“The pandemic has left many young people isolated, uncertain about the future and less in control.” ~ Emma Thomas, Chief Executive of Young Minds
The COVID-19 pandemic has been a perfect storm of combined negative factors for those suffering or recovering from an eating disorder.
The number of adolescents admitted to hospitals in America with severe illness from eating disorders has more than doubled in the first 12 months of the COVID-19 pandemic[1] This is comparable to the latest figures released in the UK by the NHS, demonstrating that hospital admissions of adolescents with eating disorders have also increased by almost 50% since the pandemic.[2]
The NEDA (National Eating Disorder Association) helpline has also reported a significant 40% increase in call volume.[3]
Eating disorders have the highest mortality rate of any mental illness, with a significantly elevated risk of suicide. These young people must receive the care and attention they so desperately need.
Compounding Factors
There is no single cause for the onset of an eating disorder. Many factors can trigger them, including emotional health, cultural pressures, genetics, and peer pressure.
Eating disorders commonly occur alongside other mental health disorders such as anxiety disorders, depression, substance use disorders, schizophrenia, and personality disorders.[4] This results in a significantly vulnerable demographic with a unique set of needs.
NAMI (The National Alliance on Mental Illness) explains that eating disorders are an especially complex condition. This is in part due to the likelihood of co-occurring disorders and the numerous unique factors that can trigger food-related issues.
However, food-related illnesses such as Bulimia Nervosa, Binge-Eating Disorder, and Anorexia Nervosa are often triggered by “people attempting to cope with overwhelming feelings and painful emotions.”[5]
The pandemic has heightened feelings of stress and isolation and has seen a widespread sense of loss of control, all of which are crucial elements for the development of an eating disorder.
Isolation
In non-pandemic times, isolation can be a profound trigger as well as a warning sign for eating disorders. Suppose an individual is no longer eating meals with their family or is canceling dinner plans, withdrawing from previously enjoyed activities, or behaving furtively around food, body image, or weight. These are significant signs that they may be struggling with food-related issues.
During lockdown, many young people have found themselves separated from their families, especially if they are studying away at college or university. This separation creates a loss of connection from loved ones and a weakening of their support systems. For those in recovery, this can be particularly harmful and trigger relapses of disordered eating behaviors.
Social Media
A recent 2021 study found that adolescents during lockdown have turned to social media in ever-increasing numbers to cope with feelings of loneliness caused by the lack of contact with their peers.[6]
Social media and those within an individual’s online social network play a significant role in the onset and recovery of eating disorders.
Numerous studies have found that the more time a person, particularly an adolescent girl, spends on social media sites such as Facebook, the greater their risk of developing a negative body image, low self-esteem, excessive dieting, excessive exercise, and eating disorders.[7]
Food Insecurity
The onset of the pandemic, along with the subsequent lockdowns, caused mass panic around the world as we saw widespread food shortages and interruptions in the food supply.
This impact on food availability directly and adversely affected the critical symptoms of eating disorders, including binge eating, dietary restriction, and compensatory behaviors.
Numerous studies have found that food insecurity, actual or perceived, has a strong relationship to the development of an eating disorder. This is of great importance within the context of COVID-19, where instances of food insecurity in homes with children and adolescents more than doubled.[8]
A 2020 study found that 69% of participants with Anorexia Nervosa and Avoidant/Restrictive Food Intake Disorder reported a significant rise in anxiety around food availability. This fear centered on the foods consistent with their meal plan and specific diet.[9]
Moreover, 30% of individuals with binge-eating disorder and 15% of those with bulimia nervosa reported intense urges to binge, purge, and stockpile foods.
Financial Barriers
The severe lack of insurance coverage is one of the most significant barriers to eating disorder care. Numerous insurance companies provide some level of financial support; however, it is frequently for short-term care or outpatient treatment.[10]
If insurance does not cover a person’s healthcare needs, they will likely go without treatment. When we consider the dramatic rise in hospital admissions for those in critical condition, it becomes clear that this situation is far from satisfactory.
These financial barriers are especially relevant as they predominantly affect low-income households. This causal relationship means that individuals from low-income, food-insecure homes are at an increased risk of developing an eating disorder and are less likely to receive treatment.[11]
Adjustments in Treatment
A key compounding factor is a lack of, or changes to, treatment models and levels of care for eating disorder sufferers.
Services in all areas of medicine were forced to alter their offerings as it became more and more challenging to operate in person. Eating disorder care rapidly transitioned from in-patient to telehealth treatment models.
Despite the accelerating demand for eating disorder care, the telehealth models cannot offer the same level of care as in-person treatment. A 2020 survey by the National Institute of Mental Health found that 74% of participants who had transitioned from in-person to telehealth found that their level of care and effectiveness of treatment decreased.[12]
Conclusion
The Covid-19 pandemic has exposed many disparities in our healthcare system. As the incidence of adolescent eating disorders continues to grow, we must acknowledge the faults in our system and address the changes required so that these young people receive the care they deserve.
If you are concerned about any issues discussed in this blog, please contact Heather R. Hayes & Associates. Call 800-335-0316 or email info@heatherhayes.com.
[1] “Study: Hospitalizations for Eating Disorders Spike Among Adolescents During COVID”. University of Michigan, 2021, https://labblog.uofmhealth.org/rounds/study-hospitalizations-for-eating-disorders-spike-among-adolescents-during-covid.
[2] “Eating Disorders in Teenagers Have Doubled During Lockdown, Survey Reports”. Diabetes, 2021, https://www.diabetes.co.uk/news/2021/aug/eating-disorders-in-teenagers-have-doubled-during-lockdown-survey-reports.html.
[3] “In Many Ways it’s Been Disastrous”: COVID Pandemic Provides Perfect Storm for Americans with Eating Disorders”. Cbsnews.Com, 2021, https://www.cbsnews.com/news/covid-19-pandemic-eating-disorders/.
[4] Kask, J. et al. “Anorexia Nervosa In Males: Excess Mortality And Psychiatric Co-Morbidity In 609 Swedish In-Patients”. Psychological Medicine, vol 47, no. 8, 2017, pp. 1489-1499. Cambridge University Press (CUP), doi:10.1017/s0033291717000034. Accessed 25 Mar 2021.
[5] Eating Disorders | NAMI: National Alliance on Mental Illness”. Nami.Org, 2021, https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Eating-Disorders.
[6] Cauberghe, Verolien et al. “How Adolescents use Social Media to Cope with Feelings of Loneliness and Anxiety During COVID-19 Lockdown”. Cyberpsychology, Behavior, And Social Networking, vol 24, no. 4, 2021, pp. 250-257. Mary Ann Liebert Inc, doi:10.1089/cyber.2020.0478. Accessed 1 Sept 2021.
[7] Spettigue M.D., F.R.C.P.C, Wendy, and Katherine A. Henderson Ph.D., C. “Eating Disorders and the Role of the Media”. Ncbi.Nlm.Nih.Gov, 2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2533817/pdf/0130016.pdf.
[8] Paslakis, Georgios et al. “A Call to Action to Address COVID-19–Induced Global Food Insecurity to Prevent Hunger, Malnutrition, and Eating Pathology”. Nutrition Reviews, vol 79, no. 1, 2020, pp. 114-116. Oxford University Press (OUP), doi:10.1093/nutrit/nuaa069. Accessed 1 Sept 2021.
[9] Termorshuizen, Jet D. et al. “Early Impact Of COVID ‐19 On Individuals with Self‐Reported Eating Disorders: A Survey of ~1,000 Individuals in the United States and the Netherlands”. International Journal Of Eating Disorders, vol 53, no. 11, 2020, pp. 1780-1790. Wiley, doi:10.1002/eat.23353. Accessed 1 Sept 2021.
[10] https://www.forbes.com/sites/williamhaseltine/2021/08/27/how-the-pandemic-is-fueling-eating-disorders-in-young-people/?sh=3f9e18222269
[11] Sonneville, K. R., and S. K. Lipson. “Disparities in Eating Disorder Diagnosis and Treatment According to Weight Status, Race/Ethnicity, Socioeconomic Background, and Sex among College Students”. International Journal Of Eating Disorders, vol 51, no. 6, 2018, pp. 518-526. Wiley, doi:10.1002/eat.22846. Accessed 1 Sept 2021.
[12] Termorshuizen, Jet D. et al. “Early Impact Of COVID ‐19 On Individuals With Self‐Reported Eating Disorders: A Survey Of ~1,000 Individuals In The United States And The Netherlands”. International Journal Of Eating Disorders, vol 53, no. 11, 2020, pp. 1780-1790. Wiley, doi:10.1002/eat.23353. Accessed 1 Sept 2021.
