Like so many other Americans, Emily, a 26-year-old fundraiser in Chicago, was admitted to the hospital recently. But Emily wasn’t sick with COVID-19 — she was starving.
Living alone, working remotely and approaching her fourth week of lockdown, Emily’s anorexia had spiraled out of control. “I know that I’m neurotically fixated on food at the best of times,” she says, “but with my general anxiety about the world and being alone all day with little else to think about, it’s definitely got worse.”
Out of a “part-manufactured” fear of running out of food, Emily severely restricted her caloric intake. “Even though I know rationally that I’ll be able to get groceries and there’s no need to hoard things, I’ve half convinced myself anything nonperishable is off limits in case of emergency,” she explains. “That makes things like using a single can of beans to make a perfectly average dinner stressful.” Emily started having panic attacks about not being able to control her diet, and when she was eventually admitted to the hospital after passing out, she’d barely eaten in three days.
At least 30 million people of all ages and genders suffer from an eating disorder in the U.S., and for many of those suffering, lockdown is worsening their condition. Claire Mysko, the CEO of the National Eating Disorders Association (NEDA), says that her organization is experiencing a “significant uptick” in people needing support during this time and who are reaching out to NEDA’s online chat service and helpline in large volumes.
Mysko says that one of the biggest challenges for people with eating disorders right now is maintaining connection. “We know that eating disorders really thrive in isolation — people with eating disorders are already very good at keeping their behavior secret and isolating themselves, so this is quite a familiar mindset,” she explains. “The important public-health recommendations around physical distancing are in stark contrast to what we learn in recovery about connecting with people and being with others, so at baseline, that’s a challenge for our community.”
Katie, a 22-year-old nonbinary music student in Nashville who suffers from bulimia, is certainly feeling that challenge. Now that Katie’s quarantined with their disabled mother and busy father, their eating disorder is shifting in nature and also intensifying: They can’t engage in the purging behavior that is usual for them, such as vomiting at parties and passing it off as drunkenness, so they’ve switched to secretive and extreme calorie restriction instead. “I’m abstaining from meals and just drinking Diet Cokes,” they explain. “It’s pathetic, I know.”
Ordinarily a “very social person,” Katie’s music performances have been canceled and they can’t attend parties or visit friends, so they’ve lost most of the outlets that used to provide some relief and distraction. This is causing Katie to spiral: As their mental health deteriorates, their eating disorder worsens, which in turn makes their mental health even worse. “I’m very depressed, and being hungry is also really depressing, so I just sleep a lot,” they explain. “My eating disorder is basically the only thing I can control during this time.”
It doesn’t help those suffering with eating disorders that there’s a pervasive, ambient pressure coming everywhere from mainstream newspapers to rise-and-grind types on social media to avoid weight gain during lockdown, and to be as productive and disciplined as possible. “There are so many comments, memes, social media posts and articles about the fear of weight gain, and a lot of companies and influencers are capitalizing on that right now,” Mysko says. “There’s a lot of food talk and weight gain fear in the broader culture, which is, of course, potentially very triggering and harmful for our community.”
Ashley, a 26-year-old advertising coordinator in Chicago who has been in recovery for bulimia and restrictive eating since 2015, says she’s noticed that this discourse has caused her recovery to backslide. “It feels like this social pressure to better myself physically and mentally while I’m stuck inside, and like people will definitely notice whether I ‘let myself go’ or ‘worked on myself’ once we emerge from this crisis,” she explains. “The old habits are returning, including the urge to throw up after eating and feeling like I don’t deserve to eat or sleep without working out for hours.” She adds that these are behaviors that took years of therapy to help rein in, which makes it all the more demoralizing to see them return.
It can be difficult to tune out these weight-loss messages at the best of times, given how deeply diet culture pervades our social landscape, but during the pandemic, they can seem almost impossible to avoid, especially as so many of us are spending increased amounts of time online. Mysko says that social media can be a “double-edged sword” at the moment: On one hand, it’s a useful tool for connecting, which she stresses is crucially important for people suffering from eating disorders; but on the other, our social media feeds can easily become a constant barrage of triggering diet and weight-loss talk, combined with filtered, Facetuned images of “perfect” faces and bodies.
And that’s Ashley’s exact experience. “TikTok helps pass the time and everyone is getting into it now, but I have to really limit my use of it,” she says. “The fitspo content and the sheer number of skinny, seemingly perfect girls on my feed just pushes me deeper into bad thought patterns.”
For people suffering from eating disorders, these “bad thought patterns” can be unbearable, like having a cruel enemy in permanent residence inside your own head. “The worst negative thoughts sound ridiculous when you actually describe them,” says Vee, a 26-year-old nonbinary editor in the Bay Area who has a restrictive eating disorder with overexercising tendencies. “But it’s literally like, ‘You don’t deserve to live if you can’t stop yourself from eating this Oreo, because everyone else can do it, but you can’t.’”
While the prospect of gaining weight on lockdown might strike some as a minor bummer and others as no big deal, for someone with an eating disorder, it can be an existential terror that cuts to the core of their self-worth. Ashley says gaining weight is “tied to a fear of being seen as incompetent or lacking self-discipline” and that the pandemic feels “like a test to see if [she’s] a loser with no self-control,” and for Katie, gaining weight would mean being “unattractive and unworthy of love.”
Clearly recovery is a crucial goal, but unfortunately, the pandemic is both increasing the number of people who require support and resources for their eating disorders, and creating the conditions that mean some of those resources are unavailable or stretched thin. Laura Collins Lyster-Mensh, executive director of F.E.A.S.T., says her organization is “seeing families being cut off from clinical support and losing access to groceries,” which means that they must care for the person with the eating disorder at home without some of the outside resources they could previously rely on.
She adds, however, that this can be an opportunity as well as a challenge. “Without the need to keep appointment schedules, travel to work and school, and other distractions, families are taking the role of 24/7 support,” Lyster-Mensh explains. “Some families are telling us they’re really making progress with recovery-oriented support in ways they couldn’t manage before. Some families are feeling grateful for the chance to really focus on recovery together.”
It’s important to stress, too, that many resources are still available, especially online. “For people who are currently in treatment, most clinicians and treatment centers have transitioned to virtual options to make sure that you’re staying in touch with your treatment team and finding alternative ways to continue your recovery process,” Mysko says. “If you’re not yet in treatment but feel like you’re struggling, it’s really important to reach out.”
As a starting point, NEDA is maintaining a pandemic-specific resources page containing a link to its helpline, virtual support groups, their COVID-19 forum, free and low-cost support for people suffering from eating disorders and a connections video series. F.E.A.S.T. has published a position statement centered around the goal of “recovery first, even in a pandemic,” and is also maintaining an extensive page of resources, including dialectical behavioral therapy skills, self-care tips and helpful articles.
As to what self-care might look like in practice, that can vary according to the individual. Mysko says that it can help to find modes of movement that aren’t focused on a particular weight loss or fitness goal, and for Vee, that means taking donation-based yoga classes. “This reminds me that my body is strong and can do things,” they explain, “and isn’t just like a vessel for fat and gender dysphoria.” Katie says they’re “finding small rituals like making matcha and doing a thorough skincare routine” to take their mind off body image helps, and Ashley is journaling to help identify triggers and incorporating “an absolute cheesy amount of positive affirmations” into her daily routine.
As for social media, Mysko recommends tailoring the experience as much as possible to ensure feeds are minimally triggering. “Do everything you can to curate your feed and make sure the accounts you’re following are building you up and making you feel good,” she says. “If you’re noticing that a particular account is constantly promoting weight loss or fitness that’s very focused on physical appearance, and that’s triggering your eating disorder thoughts and mindsets, then unfollow and try to seek out content that’s going to be supportive of your recovery.”
Tuning out the productivity evangelists can also be a sensible move. “If you’re finding that all the talk about what you can accomplish and what you can do is triggering, you’ve got to resist that and get the rest that you need during this time,” Mysko says. “We’re all experiencing heightened anxiety and collective trauma, which is exhausting, and if you’re not feeling motivated to be productive, that’s okay — it’s so important for us to be compassionate, not only with others but also with ourselves.” She adds that this might involve periodically unplugging from screens and the news cycle altogether.
One of Mysko’s most crucial suggestions for anyone suffering from an eating disorder is to stay connected to their own support networks of friends and family, making use of text messaging or video chat where necessary — and on the flip side, she says that “if you know someone is struggling with an eating disorder or suspect that they might be, now is certainly the time to check in.”
Fortunately, Emily is lucky enough to have regained some stability since she was hospitalized. “Naming the problem to my therapist and a few friends I talk to about this has helped,” she says. “I’ve been video-chatting with friends during meal times, which has been good because there’s that accountability there: I can’t skip a meal if there’s someone on the other end.”
Emily says that ultimately her recovery is hinging on adapting to the situation at hand, rather than fighting against it. “I had to readjust what I consider a ‘good’ or ‘healthy’ meal to eat at home, which means I’ve been able to obsess less over every single meal,” she says. “For better or worse, I’ve adjusted to this as the new normal.”
If you are struggling with an eating disorder and are in need of support, please call the National Eating Disorders Association Helpline at 1-800-931-2237. For a 24-hour crisis line, text “NEDA” to 741741.