By Kathryn Zerbe, MD
If someone you love struggles with an eating disorder, you may be worrying about how they will fare during the current pandemic. At least 30 million Americans report significant eating disorder symptoms over a lifetime. Stressful life circumstances, such as forced isolation, can make them flare up. The medical consequences and psychological struggles that accompany anorexia, bulimia, and binge eating disorders can quickly get worse.
For example, I wasn’t surprised when my patient Rose (not her real name) told me she was concerned about her brother who suffered from an eating disorder. Like many of us, her brother, who lives alone, is holed up in his apartment feeling sad, angry, and isolated. He doesn’t have the daily structure of going to his job every day.
We had discussed her brother’s eating disorder many times in the past. Smack in the middle of the COVID-19 epidemic, Rose, while working from home, was doing everything she could to manage two children out of school. Yet her brother’s health and battle occupied center stage in her mind.
She feared he wouldn’t be able to fight off the viral infection. He’s still not in a healthy weight range, although he is a little further down the road in his recovery. She worried he may relapse and wanted guidance on how to be supportive during this crisis.
Rose has reason to be alarmed. Even under normal circumstances, eating disorders have the highest mortality rate of any psychiatric illness. Anyone with full-blown anorexia, bulimia or what clinicians call the “continuum” (meaning those not meeting all diagnostic requirements) of eating problems and/or exercise addiction, need to be reminded—as never before–of the absolute need for healthy nutrition and exercise during the pandemic. Their life depends on it.
It’s an especially problematic time for these individuals to seek out the best avenues for constructive social support. They are left to feel alone with their eating disorder symptoms—and the depression, anxiety, traumatic memories, and obsessional thinking that often accompany them. Physical distancing measures have decreased options to attend therapeutic groups, to eat a meal with friends, or to practice self-care by learning how to depend on others.
The latter activity is important because someone with an eating disorder often keeps it secret or denies it—even when it’s obvious to those around them that it is becoming worse. Shame can be a formidable obstacle to leaning on others who can and want to help.
Rose’s brother already tended to isolate himself from others. He only had a couple of friends in recovery as well. With the stay-at-home order in place, she sensed it was important to reach out to him, but how should she do so effectively without triggering negative reactions?
Here are three tips if you’re concerned about a loved one:
1. To help with the social isolation of your loved one imposed by current physical distance guidelines, follow up with a short phone call, video chat or text every day to check in. Brevity is key. Don’t take on so much that it feels like an extra weight on your back.
Just sending a simple message of being on the side of recovery is useful. Being on someone’s “healthy side” over the long haul goes a long way to helping them internalize the positive attributes of others and builds a sense of security.
2. Remind your loved one to tune in to social networks promoting healthy living. It’s important for them to rely on friends they know are on their own path to recovery or other friends who have never had an eating or over-exercise problem.
Unfortunately, some social networks and online media are places where people share and encourage each other’s harmful eating disorder behaviors. Your loved one knows about them and where they can be found. Don't fear providing reminders to avoid these sites; it won’t encourage them to look at them. On the contrary, it sends a message that you know and understand that eating disorder symptoms can be contagious.
3. Ask your loved one to take a step back and think about their responsibility to others. Each of us is being reminded of this now, but there are particular life goals for someone who has or has had an eating disorder.
This activity promotes give and take in relationships and nourishes self-worth. It’s based on the psychodynamic principle of encouraging reflective function that helps build a sense of agency over time, a vital ingredient to everyone’s psychological wellbeing.
Kathryn Zerbe, M.D., is a psychiatrist and psychoanalyst in Portland, OR who has written and taught about the medical and psychological complications of eating disorder patients for four decades.