At Penn Medicine Princeton Center for Eating Disorders, the interdisciplinary team has worked with patients to identify these issues, determine the impact on hospitalization and eating disorder symptoms, and address them in the context of overall treatment.
According to 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.
In addition to an overall increase in admissions 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.
Based on patient feedback, themes 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.
“The more providers can be aware of their patients’ virtual lives and whether symptoms may be worsening, the better,” says Davidson. “Due to pandemic challenges, more patients may require referrals to a higher level of care.”
Sources of Support
To counter some of these negative impacts, the Princeton Center for Eating Disorders team has placed a greater focus on helping patients visualize the pathways to hope—from the nurse-facilitated psychoeducational group on engendering hope to the new “Nature in Us” group described in this newsletter. In the context of COVID-19, this sometimes involves reframing expectations or exploring nontraditional approaches. For example, someone whose motivating goal was going to college in person may still be able to take steps toward that goal, such as researching colleges and courses of study.
Likewise, comprehensive discharge planning is needed more than ever. From day one, the Princeton Center for Eating Disorders team works 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.”
In the words of our patients:
“I believe if it wasn’t for COVID, I wouldn’t be in the hospital.”
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