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Disordered Eating in a Disordered Time
Social isolation and unstructured days add to the anxiety of those struggling to achieve a healthy relationship with food.
Emily Roll, 30, began seeing a nutritionist and therapist after struggling with anorexia for 15 years. But once the pandemic started, it disrupted Mx. Roll’s recovery.Credit...Erin Kirkland for The New York Times
By Emma Goldberg
June 5, 2020, 10:52 a.m. ET
For Emily Roll, a performance artist in southeast Michigan, the beginning of 2020 offered a glimpse of hope for an anorexia recovery that was a long time coming. After 15 years of struggling with an eating disorder, Mx. Roll began seeing a nutritionist and therapist. They were spending each day busy on their feet: doing yoga, working as a medical actor at a hospital, barista-ing at a coffee shop. That meant little time or energy for overexercising and undereating.
“Then the pandemic happened and threw a huge wrench in my recovery,” Mx. Roll said. “The rationing of food, the loss of a regimented schedule. It all happened so quickly. It was the perfect ground for unhealthy coping mechanisms to start sucking me in.”
Now Mx. Roll is not working, so the days are unstructured and lack the comfort of meals with neighbors. Mx. Roll feels anxious when friends report that, because of the pandemic, they are in the best shape of their lives. “I keep having to remind myself that exercise and productivity don’t define your worth,” Mx. Roll said.
Roughly one in 10 Americans struggle with disordered eating , and the pandemic has created new hurdles for those managing difficult relationships with food. Working from home means spending the day next to a fully stocked refrigerator. Grocery trips are less frequent, creating a pressure to load up. Social meals are out of the question. And many individuals feel an enhanced degree of uncertainty and angst, which can exacerbate existing mental health challenges.
“When the world feels out of control, people want to have control over something,” said Jessica Gold, a psychiatrist at Washington University in St. Louis who treats patients with eating and other mental health disorders. “Often, it’s what you put in your mouth.”
In March and April, the National Eating Disorders Association, or NEDA, saw a 78 percent increase in people messaging its help line compared with the same period last year. Crisis Text Line, a nonprofit organization that provides mental health support by text, saw a 75 percent increase in conversations about eating disorders in the two months since March 16, to around 700 conversations from around 400 conversations weekly. A vast majority of those texters — 83 percent — were women, and more than half were under the age of 17.
“There are jokes circulating about people’s fear of weight gain during the pandemic,” said Claire Mysko, the chief executive officer of NEDA. “There are influencers putting out messages about what you should and shouldn’t be eating. On top of that we’re seeing pictures of empty grocery shelves. That can be a trigger to people with eating disorders.”
Community is often a critical component of healing from an eating disorder, so the isolating nature of the pandemic has been especially difficult for those in recovery. For Katelin, a sophomore at Wesleyan who asked not to use her full name because of concerns about privacy, the transition from college to a quarantine routine was intense: no more big group meals in the cafeteria, no more exercise classes with friends. Just hours of class on Zoom and the quiet of her family house in New York.
The start of New York’s stay-at-home order, which came as she was recovering from bulimia, quickly renewed old anxieties about food. “Right away I had purging urges in a way I hadn’t in a long time,” she said. “It wasn’t like my routine fell away slowly. Everything immediately collapsed.”
Her stress was exacerbated by public health advisories about limiting trips to the grocery store; typically, she finds it comforting to have fresh fruits and vegetables available for snacking. Even worse were the social media posts she saw from friends worried about gaining weight while sheltering in place.
Chelsea Kronengold, who works at the National Eating Disorders Association, said her eating disorder was at its worst when she cut herself off from friends and family.Credit...Anastasia Samoylova for The New York Times
For Chelsea Kronengold, 27, a staff member at NEDA, the term “self-isolation” was itself a trigger. Ms. Kronengold has struggled with binge eating for years. Her disorder was always at its worst, she said, when she cut herself off from friends and family. So when New York announced social distancing guidelines, she began to worry about eating meals in her apartment alone.
Ms. Kronengold decided to fly to Florida to quarantine with her parents in late March. She said that she has found it comforting sitting down to dinner with family each night at 6:30, giving her relationship with food a sense of structure.
But for some young people, especially college students, leaving the comforts of campus to quarantine with family has been a challenge to their mental health.
Chelsea Albus Rice, a college social worker at Washington University in St. Louis who often helps students with eating disorders, has seen many of her patients struggle as they returned from campus to their hometowns. They lost the sense of independence they established at school, where they could create their own routines for healthy eating. One patient agreed to let her mother weigh her at the end of the semester to track her recovery progress. But now that she is sheltering in place at home, it feels as if her family is tracking her eating patterns day by day.
“Having the watchful eye of a parent or sibling creates a lot of anxiety,” Ms. Rice said. “There might be a comment from mom like, ‘Do you really need a second helping?’ Students feel like they’re under a microscope.”
Dr. Gold recommends that parents focus on providing opportunities for their children to share their stories and personal experiences, rather than closely monitoring their food intake. She said that it can be helpful for parents to begin by discussing their own vulnerabilities, with open-ended questions like: “I’ve been struggling a lot with my emotions during the pandemic. How has stuff been for you?”
Frequently Asked Questions and Advice
Updated June 5, 2020
How many people have lost their jobs due to coronavirus in the U.S.?
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Will protests set off a second viral wave of coronavirus?
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
How do we start exercising again without hurting ourselves after months of lockdown?
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
My state is reopening. Is it safe to go out?
States are reopening bit by bit . This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
What’s the risk of catching coronavirus from a surface?
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals . But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
What are the symptoms of coronavirus?
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
How can I protect myself while flying?
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
How do I take my temperature?
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
Should I wear a mask?
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms . Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
What should I do if I feel sick?
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
How do I get tested?
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
While family members can provide some comfort, many people with eating disorders are finding meaningful support in virtual forums. Early on in the quarantine period, Mx. Roll reached out to five friends who had struggled with disordered eating, and together they created a Facebook group to share stories and advice. Some have added their friends, and the group has grown to over 20 people.
Mx. Roll said that encouragement from the group’s members had helped to find joy in preparing meals during quarantine. “I’ve gotten really into sandwiches,” Mx. Roll said. “It used to be a fear food of mine. Now I’m eating basic stuff like I did in elementary school, which is nice.”
Others have found support by plugging into the communities created by larger organizations. The National Eating Disorders Association has hosted virtual events throughout the pandemic, including webinars and online versions of the organization’s walkathons.
At a recent digital NEDA event, a group of young people gathered to exchange recovery stories, sing “Fight Song” by Rachel Platten and have a dance party. One mother-daughter duo said that it was the highlight of their quarantine.
“Eating disorders thrive in isolation,” Ms. Mysko said. “We’ve realized the need for a sense of connection, and we’re reframing what our community looks like while we’re sheltering in place.”