Managing eating disorders during home quarantine

Managing eating disorder symptoms is difficult during the best of times, but even more so during challenging times like we’re currently facing. Anxiety about the coronavirus pandemic, as well as quarantine restrictions, can be very stressful for people with a risk or history of disordered eating.
Furthermore, the need for flexibility is especially challenging, as those who struggle with disordered eating or eating disorders tend to be more rigid and less flexible. Add social distancing, limited access to food and a disruption in exercise routine, and unique challenges and new stressors can arise.
These include:

• Social distancing, although necessary to decrease the risk of the virus spreading, also decreases access to support systems, such as supportive people, treatment and community support groups. For some, quarantining at home can be difficult because of already existing conflicts, which can be made worse by extended periods of confinement.

• Shopping for food can be especially difficult to maneuver. Limited access to some foods typically purchased, longer lines and increased anxiety regarding food shortages or contracting the coronavirus all contribute to additional stressors.

• A disruption in one’s typical exercise routine can be especially troubling, as this interferes with a way you might cope with stress. Body image issues can be exacerbated and feelings of guilt and shame can increase when unable to exercise as usual.

• Those who tend to restrict their caloric intake may rationalize that it’s important to ration their food in case of a food shortage or may falsely believe that they can contract the virus from food. Hoarding or over-purchasing food can create difficulties for those who struggle with binge eating.

• Those struggling with orthorexia, a specific expression of disordered eating, have an inordinate focus and fixation on eating only things touted as being healthy, safe, natural or “clean.” Right now, this subset of people with eating disorders are particularly vulnerable, due to the rise in marketing of products that promise to “boost” your immune system, playing into people’s current fears.

• Right now, many people are feeling a loss of control over many things. Those who are more vulnerable to disordered eating may focus on things they can control, such as how much food they consume, their weight or engaging in other compensatory behaviors, which might include purging or compulsive exercise.

Tools to cope with new challenges
The good news is there are ways to manage these new challenges and maintain or work toward recovery. First — and I can’t say this enough — it’s OK to feel overwhelmed and uncertain. You are not alone in these feelings.
Try to give yourself grace and practice self-compassion during this very difficult time. Remember, none of us have ever had to navigate a global pandemic before.
I recommend the following additional ways to cope:

• Identify and name your feelings and triggers. Take the time to get in touch with your emotions and accept them for what they are: feelings. It takes a lot of energy to avoid one’s emotions, which can result in unhealthy behaviors. Instead, once you’ve identified your feelings, problem-solve other ways to meet your needs.
  For example, if you’re eating because you’re lonely, reach out to someone. Recognizing when you may be more prone to engage in disordered eating behaviors can assist you in identifying new ways to manage a situation.

• Make conscious choices about your eating and when you will have your meals. Spacing out your meals and snacks evenly throughout the day will help you in regulating your hunger and fullness cues and can decrease binge eating or assist you in not undereating. Plan meals that are both physically satisfying and taste good. Now is not the time to deprive yourself of adequate nutrition or food that you enjoy.

• Face your “fear foods” head-on. So many foods that cause people with disordered eating to experience increased anxiety are also the most shelf-stable, such as pastas, rice, crackers, chips, canned vegetables and processed foods. It’s going to be important to challenge the notion of “good” and “bad” foods and remember that food is energy that we all need to survive.

• Don’t place unrealistic expectations on yourself. Now is the time to be gentle with yourself. Try to refrain from making excessive to-do lists. Don’t compare yourself to others, especially those on social media, which often represents more fiction than fact.

• Engage in an activity that is self-soothing. This can include meditation, yoga, puzzles or crafts. As long as you’re able to adhere to the current restrictions, go for a walk or be in nature, even if it’s simply sitting in your car with a view of the water.

• Reach out for support. Make sure you make time for connecting with others. Video conferencing with supportive people can be very helpful and decrease feelings of isolation and loneliness. Invite a friend or family member to “join” you for a meal or snack to assist you while you challenge yourself to eat what you need or just to check in and connect.

• Monitor your use of social media. Avoid feeds with “thinspo” or “fitspiration” content, which may make you feel worse about your body and increase your symptoms. Do not engage in jokes about weight gain during this time of sheltering in place. Weight stigma is a risk factor for many, and one that doesn’t need to be added as another additional stressor. This is a time to instead seek out feeds and posts that celebrate body acceptance and body positivity.

Most importantly, remember that you are not alone. There are many free online support groups for people struggling with disordered eating. The National Eating Disorder Association (NEDA) offers a variety of resources, which are free or low cost, including a helpline, online forums, virtual support groups and recovery mentors.
Talk to your doctor if you or a loved one is concerned about behaviors related to food. Sharp Mesa Vista Hospital offers specialized eating disorder treatment programs and our therapists are currently offering telehealth appointments. We are all in this together, and we will get through it.

Dr. Linda Santangelo is a lead clinical psychologist at the Eating Disorders Program at Sharp Mesa Vista Hospital.

This story was updated on June 23, 2020.