Study details effects of pandemic on people with eating disorders

By Catherine Robertson Souter
October 6th, 2020
Cynthia Bulik, Ph.D, study co-author and founding director of the University of North Carolina Center of Excellence for Eating Disorders
Cynthia Bulik, Ph.D, study co-author and founding director of the University of North Carolina Center of Excellence for Eating Disorders.

For those with an eating disorder, isolation, loneliness, anxiety, and stress can be major contributing factors. And of course, what are the major factors we all face during a pandemic and related shutdown? Isolation, loneliness, anxiety and stress.

A recent study published in the International Journal of Eating Disorders shows that, across the board, those dealing with eating disorders have reported increased symptoms and concerns about the effects of the current situation on their mental health.

“People with eating disorders,” said Cynthia Bulik, Ph.D, co-author of the study and the founding director of the University of North Carolina Center of Excellence for Eating Disorders, “are experiencing the same general mental health effects as the rest of the world, such as increased anxiety and depression, but on top of that, they are experiencing effects that are specific to their illness.”

The study, run in both the United States and in the Netherlands in April and May, was made up of just over 500 participants in each country. An online survey asked them to rate how concerned they were about access to food and treatment, the challenges they faced in maintaining a social support system, and how triggering they found their typical environment.

The survey also looked at the impact of the pandemic on specific eating disorders’ symptoms and allowed for open answers to provide additional comments both positive and negative.

"Therapists need to be aware that they cannot necessarily assume that virtual care is a perfect replacement for traditional psychotherapy." -- Cynthia Bulik, Ph.D, study co-author and founding director of the University of North Carolina Center of Excellence for Eating Disorders

The results showed what the study authors called “strong and wide-ranging effects” on participants’ eating disorder behaviors. Of the sample, 62 percent (69 percent in the Netherlands) of those with anorexia nervosa showed an increase in eating restrictions and anxiety over finding appropriate food.

For bulimia nervosa and binge-eating disorders, 30 percent (15 percent in the Netherlands) reported increases in symptoms of binge-eating and urges to binge.

“Isolation has been a major risk factor and contributor to increased eating disorder behaviors during the pandemic, especially for my clients who live alone,” said Abby Brown, Psy.D, a licensed clinical psychologist and director of training at Cityscape Counseling in Chicago.

“With minimal to no accountability, many clients have felt they can get away with their eating disorder behaviors. The problem is that eating disorders are inherently isolating, and the pandemic hasn’t helped with that.”

The study also reported increases in anxiety and noted the respondents’ comments about the limitations of tele-health services.

“Granted our first wave was conducted fairly early in the pandemic, but somewhat surprisingly, almost half who had transitioned to telehealth said that their treatment was somewhat or much worse than the face-to-face treatment they received before the pandemic” said Bulik.

“Therapists need to be aware that they cannot necessarily assume that virtual care is a perfect replacement for traditional psychotherapy.”

Brown has been using telehealth to reach her clients since March. After a tough transition, the team has found that clients are happy to have the option but there are drawbacks.

“Not having access to my clients’ in-office has posed some unique challenges,” said Brown. “There are a number of benefits to seeing clients in person including the ability to assess certain aspects of the clients’ health… as well as being able to obtain weights for specific eating disorder clients.”

Some of the study participants also reported positive effects of the pandemic-related shutdown, such as greater time for self-care and time to build stronger connections with family.

“Some of my clients were forced to alter their living arrangements because of the pandemic,” said Brown. “I’ve seen family members become more involved in their loved one’s recovery in ways they wouldn’t’t have pre-pandemic. For some, there has been a silver lining, which has been a relief to witness. But for many others, there hasn’t been.”

The idea that this stay-at-home time would be the perfect opportunity to do things, clean out the house, tackle a big life goal like writing a novel, or focus on healthy eating and exercise has hit especially hard for those with eating disorders. Allowing oneself permission to just get through it seems almost reprobate.

“A lot of clients have reported unbelievable pressure to lose weight and get fit during the pandemic,” said Brown. “Not surprisingly, social media has not helped improve society’s relationship with food and body, especially right now.”

For therapists, Brown recommends being extra sensitive to how clients are handling the effects of the shutdown.

“Explore what social media accounts your clients are following,” she said. “Be curious about diets or workout plans…however healthy or lifestyle-based they may seem. I also encourage you to check in with your own biases about weight and health, as it is often our own bias that can keep us from missing disorder right in front of us. Additionally, I encourage all of us to deeply reflect on and ethically provide treatment with respect to the profound issues impacting the BIPOC community who may also be living with eating disorders.”

As the pandemic continues into the fall, experts fear the effects felt by everyone and particularly those with eating disorders, will continue to rise.

“Given the rising unemployment,” said Bulik, “I am increasingly concerned that people will lose jobs and lose insurance coverage and we will find even more people going without treatment. In our study, 45 percent of individuals with current symptoms were not receiving treatment. This is consistent with many other studies. My fear is that this number will rise and more people will be living without care.”

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