The Impact of COVID-19 on People With Eating Disorders

By Elise Tecco

Eating disorders are a mental health illness, not a choice. Furthermore, according to the National Eating Disorders Association, eating disorders have the highest mortality rate of any psychiatric illness.

Last July, a survey in the International Journal of Eating Disorders found that 62% of Americans with anorexia experienced worsened symptoms when the COVID-19 pandemic hit. And nearly one-third of people in the United States with a binge-eating disorder reported increases in their binge episodes.

While the beginning of the pandemic certainly created many challenges, the “reopening” of society is presenting its own set of problems for people with eating disorders.

The Challenges of Reentering Society
According to eating disorder specialist Kerry Heath, LPC-S, NCC, CEDS-S, both individuals and their providers are finding it a challenge to manage in-person activities, such as going back to the workplace and social gatherings or returning to school or a treatment facility.

While it may seem illogical to some, Heath says the lockdown that required people to stay at home and distance themselves from others actually escalated social anxiety for many individuals. More time spent at home led some people to gain weight, whether they turned to food to cope with the stress of the pandemic or because of lifestyle changes such as inactivity. Now that life is returning to normal, they are feeling more anxious as they face being seen by other people in public again. As Heath explains, in terms of body image, people with eating disorders typically struggle more than members of the general public.

“These clients have not had the opportunity to engage in the process of exposing themselves to their fears, which only worsens these conditions,” Heath says.

Focus on Improving Body Image
A study published in the journal Personality and Individual Differences found that adults in the United Kingdom who experienced more anxiety had an increase in body dissatisfaction during the pandemic.

“Certainly during the initial spring lockdown period, our screen time increased, meaning that we were more likely to be exposed to thin or athletic ideals through the media, while decreased physical activity may have heightened negative thoughts about weight or shape,” states Viren Swami, PhD, lead researcher on the study.

As a result, clinicians will need to focus on helping their clients improve their body image, or the way they perceive their body physically and mentally. Some people’s perception of an ideal body is “so unrealistic that no amount of time in the gym, dieting, or plastic surgery will gain them that which they desire,” Heath says. This leads to a distorted, negative body image, inviting a variety of mental health problems, including eating disorders.

Using Exposure Therapy
Clinicians may also need to use exposure therapy for clients who are anxious to enter the real world again. Some clients, Heath says, have isolated themselves for more than a year, so the thought of going out and seeing others is hard to overcome. According to Choosing Therapy, exposure therapy is a type of cognitive behavioral therapy that places clients in situations that enable them to face their stressors. With the reopening of society, it is harder for clients to avoid many of their fears related to food.

“By avoiding the stress, the person believes that they will avoid symptoms, but this plan actually sensitizes the individual to the feared stimuli,” says Eric Patterson, LPC.

Virtual vs. In-Person Care
When it comes to receiving treatment, some individuals have benefited from telehealth as a way to talk to professionals they couldn’t have before COVID-19 due to geographic limitations. However, what happens if these professionals discontinue virtual services? Clients will either have to travel considerable distances or be forced to work with providers who may not be as qualified to treat their condition.

“In the long run, [changing providers] may not be a negative switch, but initially it can cause upset,” Heath explains. “For clients who are fragile, this can be difficult both emotionally and physically.”

When returning to in-person services, Heath says that, given the client’s temporary ability to hide their decline, a client’s condition could be more serious than the clinician originally believed. Some clients may want to stop seeing the therapist in order to avoid this “embarrassment.”

Each client is different, and the best option for easing the transition, Heath suggests, is for some providers to offer in-person sessions and others to provide telehealth sessions. Heath says this can happen through “working as a multidisciplinary team and communicating regularly about clients with eating disorders to provide the best quality care.”

For those professionals who are working virtually, it’s important that the treatment be as effective as in-person services. This can be accomplished by using technology such as virtual scales and apps to monitor their clients’ status.

Heath adds that one of the biggest challenges she has seen during the pandemic is longer-than-normal waiting times for inpatient facilities. The reason? Facilities were accepting fewer patients due to COVID-19 health concerns. Plus, some patients were unable to remain in lower levels of care while being seen virtually. Accordingly, the demand for inpatient and outpatient care increased.

“COVID has created a systemic issue that has lessened provider availability at all levels of care,” Heath says. This should normalize, however, as pandemic restrictions ease and clients improve, she notes.

A long-term solution is for more providers to be trained on how to effectively treat eating disorders. From counseling to nutrition and medical to psychiatry, clients need a full care team that is specially trained to help treat them safely and effectively at all levels of care.

The Takeaway
The COVID-19 pandemic has taught us the importance of being flexible and resilient even in the hardest of times. The reopening of society, while exciting for many, also comes with unique challenges. In order to effectively help patients suffering from eating disorders—and all illnesses for that matter—a multidisciplinary approach is recommended.

“The more options [people with eating disorders] have when seeking out treatment, the more likely they will be to access care and be successful when they do,” Heath says.

— Elise Tecco is an intern with Social Work Today.