COVID-19 Q&A: Dr. James Lock on Eating Disorders

Mental health conditions can be exacerbated because of the additional pressures brought on by the Coronavirus pandemic. In this COVID-19 Q&A with Dr. Lock, a Professor of Psychiatry and Behavioral Sciences and Director of the Stanford Child and Adolescent Eating Disorder Program, we focus on how eating disorders may be further triggered by the conditions imposed by COVID-19 safety measures.

Dr. James Lock

How is the stress and fear which COVID-19 is bringing to us all impacting those already struggling with an eating disorder?

Dr. Lock: People with eating disorders, like all of us, are experiencing significantly increased stress and fear as a result of the COVID-19. Increased stress and anxiety is difficult to manage and sometimes we turn to strategies that are not helpful but that we believe help or are familiar to us. For people with eating disorders, these may include increased preoccupations about appearance and weight, severe dieting, over eating or fasting, or attempts to use excessive exercise or binge eating or purging to manage these stressors and fears.

Are certain aspects of our public response to the virus exacerbating their challenge…and perhaps curtailing therapeutic activities and practices? Social distancing, curtailment of other activities, isolation, sheltering-in-place?

Dr. Lock: Being socially isolated is not healthy for us because humans are inherently social animals. Seeking out others in times of stress and anxiety is the natural response for us. So, social distancing in general is a challenge for us, but when a person with an eating disorder is socially isolated things can go from bad to worse quickly in terms of their illness. In addition to the usual burden of loneliness and feelings of isolation, there is an opportunity for the distorted beliefs and destructive behaviors associated with eating disorder to increase and go unchecked by others who ordinarily support healthier strategies to manage them. Strategies that people were using to challenge their eating disorder and promote recovery (following up regularly with medical providers, eating with others, investing in other areas of their life besides their body) can be harder to do because of social distancing guidelines and concerns. Additionally, people seem to often be looking to social media as a source of social connection while we are isolated, but increased use of some types of social media can sometimes facilitate increased preoccupation with shape and weight.

As many of us look to humor to get us through the unusual circumstance in which we find ourselves, there are plenty of jokes and memes circling around about how we’re all gaining weight because we’re eating out of boredom, or working in too close a proximity to our refrigerators. But, for those who have an eating disorder, this situation must be anything but funny?

Dr. Lock: Yes, there are many memes and jokes about COVID bodies, gaining weight because we no longer have access to regular exercise, sports, and gyms. People with eating disorders are especially sensitive to these types of messages about societal valuation of fitness, thinness, and exercise and in response some will experience increased worry about their own weight, shape and appearance. This increased worry can lead to an increase in dangerous behaviors like binge eating, fasting, and over-exercising to try to manage them. Furthermore, having stockpiles of food in the home can be quite challenging for people with binge eating, as limiting specific foods immediately available is often a strategy used to curtail this symptom. Conversely, for others, the pandemic is exacerbating food insecurity, which can paradoxically increase risk for binge eating.

Under these unique circumstances, many of us may find ourselves battling eating behaviors, even if we haven’t previously recognized any signs of this challenge? Is this normal? How can we tell if we have, or are developing an eating disorder?

Dr. Lock: Yes, we have seen that people are cooking more, baking more, eating more, exercising less, watching TV/movies more, and often feeling guilty about it. People handle stress differently – some may eat more in times of stress whereas others may notice a decreased appetite and eat less. In some cases, people who have been previously well may develop symptoms of an eating disorder for the first time. While some of these responses are normal, if a person finds themselves excessively worrying about their weight, beginning a severely restrictive diet, over exercising, or binge eating or purging, then it is time to think about getting help.

Finally, what can those of us who are battling and being treated for an eating disorder…or someone we love is…do to remain as healthy as possible and stay on our course of treatment and self-care during this pandemic? Adults, and children?

Dr. Lock: One of the biggest challenges the COVID-19 has created is how to take care of pre-existing or new health problems without increasing transmission risks related to the virus. Much of routine health care has been unavailable for weeks. For people with eating disorders, this has often meant deferring or postponing evaluation and treatment. While psychological treatments can be conducted via telehealth—and we are doing this with 95% of our eating disorder patients now at Stanford—we believe that it is likely that many patients who have eating disorders are not seeking care and are becoming increasingly ill as a result. We would want anyone with symptoms of an eating disorder, adult or child, to seek evaluation and treatment as soon as possible rather than postpone it further.

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