not only the best safety mechanism we have at our disposal, but is also a privilege reserved for those financially able to afford a safe place to #StayHome in.
It has been a dangerous time for those who experience abuse or violence at home, as seen all over the world and evidenced in our own hometown of Kingston, Ontario, where our Sexual Assault Centre has seen an unprecedented 40% increase in crisis calls since COVID-19 restrictions were put in place.
And, though seldom spoken about, this is a similarly difficult and dangerous time for those with disordered eating.
We live in a world where disordered eating is rampant but where its causes or stressors go unnoticed or unaddressed.
We talk about “clean eating” and “dieting” to “look good” under the guise of health, often without realizing that the underlying forces at play might simply be a toxic relationship with food and a broken relationship with our bodies.
We don’t talk about it, and if we do, it’s without ease or comfort. This is not to say that things like eating disorders are going to ever be “easy” to talk about, but we aren’t putting the same effort into becoming more literate and vulnerable within this space as we are within the realms of mental health, sexual violence, or gender diversity. Even though eating disorders themselves are a form of mental illness, they are repeatedly left out of the broader mental health discourse.
So, let’s try to begin that discussion today, and let’s place it within the context of a worldwide pandemic that exacerbates several of the evil powers eating disorders have at their disposal.
What is an eating disorder?
Whether or not we realize it, many of us have a complicated relationship with food. We call ourselves “bad” when we have two slices of cake, talk about “eating healthier” when we mean reducing our caloric intake, and rationalize eating an extra slice of pizza as long as we know we are hitting the gym later on.
That said, just because someone may have a complicated relationship with food that ought to be unpacked, that doesn’t necessarily mean they have an undiagnosed eating disorder.
When it comes to eating disorders, there are a few key defining features, but it’s important at the outset to know that they exist in the lives of folks of every gender and race, of every body size and of every age, and can vary greatly in how they manifest in people’s lives.
When you hear “eating disorder”, it’s important that you don’t hear “dangerously skinny person who does not eat.” This reductionist conceptualization of disordered eating can be extremely harmful, and while some do struggle with restrictive symptoms, others are suffering very differently. Eating disorders don’t look any particular way and they don’t discriminate.
Anorexia Nervosa, Bulimia Nervosa, Avoidant & Restrictive Food Intake Disorder, Otherwise Specified Feeding & Eating Disorder, and Binge Eating Disorder all have particular presentations but share many symptoms and baseline characteristics. Quite often, someone will be battling multiple eating disorders at once, or their disorder is a blend of multiple illnesses rather than fitting neatly into one category even if they have a singular diagnosis.
Generally speaking, an eating disorder diagnosis will mean that someone has an obsessive, neurotic relationship with food and its relationship to their body. Eating disorders will typically be characterized by one or many particularly problematic behaviours, such as restricting food (limiting or ceasing the intake of food, or of particular foods), binging (a rapid and intense episode of over-eating), purging (any compensatory behaviour, such as intentional regurgitation or the targeted use of laxatives/exercise to evacuate or ‘work off’ food), and/or an obsession with “clean eating” and exercise (often associated with the term “orthorexia”).
Beyond merely being anxious about food or having a mild-to-moderate pre-occupation with managing one’s weight, disordered eating is a life-threatening form of illness that is obsessive and difficult to shake. According to Canada’s National Eating Disorder Information Centre, Anorexia Nervosa (AN) has the highest mortality rate of any psychiatric illness, with 10% on average dying within the first 10 years of the disorder’s onset. For women aged 15-24, the mortality rate associated with AN is 12 times higher than all other causes of death combined. It is estimated that approximately 1 million Canadians are currently suffering from an eating disorder.
Our collective ignorance when talking about things like food, body image, and exercise makes recovery for those who are struggling that much more elusive. Where we have become much more considerate when it comes to our language within conversations pertaining to things like depression, sexual assault, disability, racism, and beyond, we still talk about “losing the holiday weight”, “working off croissants at the gym”, and “starving myself for a week before the wedding” without a second thought about how triggering this can be for someone fighting for their lives.
Seeing as eating disorders exist in the lives of folks that we may never have imagined are struggling, being “selective” when making comments about these things simply will not do. Instead, we must get into the habit of being mindful of these issues at all times as we work to grow out of these harmful conversational habits.
Building out empathy necessitates that we first build out our awareness. It requires us to hold up a mirror, for ourselves and for each other, such that we are able to identify and minimize the ways our words and behaviours negatively impact other people.
Having established some of the basics of what eating disorders are, this piece will hopefully serve as a mirror for us all as we work to empathize with and support those living with disordered eating right now, especially when taking into consideration what it feels like for many during the isolation of the COVID-19 pandemic.
How do COVID-19 and isolation impact an eating disorder?
No one has it easy during a pandemic like this, but that doesn’t mean that those suffering in different ways can or should not make space for and empathize with the deeply unsettling and dire nature of COVID-19 for those with disordered eating.
This list cannot possibly claim to be exhaustive, but provides a starting point to understand what some of these specific issues are.
1. A loss of routine and control
We are experiencing less collective agency right now as folks are being asked to stay home, or are essential workers and are on the front lines keeping us afloat, and we feel varying levels of distress as a result. For those with eating disorders, it means the disruption of a routine, which often serves as a lifeline and integral coping mechanism. Together, all of it might feel like losing control, and for many with disordered eating, control is everything.
In many instances of disordered eating, food is used as a means of coping with stress, anxiety, or trauma, and in times such as these where these stressors are likely to be elevated, it becomes dangerous for some to be surrounded by food constantly while staying home. This can lead to overeating, and a subsequent overreaction to overeating, creating a cyclical trap that becomes extremely difficult to break out of.
By now, the existence of a routine in one’s life, including and beyond food, has either been uprooted or the routine has fundamentally changed shape. With routines often serving as a means of survival for those with disordered eating, this change hits harder than it may for others. With this coping mechanism being taken away, things can become tougher and tougher to manage.
Those with disordered eating stand to benefit from patience, logistical support, and encouragement as they work to establish a new routine that supports their recovery and keeps them nourished.
2. Lack of access to safe foods
As we endeavour to diligently maintain social distancing guidelines, it is no secret that grocery shopping is less accessible than it was even a few months ago. In most cases, we have less access to fresh fruits and vegetables that most often will serve as “safe foods” — foods that feel less dangerous, and thus are more accessible for those with eating disorders to consume. On days of low resilience and particularly low self-esteem, limited or non-existent access to safe foods can feel insurmountable.
On the flip side, carbs like pasta, grains, and rice will often exist as “trigger foods” — foods that become directly associated with self-loathing, issues with body image, and mental exhaustion for those with eating disorders. Unfortunately, these are all foods we are relying on right now more than ever.
Now, it’s important to note that these foods aren’t “bad” foods. Food is sustenance and these foods do their part to fuel our bodies. It’s important to try and achieve as much nutritional balance as possible, but often we end up vilifying some parts of that balance while deifying others.
Regardless of how we ought to talk about and see these foods, many with eating disorders are having a particularly hard time right now eating them day after day.
The scarcity of access to safe foods and the prevalence of contact with trigger foods can make life especially taxing for those with disordered eating. It is true that a lack of variety and of fresh and “healthy” food options will have consequences for those without an eating disorder, but those with eating disorders are navigating these treacherous waters having lost their life vests while those around them seem to float on life rafts. It’s important that we make space for this struggle and work to keep each other above water as we wait this out.
3. A shift of focus onto exercising and fitness
It has been wonderful to see so many using this period of isolation to refocus and re-establish habits to include fitness and exercise. Folks are being mindful that our bodies need movement and activity to flourish, and with so much time being spent at home, the streets and sidewalks seem to be populated almost exclusively by individuals, couples, and families going for walks, runs, or rides.
Similarly, for those who’ve taken to perusing through Instagram stories even more than usual, just as one example, they’ve likely noticed a spike in the amount of content being shared that showcases innovative workouts and exercises that are being done from home. Without access to organized sports, daily walks to and from work or school, and an inability to get together with friends, many have taken it upon themselves to look after their health and well-being via independent physical stimulation and exercise.
While this should not be a movement that is vilified in any way, as it has a wide range of potential benefits, it’s important to understand what this will mean for many with disordered eating. When someone has an eating disorder, they are almost certainly going to be navigating the toxic triangular relationship between food, exercise, and body.
The pressure to exercise that someone without an eating disorder feels after watching someone else working out, which is a common feeling that many share, is often going to be sufficiently outpaced by the neurotic and incessant guilt someone with an eating disorder will feel in the same situation. For that person, it might result in dangerously over-working their body or using food (restricting, binging, or purging) to compensate in extreme and unsafe ways.
It’s of the utmost importance that we internally understand that exercise is a positive thing when it exists to facilitate good health and vitality. When we aren’t intentional about maintaining this internal framing, and when it becomes a conversation about “looking good”, equating being healthy with being thin, or toning our bodies to reach a surface-level, often unattainable ideal of physique, it can become toxic to ourselves and dangerous for others, especially when disordered eating is involved.
4. Sitting around and being sedentary leading to over-compensation
Our world is changing. Our days, our jobs, and our lives look different right now. Our routines have morphed and our structures have altered. Why, then, wouldn’t we expect our bodies to change, too?
There is a collective fear right now, often disguised in memes or jokes, that folks are and will continue to gain weight over the course of the pandemic and end up with an undesirable “Corona-bod.” There are so many negative emotions associated with weight gain and fatness in our society, and as a result, our sedentary, stationary lives are under the microscope.
For folks with eating disorders, this conversation is part of what leads to the ultimate, daily, toxic calculation:
Less activity needs to mean less food; more activity unlocks the ability to eat more food.
We are at war with our bodies and we are waging it on social media, in group chats with our friends, and in our minds at the dinner table. The scariest part is we barely recognize the war is even happening to begin with; our world has conditioned us to see the hatred and fear of fatness as normal and right.
For folks with disordered eating, this war is heightened and the stakes are even higher. Where over-compensation and ideals of beauty are the soldiers, we must understand that our war is only won when we reach the deep understanding that our bodies will always look after us.
When we’re hungry, our bodies are telling us to eat. When we’re full, our bodies are telling us they’re good to go. Our bodies give us permission to listen to intuition and ask us to trust that they will send us the necessary signals to adjust our behvaviour when and if necessary.
A good starting point to building empathy in this area would be to read more about set-point theory, as it explains how and why dieting is counter-productive when looking to establish long-term health, and shows us the critical path needed to reconnect, in love, with our bodies.
5. Inability to escape psychological triggers at home
That there exists a strong connection between trauma, PTSD, and eating disorders is evidenced in multiple studies and beyond dispute. This is not to say that all eating disorders are caused by trauma, nor to imply that trauma exists as a singular cause of disordered eating. Rather, the causal relationship between trauma and eating disorders is well-established, and parsing this relationship out is a productive and illuminating exercise.
Restricting, binging, and/or purging food becomes a coping mechanism that pushes trauma and its source memory out of the conscious mind and attempts to take over the brain in order to keep the trauma locked away.
There are even times when one in recovery will speak with an affinity for and mourn the loss of their disorder. This might feel quite perplexing until it is placed in the context of protecting oneself from trauma and pain. An eating disorder causes and exists as its own trauma, but so often, it is borne out of trauma itself as a means of “protecting” the brain. Recovery, then, often means peeling back the layers and facing trauma head-on by removing the coping mechanism of disordered eating.
Seeing as many eating disorders involve a relationship with trauma, and seeing as trauma can often be experienced within the context of familial or intimate partner relationships at home, being isolated in close physical proximity to one’s source of trauma can lead to an increase in disordered eating behaviour during this pandemic.
Sexual violence and domestic abuse are occurring with increased frequency during this pandemic, but victims and survivors are often without accessible escape routes from those sources of trauma.
For victims and survivors of sexual violence and abuse in their homes, and for those who’ve experienced past trauma at the hands of someone in their home, the use of disordered eating as a dangerous coping mechanism is exacerbated and relied upon more heavily. As the pressure applied by trauma increases, so too does the reliance on the symptoms of an eating disorder being used to cope.
If you or someone you know is struggling with violence or abuse at home, you are encouraged to look into support being offered by Unsafe At Home.