How the Coronavirus Lockdown Can Affect Eating Disorder Recovery—and What You Can Do About It
It’s only 9 a.m. and I’ve already added and removed a bag of avocados from my Amazon shopping cart seven times. For me, this is what it’s like to be in recovery for anorexia during the coronavirus pandemic. I’ve been consistently healthy for about five years, but in that time, I haven’t faced as big of a challenge—or trigger—as I have in these past three weeks.
The impact of the COVID-19 outbreak on people struggling with eating disorders (ED) might not be immediately obvious. These disorders thrive in secrecy. For those who are either in recovery or are actively battling EDs of all stripes, the coronavirus—and the subsequent lockdowns and limitations—introduced an assortment of new threats and obstacles to overcome. (Related: What to Know About Coronavirus and Immune Deficiencies)
“People with eating disorders might struggle with a heightened or increased preoccupation with food during this time,” explains Melainie Rogers, M.S., R.D.N., founder and chief executive officer of BALANCE, an eating disorder treatment center in New York City. “When things feel out of control around us, those with eating disorders often look to food, weight and their bodies to control something.”
How to Deal with Limited Access to Gyms
Pandemic or no pandemic, I fight feeling trapped in my body nonstop. I found that this is a shared sentiment among some of my peers who also struggle with ED and body dysmorphia—a disorder that commonly accompanies ED in which someone constantly ruminates on a perceived physical flaw. It’s taken years of intense therapy to identify and address this. Now, the sensation of being held captive in my home has reinforced and magnified this sense, especially now that I have less access to my go-to grocery store, and that the gym—my haven—has temporarily shuttered.
After a subpar run during the first week of social distancing, I heaved over and had a panic attack in the middle of one of my favorite jogging paths. I could feel the fat blossoming all over my body. Intellectually, I knew this was my ED taking a stab at regaining traction, but emotionally, I was a mess. How was I going to remain the same size without access to a gym? And ultimately, who will love me if I do not adhere to the physical standard I have set for myself? I haven't had these thoughts in years, and now they were swarming as if they never left. (Related: How I Learned to Appreciate My Body After Countless Running Injuries)
On a good day, working out—running, especially—empowers and grounds me. On a bad day, I have a compulsion to “make up” crappy runs with unhealthy behaviors like logging two-a-days or exercising despite having serious injuries. This has taken years to unpack and curb. It will probably be a lifelong struggle to go against this impulse, and that’s okay. Struggling means that I’m still fighting. Pre-coronavirus, I had these tendencies under control—I quelled them into white noise that, though annoying, was manageable. But now, in this unsettled time, I’ve found myself struggling to keep these familiar urges from creeping back in. (Related: Four Women Share How CrossFit Helped Them Overcome Eating Disorders)
Rogers recommends any flood of similar feelings as a signal to reflect. “For those feeling out of control because of this unpredicted change, perhaps this is a good opportunity to look into the thoughts driving the behavior," she says. "How does this behavior impact your life? Why do you do these activities in the first place? Can you find a healthier way to use movement as a tool to cope with the stress of what's going on?”
I rely on working out as a way to feel strong and in ownership of my body. I love to exercise after the workday because it punctuates a shift from work life to personal life, and it helps me decompress and abate any stress that might trigger my ED. I work up an appetite for dinner.
Throughout my recovery, I've worked with experts and therapists to implement a daily structure to remain present, reduce disordered eating behaviors (to almost nonexistence!), and improve self-confidence. Exercise and hitting the gym are a key part of this, so gym closures are more than an inconvenience—it threatens my mental health. I am hugely intimidated that my ED will return, but also of losing the fitness I've worked to achieve and maintain. It's a double-edged sword. What’s more, I now have unwanted freedom and space to mull over self-perceived wins and losses of the day—a self-destructive but persistent habit.
“Many people who struggle with an eating disorder use exercise to lessen their body image concerns,” says Rogers. “If you're unable to partake in your normal routine due to the gym being closed or fitness classes on hold, you may feel more worried about your body. The fear of weight gain and body changes are not uncommon when your entire routine is disrupted.”
Not only is my routine disrupted, but the extra time I have on my hands now is especially daunting. “For those with overexercise tendencies, the free time available may lead to an increase of working out,” says Rogers. There’s a temptation, pressure even, to “make the most” out of this time—that I should emerge from self-quarantine glowing, shredded, and clocking personal records for my 5K time. Honestly, this is just an excuse to introduce restrictive eating and overexercising habits back into my routine.
"Challenge the idea that you need to be making the most of this time and be ultra-productive," says Rogers. "Instead, take this time to challenge perfectionism and rest. Limit your time online if you are finding these messages triggering. Unfollow influencers pushing this ‘side hustle’ and ‘ultra-productive’ narrative."
And I’m not alone. “Along with more free time, there has been an increase in social media posting of peoples’ home workouts," says Rogers. "This can be very anxiety-provoking for those struggling or in recovery as they may feel guilty comparing themselves, and for not joining that bandwagon.”
In this new normal, social media is a lifeline to check in with friends, blow off steam, or hell, waste a few minutes at night. But lemme tell you, the influx of home-workout posts put me over the edge on the most stress-riddled days. With no home gym in sight, these types of posts leave me reeling with feelings of inadequacy and failure. (Related: The Reality of Exercising After an Eating Disorder)
TBH, some days the most motivation I can muster is to change out of night leggings into ~fancy~ day ones instead. And yet, the ED voice in my mind tells me that I should exercise even when I’m drained, that I’m not as committed as these people who are lifting gallons of water as makeshift weights (which is so rad!)—that not burning calories, is in fact, the end of the world for me.
One thing that helps? “Unfollow triggering accounts,” recommends Jessica Cording, M.S., R.D., C.D.N., dietitian, health coach, and author of The Little Book of Game Changers: 50 Healthy Habits for Managing Stress & Anxiety. “Follow things [on social media] that make you happy, like funny animal videos or uplifting accounts that bring you laughter and joy right now.”
Together with my therapist, I did just that. I tidied up my social media and muted or unfollowed folks whose accounts weren’t the best for my mental health. To clear my head, I time daily walks to line up when I usually feel the most anxiety (after I eat), and I journal with my morning coffee. Because I have osteopenia—the precursor to osteoporosis, a common side effect of not nourishing your body—I can't run every day as I'll likely trigger a stress fracture.
To get my sweat fix, I've tried to sustain the mindset of experimentation. Up until three or four weeks ago, my workout program was geared and timed to a race I had on deck. Now that there aren't any races on the horizon, I'm playing around with apps that I previously claimed my workout program didn't have space or time to include. I stripped back the pressure I used to place on myself and instead, just, well, run. No watch, no pace in mind, just me, the road, and my legs.
After an especially deep scroll of puppy videos, I felt more resolute in my recovery, like I turned a corner, that the worst was over. Then I tried to order groceries online.
How to Strategically (and Mindfully) Grocery Shop
Let me start by saying: I am enormously grateful to be in a position where not only can I work remotely, but I can also afford a variety of groceries from different markets. This is a privilege, and I am deeply aware that some do not have this option. If anything, this awareness has occasionally left me feeling even more embarrassed of my unhealthy gut reactions to skip meals, resent online grocery shopping, and bemoan the challenges of gaining access to my go-to foods.
Pre-coronavirus, my grocery shopping routine was nearly identical every week. I had a specific route I’d take in the store to avoid trigger foods; my therapist and I developed a process to look at nutrition labels in a healthy way; and I practiced breathing techniques to circumvent the nagging guilt that commonly washed over me after I checked out at the store—ashamed that, for another week, I chose survival above my ED.
A couple of weeks ago, I made the decision to stick to ordering online grocery delivery after a particularly harrowing trip to the store. Coming off a great workout, I swung by the local Trader Joe's to grab my usuals. I was met with all-out chaos. In the frozen food section, two folks fought over the last package of cauliflower rice (you couldn't make this shit up). The shelves were bare—I'm pretty sure I spotted a tumbleweed blowing through the empty aisles.
This is all to say, the foods that I rely on for my regular meals were completely sold out. It's taken me years to perfect these meals—they leave me satisfied, nourished, and secure in the sense that I've sufficiently fueled my body. Now, I had basically zero options of items to even concoct a meal (enchilada sauce and cookie butter would not suffice). Not dissimilar to my reaction after my crappy run a few weeks ago, the negative thoughts spiraled. What's more, I felt the old draw, the secret pleasure to throw my hands up in false concession that I guess I'd "have" to forfeit my meals for the day, for the week, for as long as I could keep up the charade.
I’d nearly exhausted my rations before finally deciding to give Amazon Prime Now a whirl—the unfamiliarity was intimidating. ICYDK, the platform allows you to fill up your basket with items that might be segmented between Amazon Prime and, in my case, Whole Foods. When it’s time to check out, certain products might be removed because they’re out of stock. I expected some of the obvious ones to get the boot (toilet paper), but not the foods I regularly eat for breakfast (berries, healthy cereal, and bagels). Cue another downward spiral. How was I going to remain healthy if the internet wouldn’t allow it? I feel ridiculous even as I type that.
TBH, I still haven't cracked the code on grocery shopping online without feeling triggered. But I have gotten better at planning for the unexpected. For example, I listed out my normal, pre-coronavirus grocery haul in one column. Next to it, I wrote two or three alternates that I'd feel okay with swapping in for these options should they not be available. Having a plan has helped me deal with these curveballs. I also try to focus on the positives. Before I open up the app, I meditate on the gratitude I feel that I can afford groceries, delivery services, and stay home in the process. This helps to set the stage for getting through the task as painlessly as possible.
Both Cording and Rogers emphasize the importance of remembering that this situation is temporary and that these limitations present an opportunity to practice flexibility—something that’s a challenge for many who suffer from EDs. “You’re going to get through it,” says Cording. “Right now, focus on the basics of nourishment and look at food as a way to give your body energy and feel grounded.” (Related: How to Safely Handle Your Groceries During the Coronavirus Pandemic)
“For those who struggle with rigidity in their eating disorder, it's very challenging to not have the ‘healthy’ or ‘normal’ food options they typically rely on,” explains Rogers. “My advice to these people is to not let the ‘all-or-nothing’ mentality (which often comes with an ED) win!”
What that can look like: If your go-to yogurt, for example, is unavailable, “Get creative to recreate other favorite snacks,” suggests Cording. For me, toying around with concocting new smoothies has been especially enjoyable.
What’s more, as the restaurant industry has almost fully collapsed under coronavirus pressures, Rogers recommends trying to patron local spots that might offer delivery or pick-up (if you feel safe leaving your home). “If you're unable to grocery shop easily and ordering takeout or delivery is financially viable and an option near you, take advantage of that as a resource,” she says.
Personally, I decided that every Friday, as a celebration for muscling through another week of uncertainty, I’ll relish in the indulgence of ordering no-contact delivery. (PSA: Be sure to allow for longer wait times since delivery staff might be reduced or overstretched.)
How to Avoid Secrecy
Partaking in secretive behavior to conceal ED is relatively common. Years later, I still wear baggy tops as a way to conceal my body. “Eating disorders by nature thrive in secrecy,” says Rogers. “It can be very easy to hide behaviors during a time of isolation, especially if someone lives alone.” (Related: An Open Letter to Anyone Hiding an Eating Disorder)
To beat back the temptation of falling into old habits (or entertaining active ones), tap into your support system: your family, your friends, your S.O, your pet, plant, social media network, whatever. But perhaps most importantly, if you have it, your professional safety net. “If someone has a treatment team, they should check in with them as usual,” says Rogers. “Therapy and nutrition counseling are very important to keep recovery in check now more than ever.”
Dovetailing with that, try to coordinate an accountability structure that helps you stay on track. Use technology to your advantage, whether that’s texting a video of you eating (and swallowing, just chewing doesn’t count!) a meal, scheduling a Zoom lunch date (also a great way to keep in touch with your frandz!), messaging with your therapist around the time that the itch to purge typically unfurls, or go analog and sit down for each meal with a member of your quaran-team. (Related: What Is Telemedicine, Exactly?)
Even as I’m drumming up ways to hold myself accountable to be shared here, I’m thinking of how I could find loopholes. That comes with the territory of being in recovery. You know your ED—and secrecy habits that enable it—better than anyone. The only choice many of us have at this moment is to hold the behaviors to the light for others to see, understand, and help diminish. This will be terrifying but liberating. You’re not alone in this.
How to Secure Professional Help—Even During Financial Uncertainty
So let’s talk about therapy for a minute…mmkay? Seeing a professional therapist, registered dietician, or nutritionist, isn’t cheap—even when everything in the world is hunky-dory. But the expense shouldn’t mitigate its importance for your recovery—and many individual professionals and treatment centers are offering free or highly discounted services at this time.
“Many clinicians are offering virtual programs and services. Our team [at Balance] is offering everything from a full-day treatment program to meal support,” says Rogers. “There are also many free resources available such as recovery groups that our team is offering along with many other clinicians. Our team put together a free Recovery Handbook geared toward coping with COVID-19, so people have a resource no matter where they are. The National Eating Disorders Association (NEDA) and Crisis Text Line are also great resources if you need support and want to talk to someone.” (Related: How to Go to Therapy When You're Broke AF)
If you’re looking for a virtual health coach, Cording recommends searching for registered dietitians or nutritionists, as they’ll have more in-depth medical training and can speak to the science behind how your body will react to certain foods. (She suggests referencing Eat Right to find someone.) What’s more, if you can, veer away from online coaches who only work within FaceTime or basic text communication, as many aren’t HIPAA-approved. “However, some of these electronic services like Get Healthie have encrypted video and files to ensure all of your communication is HIPPA-compliant,” she adds.
Look, it’s a scary time in the world. Unemployment rates are skyrocketing, certain industries are crumbling, and many of us are so burned out that we don’t even know what day it is. It might be tempting to forego the cost of therapy in lieu of cost-saving measures, but I urge you to save cutting therapy as a last resort. (Related: The Best Therapy and Mental Health Apps)
“Your health is an investment. By investing your resources and by taking care of yourself, other areas will benefit,” says Cording. If your current therapist (or one you just uncovered) is out of your price range, ask them if they offer a sliding payment scale. (ICYDK, some therapists offer this benefit so folks of different income levels can afford professional help. This is generally based on your income and can help if your health insurance plan doesn't cover mental health expenses.)
If that’s still a bit too much, there are companies like Rise and AmWell that connect you with a registered dietician, she adds, where you can snap pictures of your meals, get one-on-one guidance, and more, depending on the platform. Rise charges between $100 and $300, a traditional therapist might run you upwards of $400 per session (not taking into consideration sliding scale concessions or health insurance coverage).
Also, don't be afraid to tap into social media to find a community of folks who are dealing with similar struggles—but this shouldn't replace a therapist. That said, connecting with people who are in similar boats can be powerful, and help keep you accountable. Pages such as @CovidEatingSupport offer Instagram Live meal support.
Despite where you are in your ED journey, both Cording and Rogers underscore that we are all worthy of recovery. Yes, there are people who are super sick and dying right now, but that doesn’t discount your struggle, either.
“Yes, we are dealing with a tragedy and people are losing their lives; but that does not take away from the fact you deserve support on your journey to recovery,” says Rogers. “Your mental health is very important, and you are not a burden for needing a hand.” Hang in, y’all, we’re going to get through this—even if it’s from a responsible, social distance.