Around the same time restaurants started closing or switching to take-out only, I volunteered as a recovery mentor for the National Association of Anorexia Nervosa and Associated Disorders (ANAD). As someone who is passionate about eating disorder (ED) issues, I thought it would be a great opportunity to connect with a mentee who was struggling, especially during such an unstable time. Little did I know that this would be the time my mentee would need me the most. As I checked in with my mentee regularly, I saw the barriers and challenges to recovery for individuals with EDs that the COVID-19 crisis has either produced or exacerbated.
I was able to empathize with those who were anxious about not making progress toward their recovery goals because they lacked critical resources and could not readily control the numerous intrapersonal and environmental factors that can worsen their conditions. Approximately 30 million Americans will develop an ED at some point in their lives. This is a public health concern that should be addressed because the guidelines we must follow to be safe are restrictive and can force some people to remain in places that are disadvantageous to their mental well-being. Access to certain foods is limited due to groceries selling out of stock. Most — if not all — schools have switched to a virtual curriculum, and most businesses are operating remotely, forcing many to work from home and readjust to old family dynamics. Isolation, closure of gyms and continuous access to food at home can fuel anxiety and promote unhealthy eating behaviors. While social media provides a convenient way to connect with one another, it can also be a platform where people can perpetuate messages that can be triggering to those struggling with an ED.
In order to flatten the COVID-19 curve, many people have been practicing social distancing and staying at home to avoid possible exposure to carriers and infected individuals. While these measures are necessary to slow the spread of the virus and keep the number of cases at a manageable level, they have several implications for mental health. In late March, a Kaiser Family Foundation poll demonstrated that 45% of adult respondents felt that the stress of the pandemic had negatively affected their mental health, which was a 13% increase from early March. The results also revealed that the stress has affected more than 25% of women, Hispanics and African Americans.
Social distancing for an extended period of time is against human nature, and isolation brings a wave of negative emotions. All of this can be difficult to navigate without adequate social support. Furthermore, social isolation, stressful or traumatic events and a lack of social support are risk factors for suicidal ideation. In Italy, two nurses committed suicide after the extreme stress of the pandemic traumatized them. Similarly, there have been several reports of self-inflicted deaths in the United States, including the recent passing of a top emergency physician in Manhattan, New York.
Regardless of one’s preexisting mental health conditions, it is clear that the pandemic has affected almost everyone in some fashion, including those who are at the forefront of fighting the disease. Fear of contracting the virus, social isolation and lack of awareness have precluded people from getting proper support for their mental health concerns. However, amidst all the uncertainty, there are some excellent alternatives and resources for individuals who are struggling. Many patient visits have gone virtual, which means appointments with health care providers can be made at patients’ convenience and in the comfort of their own homes. For those who are struggling with substance-related issues or other addictive behaviors but are finding it difficult to attend virtual peer support group meetings, there is an online community that hosts several meetings throughout the day and has a chat room open 24/7 for social support. There is also a smartphone app that offers patients helpful tips on recovery skills, connects them with experienced counselors and allows them to write about their recovery journeys.
For those who are dealing with an ED, there are telehealth sessions available as well as therapists who will virtually “sit” with people during their meals for accountability and support. While home may be a place of refuge for some, it can be a place ridden with fear and instability for others. Those who are confined to places where they feel unsafe are encouraged to formulate a safety plan to protect themselves, and if at any point they need help, they can call the National Domestic Violence Hotline. For youth, this may be an especially hectic period filled with various adjustments to their daily routine. One way to cope with stress and connect with peers is by creative expression through artwork or by submitting a blog entry to an online community where teens and young adults can share their struggles and experiences with mental health conditions.
Overall, being vigilant and sensitive to others’ needs is crucial. Communicating with one another is key during this time. When people open up about their struggles, it may be helpful to follow the V-A-R conversation guide, which includes validating their feelings, appreciating their courage and referring them to the appropriate resources. However, there is no formula for showing empathy. Simply checking in regularly on family and friends and showing that you care can help decrease the burden of emotional distress and address underlying mental health concerns.