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The ongoing coronavirus epidemic in the U.S. has affected people from all walks of life, including the elderly, those with underlying health conditions, recovering addicts, those with an autism spectrum disorder, and beyond. But for the estimated 30 million Americans who live with some type of eating disorder, being sequestered from others under stay-at-home orders could adversely affect their condition, impacting a recovery timeline and more.
“Eating disorders truly thrive in isolation,” Dr. Cynthia Bulik, the founding director of the University of North Carolina Center of Excellence for Eating Disorders, told Fox News.
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Read on for a look at how those who suffer from an eating disorder — said to have the highest mortality rate of any mental illness, according to the National Association of Anorexia Nervosa and Associated Disorders — may be affected during this time.
The following has been edited for length and clarity.
Fox News: How could the coronavirus lockdown affect people with an eating disorder? Is this more dangerous if that person lives alone?
Bulik: People with eating disorders are really struggling—in different ways if they live alone or with others. Those who are alone are really feeling the lack of support and are saying that they find themselves swirling around in eating disordered thoughts (negative thoughts about their bodies, constant weighing, body checking, etc.). They are also finding it hard to stay motivated to recover. On the other hand, the people who are living in close quarters with others are having trouble finding the privacy to, for example, have telehealth sessions with their treatment teams. Often their roommates or family might not know they have an eating disorder and there is nowhere for them to go to have a private conversation. So both can be challenging—living alone or with others.
For some families who have engaged in family-based treatment (FBT—which is the evidence-based approach for youth with eating disorders in which parents take over the job of renourishing their children), being quarantined together can actually support the work that has to be done in FBT (close parental supervision, parents providing all nourishment). However, for those who have “graduated” from FBT and maybe gone on to college or other independent lives, coming back home can be a major adjustment and make them feel like they are under the microscope again. This required families to renegotiate their stance toward each other.
Fox News: Is it normal for people with eating disorders to struggle in their recovery during isolation? Why is this?
Bulik: Yes. Eating disorders truly thrive in isolation. Much of the secrecy associated with eating disorders are driven by anxiety and can include secret exercise for weight loss, secret binge eating, secret purging, or other behaviors. Having others around can be a deterrent to engaging in unhealthy behaviors. When you are alone, there are no social deterrents, so the eating disorder can escalate unchecked.
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Fox News: How may the coronavirus epidemic affect different eating disorders differently?
Bulik: People with binge-eating disorder (BED) have been telling us that they are struggling with persistent urges to binge — especially if friends or family are stocking up on foods that are typically binge foods for them (high-calorie foods, or larger sizes than usual — like large boxes of cereal). Many people with BED will adopt a strategy during recovery of keeping high-risk foods out of the house to reduce the temptation when they get an urge to binge. However, with concerns about food availability and disruptions in the food chain, many people are trying to keep supplies plentiful. This can be very difficult for someone with BED. Some people have asked for help keeping nonperishable high-risk foods locked up to reduce the risk of them binge eating. When they do, there is often enormous guilt because they have eaten food that was meant to be a safety supply.
For people with anorexia nervosa (AN), the situation can be quite different, but equally as scary. Many people with AN have a limited range of foods that are safe foods for them — and many of them are perishable (fruits and vegetables). They can also be very particular about the foods that they choose and can spend hours food shopping and reading labels. So for them, the struggles are not having access to “safe foods,” being surrounded by foods that feel very threatening (the foods that are being stockpiled), the unpredictability of substitutions when using shopping services (for most people changing a brand or a flavor might be a minor irritant, but it can be highly anxiety-provoking for someone with AN to the point where they will choose just not to eat it), and just the anxiety of not being able to shop by themselves and check labels can be very anxiety-provoking. The same holds, but perhaps even more so, for people and families with avoidant/restrictive food intake disorder — those people who have extreme food aversions and restrictions — food unavailability can be a true nightmare for them.
Fox News: What signs should roommates, friends, or family look for when determining if someone with an eating disorder is struggling?
Bulik: For anorexia nervosa, of course, not eating with you, clear weight loss, excessive exercise, [and/or] spending lots of time in the bathroom. For bulimia and binge eating disorder, signs of food disappearing, signs of purging behavior (clogged showers, sinks, toilets, running to the bathroom after meals). Generally looking unwell, loss of energy, withdrawal, increased irritability. The most important stance is expressing your concern with firm compassion and offer your support.
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Fox News: If someone with an eating disorder feels their recovery is being impacted, what should they do?
If you have a treatment team, reach out. Get teletherapy sessions organized even if you have to do them from a closet or a bathroom for privacy. Support is so important at this time. Also, reach out to the community. The National Eating Disorders Association (NEDA) is holding a regular NEDA Connections series and lots of therapists and dietitians are doing Instagram postings for healthy meal support. Every major eating disorder advocacy organization has posted resources.
Here are some examples:
National Center of Excellence for Eating Disorders
F.E.A.S.T. for families
Academy for Eating Disorders
Fox News: How can other people help?
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Bulik: Be compassionate and ask how you can help. If someone is having trouble reaching out for professional support, you can help them. The NEDA Helpline is a great place to start.