Eating Disorders—Innovative Approaches to Care During the Pandemic
Since the COVID-19 pandemic began, increased levels of stress, anxiety and depression have been widespread across America. For those at risk for or those with current eating disorders, the challenges and mental health fallout appear to be compounded.
The National Association of Anorexia Nervosa and Associated Disorders estimated — before the pandemic — that 2.8 million Americans, or 9 percent of the population, will have an eating disorder in their lifetime. Other data is surfacing. The Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany, conducted a survey with 150 patients. Approximately 70 percent of participants reported that eating, shape and weight concerns, drive for physical activity, loneliness, sadness, and inner restlessness increased during the pandemic.
Another recent study including 500 individuals from the United States (US) and 500 from the Netherlands (NL) with eating disorders, was conducted through email in the first six months of the pandemic. Individuals with bulimia and binge-eating disorder (US 30% of sample; NL 15%) reported increases in their binge-eating episodes and urges to binge. Participants experienced increases in anxiety since 2019 and had greater concerns about the impact of COVID-19 on their mental health than physical health. Although many participants acknowledged and appreciated the transition to telehealth, limitations were raised. Individuals with past histories of eating disorders also expressed concerns about relapse related to COVID-19 circumstances.
Princeton Center of Eating Disorders experienced an overall increase in admissions to the due to the pandemic. Nutrition Therapist Kelly Davidson, RDN reports that patients have cited higher levels of anxiety and depression and an increased use of eating disorder behaviors to manage these symptoms and fill time in isolation, which can result in a downward spiral. According to Princeton House Senior Eating Disorders Therapist Alison Locklear, LCSW, 90 percent of the adult and adolescent patients she counseled between August 2020 and February 2021 cited the pandemic as a contributing factor to eating disorder symptoms. Half of her patients—all adults—had prior treatment and cited the pandemic as a factor in their relapse. Princeton Center patients gave their own thoughts and insight:
—“I believe if it wasn’t for COVID, I wouldn’t be in the hospital.”
—“The things I went through in the past few years were the match for the eating disorder and COVID was the fuel on the fire.”
—“Since the pandemic started, I lost all of my jobs which made me lose purpose in life. I feel like I’m not contributing to the world…It’s made me more aware of my eating disorder since I’m just sitting around all day. It’s the only thing I focus on.”
At Princeton Center for Eating Disorders, the care team has been working with patients to identify these issues, determine the impact on hospitalization and eating disorder symptoms, and address them in the context of overall treatment. Based on patient feedback, themes have emerged as contributors to an increase in eating disorder symptoms and hospitalization:
Isolation/quality of life. One focus of treatment is to help patients create an identity and a life outside of their eating disorder. Yet the pandemic has forced people to retreat inward. When connections to family, friends, school, and activities that enhance quality of life and help keep symptoms at bay are no longer accessible, isolation with one’s eating disorder can very easily make it the primary focus.
The perils of social media. Isolation in the real world has led to a greater reliance on a virtual world full of misinformation and societal pressure, including dieting and exercise trends that influence eating behaviors. It can be easy to believe that false ideals are attainable—especially for those seeking ways to make themselves feel happier. Because this is not a solution to deeper problems, it can make them feel more broken.
Additional food-related anxiety. Food-related COVID-19 challenges have been especially difficult for those with eating disorders—from grocery store safety concerns and issues with food access to fewer opportunities to practice skills in settings like restaurants.
Family/home dynamics. If an eating disorder was used to cope with criticism, trauma, or negative relationships at home, or if family members also have eating disorders, being forced to coexist with those stressors and isolate from sources of support can magnify symptoms.
From day one, the Princeton Center for Eating Disorders team has worked to identify the additional barriers and contributing factors that may exist at home so that they can be addressed in discharge planning. This has included connections to food banks, meal delivery services, virtual support groups, virtual community groups, National Eating Disorders Association (NEDA) resources, and more.
“We’ve seen a lot of resilience and creativity among treatment team members in linking patients to any resources we can find,” says Locklear. “In the eating disorders community, professionals are all coming together to help each other battle the same issues.”
“Our entire team has an authentic passion for forward-thinking approaches to care that are also grounded in clinical research,” says Robbi Alexander, PhD, APN, PMHCNS-BC, present Director of Princeton Center for Eating Disorders. “We’re proud to offer this level of treatment for people across the country, and we’re planning to build even further on these initiatives as we look to the future.”
The Princeton Center for Eating Disorders is celebrating 25 years of providing high-quality, compassionate care for those with eating disorders. The Center now serves patients of all genders, ages 8 and up with a strong focus on evidence-based care and the expertise to treat a wide range of co-occurring medical conditions as part of its academic medical center setting. In 2020, the center received patient referrals from 40 states across the U.S. For more information go to: https://www.princetonhcs.org/care-services/center-for-eating-disorders-care.
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Schlegl, S, Maier, J, Meule, A, Voderholzer, U. Eating disorders in times of the COVID-19 pandemic—Results from an online survey of patients with anorexia nervosa. Int J Eat Disord. 2020; 53: 1791– 1800. https://doi.org/10.1002/eat.23374
Termorshuizen JD, Watson HJ, Thornton LM, Borg S, Flatt RE, MacDermod CM, Harper LE, van Furth EF, Peat CM, Bulik CM. Early impact of COVID-19 on individuals with self-reported eating disorders: A survey of ~1,000 individuals in the United States and the Netherlands. Int J Eat Disord. 2020 Nov;53(11):1780-1790. doi: 10.1002/eat.23353. Epub 2020 Jul 28. PMID: 32720399
MEDIA CONTACT:
Jennifer McGinley
jennifer.mcginley@pennmedicine.upenn.edu
410-303-2252
