COVID-19 and Eating Disorders: The Continued Impact on Treatment and Recovery (And it's actually not all bad...)
Written by ‘Ai Pono Hawaii Staff Writer
The COVID-19 pandemic has changed every part of life as we knew it — for better and for worse. Health systems have been strained in every way imaginable and in-person connections have been limited for over a year. But we've found new ways to connect and share information. Eating disorders during COVID-19 are experienced and treated differently, too.
The initial impact of COVID-19 was largely feelings of anxiety, depression, and isolation — all things that eating disorders thrive on. But what about now, one year into what can only be called a collective trauma? How has eating disorder treatment during COVID-19 informed and changed treatment for the post-COVID world? What is the continued impact of COVID-19 on eating disorder recovery? How have sufferers and treatment professionals handled (and continue to handle) the fallout of this crisis?
Read on for the answers to these questions and more…
The Positives of Eating Disorder Treatment During COVID-19
Policy Improvements in the Wake of COVID-19
On a larger scale, the COVID-19 pandemic has highlighted the areas of need in healthcare, and especially in the field of mental healthcare. In response to pandemic induced distress, the U.S. government has included billions of dollars in funding for the expansion of mental health services.
The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), a stimulus bill passed in March 2020, allocated $425 million for use by SAMHSA as well as several provisions aimed at expanding coverage and availability of remote mental services for people covered by Medicare, private insurance, and other federally-funded programs.
Increased Availability of Treatment Services
In the initial wave of shutdowns, treatment providers scrambled to provide remote treatment services for those in need. Telehealth services remove location, time, and (in some cases) monetary barriers to treatment. With expanded treatment availability, there are many options for individuals looking for treatment.
The Negatives of Eating Disorder Treatment During COVID-19
Challenges Eating Disorder Treatment Centers Face During COVID-19
Several eating disorder treatment programs have shifted from in-person to partially or fully remote settings. The abrupt change in treatment structure has been jarring for several patients who were in treatment when the pandemic hit, and for those going into or returning to treatment.
On-site residential and inpatient programs have had to modify their facility living arrangement, scheduling, and activities. Due to spacing and testing issues, many facilities have had to limit the number of people they take in, the spacing of tables and seating, and create isolation spaces if COVID testing is needed. This is difficult, but is absolutely necessary for ensuring everyones’ safety.
Many treatment providers have severely limited visitation from family and friends to limit the spread of COVID-19. This has made patients feel more isolated and alone. This restriction limits a potentially strong source of support and motivation for those going through in-person programming.
A standard part of most eating disorder treatment programs is going out to eat. However, throughout most of this past year, facilities have had to rely on takeout to do exposures to restaurant food. This is a great alternative to eating out, but it is not a direct replacement. (However, as more people get vaccinated and restrictions are lifted, treatment providers may start taking groups on outings again.)
How to Make In-Person Eating Disorder Treatment During COVID-19 a Little Better
If you are in or about to go into a residential or inpatient eating disorder treatment program, remember that just because you may feel isolated from your supports at home, they’re still there for you. In most cases, you are able to call or video chat them — try to maintain a sense of connection during this time. (This is also great advice for if you end up receiving eating disorder treatment farther away from home.)
If you are nervous about COVID-19 protocols at a treatment facility, you can call them and/or read up on their current policies and practices. Rest assured, though,that wherever you go for treatment, your providers take cleanliness and personal safety seriously.
If you are having takeout during your treatment program — be proud of yourself! That’s a huge recovery win! You will have opportunities in the future to challenge eating out. And you can do this in a small group, with your support system.
Challenges of Remote Therapy and Psychiatry
Unfortunately, a number of eating disorder treatment professionals have noted several barriers to providing adequate treatment in the remote setting. These include:
Relying on patients to monitor their own weight, which can be an opportunity for those in recovery to mask weight loss
The inability to measure things like heart rate and blood pressure, which can be severely compromised by engaging in eating disorder behaviors (but it’s important to note that eating disorders are just as serious for physically stable people as those who are medically compromised)
The decreased sense of connection between clinician and patient, which takes away the feeling of having professional support
The inability to pick up on nonverbal body cues that inform clinicians of how their clients are feeling
Patient discomfort with seeing their face on-screen during sessions
The limited opportunities to do exposures such as eating at a restaurant
A lack of privacy while completing treatment sessions/programs from within the home
How to Minimize the Negative Parts of Remote Treatment
The best thing to do in online sessions is to be honest. Since your treatment provider can’t see you in person, you have to rely more on your words to communicate. Don’t worry about saying the “right thing.” Just start somewhere, and you and your provider can go from there. Even if you start with something that seems irrelevant or not what you mean to say, the two of you can work to unpack your words and get clarity about your thoughts.
If you struggle with seeing yourself on-screen during sessions, you are probably able to change your virtual meeting settings so that you only see your clinician. If this isn’t possible, you can move back from the camera so that you aren’t staring at yourself so much.
You can also work with your clinician to do challenges virtually. If you have difficulty putting together meals, or struggle facing fear foods, you can do challenges online, with the support of your treatment providers. You can practice food based challenges by taking your computer to the kitchen and prepping meals with them during your session. You can do body image challenges using mirrors at home, or you can even practice looking at yourself on camera during sessions.
Related: A lot of these challenges are part of exposure therapy for eating disorders. Learn more about what exposure therapy is and how it works here.
Eating Disorder Recovery During COVID-19
Exposure to Recovery (and Diet) Oriented Content
There has been a huge influx of recovery oriented content by those working on their recovery during the pandemic. People in recovery can join recovery communities and engage in positive content on social media.
The flip side of this is, of course, the perpetual warnings of weight gain while in quarantine and advice on how to "lose the weight." These messages are projected by several media outlets right now.
Time to Focus on Recovery and Self Development (But Also to Act on Urges)
During periods of in-person event cancellations and isolation, many people have picked up new hobbies as a way to distract from distressing emotions. These include things like crafting, journaling, and music making.
The flip side of this, though, is too much unstructured time, which has caused several people to lose established eating and exercise routines. Individuals may engage in binge eating due to stress or boredom, engage in excessive exercise to cope with so much free time and anxiety, or restrict in order to numb out from their feelings all day long.
Motivation and Recovery During COVID-19
One of the huge motivators of recovery is all of the things you can do once you're not spending all your time and energy on your eating disorder. People look forward to being out with friends, traveling, going to events, getting their dream job, etc.
In the age of COVID, plans have been skewed for just about everyone, to say the least. Not being able to act on these big plans has taken a toll on many people's motivation to recover.
On the other hand, we have all witnessed the cracks in the system we live in, and many have found motivation through helping others. Some have gotten involved politically, some to those in need in their local area, or online.
And what about after COVID?
Even while the world is still reeling from the past year, your recovery is the most important thing you need to take care of. Without nourishing yourself and taking care of your mental health, you can't fully take on the challenges and opportunities of the new, post-COVID world.
If you or a loved one is suffering from an eating disorder, take the first step today and talk to someone about recovery or simply learn more about the holistic eating disorder recovery programs we offer.