Eating Disorders Awareness Week begins from 1 March 2021. To mark the week, Dr Kate Corrigan, Dr Róisín McManus, and Dr Aileen Murtagh from our Willow Grove Adolescent Unit (WGAU) look at the impact of the COVID-19 pandemic on our relationships with food, some common symptoms of eating disorders, and some ways we can support someone who we think might be developing or living with an eating disorder.
Eating Disorder Awareness Week is an opportunity for enhanced awareness of eating disorders (EDs), which can so often be hidden under the radar in homes across Ireland. It is interesting that, in 2021, this week falls almost exactly one year since the first confirmed case of COVID-19 in Ireland was announced. Since then, our lives have been completely upended in ways we never could have imagined. People have found themselves under immense stress, with our lives often unrecognisable from how they were prior to the arrival of this terrible disease.
Impact of COVID-19 on rates of EDs
We are still unsure of the long-term effects on mental health from COVID-19 and its associated restrictions, but the general expectation among professionals is that they will be profound and far-reaching. There are indicators that the rates and severity of mental health problems are increasing across all clinical settings during the pandemic.
The global pandemic has created the perfect storm for triggering EDs or exacerbating pre-existing disorders. The Royal College of Pediatrics and Child Health issued an alert in December 2020 to families and carers to be vigilant for signs of an ED among young people amid reports of a rise in cases across the United Kingdom (UK). A 66% increase in Irish paediatric hospital admissions due to EDs in 2020 compared to 2019 has also been reported.
Factors contributing to rise in EDs
There are several factors likely contributing to the surge of EDs that we are experiencing. A prominent factor is almost certainly the psychological stress we are all collectively experiencing. The sources of stress arising from the pandemic are multiple and individualised, including worries about contracting the virus, concern for family members, or even the loss of a loved one to the virus. Financial concerns and general uncertainty for the future can also contribute.
Public health restrictions, whilst prudent, have meant reduced social supports and social isolation and, therefore, people’s capacity to tolerate stress is compromised. Some people may focus on controlling a variable under their personal control - such as food, weight or shape - to manage this stress and anxiety. With all this angst and uncertainty, it is no surprise that people are struggling with their mental health and that cases of EDs are on the rise.
This past year has been a difficult one for people with a pre-existing ED or who struggle to maintain normal eating habits. The government advice to limit trips to the grocery store has, in some cases, led to stockpiling of food in households, which can be overwhelming for people who struggle with binge eating. Equally, anxiety surrounding food availability may trigger restrictive or starvation behaviours. For some people, limited availability of “safe foods” or specific food items in their meal plan in the supermarkets can induce intense anxiety.
Social media allows for connectivity and shared experience that brings us together when we are asked to stay apart, but these platforms can often feature unhelpful advice telling us to exercise at home and avoid the “quarantine 15” or “corona-stone”. Such messages can be extremely triggering for someone who is struggling to maintain normal eating habits. People have been encouraged to exercise to maintain mental health, albeit within five kilometres of home under current Level 5 restrictions. An increasing obsessive focus on exercise can occur. For other people, staying at home and restricting movements can feel lazy and unproductive with excessive control of food utilised to counteract these feelings.
Possible signs of an ED
Some signs or behaviours to look out for if you are concerned about someone or suspect that they may be living with an ED include:
- Change in behaviour, such as skipping meals, excessive discussions around food and related irritability or mood swings
- New self-imposed rituals or routines around eating or meals
- Eating disordered behaviour, such as playing with food, pushing food around the plate and cutting up food in excessively small pieces
- Increased fluid intake to supress appetite
- Secretive disposal of food (spitting food into a napkin, hiding under cushions or in pockets and so on)
- Frequent weight checks
- Weight loss or gain
- Body checking or viewing reflection in reflective surfaces, such as mirrors and windows, excessively
- Wearing baggy clothes to hide weight loss
- Change to eating habits, such as cutting out certain food groups, eating in secret, calorie counting, switching to a vegetarian/vegan diet and so on
- Involvement in food preparation but not eating the products themselves; a focus on feeding others (including pets) and not themselves
- Excessive exercise
- Using the bathroom immediately after meals (for self-induced vomiting)
- Excessive interest in online or social media resources on recipes and/or weight loss tips
- Frequent purchasing of laxatives or discovering empty packets
- Physical symptoms, such as cold intolerance, dizziness, low energy, constipation, loss of periods.
Support for someone with an ED
If you are worried that a loved one may be living with an ED, it is important to approach them in an open, non-judgmental manner. Listen to their story and try to understand it. It is important not to invalidate their experience or to comment on their body shape or size. You may find that they are relieved to talk to someone about their struggles.
If you feel that you or a loved one might be struggling with an ED, it is important to get support. Help is available and EDs are treatable. Early intervention is important and is associated with faster recovery. Contact your GP who will do a physical and psychological assessment and decide if you need onward referral. Treatment is available in outpatient, day patient and inpatient settings depending on the severity of the illness.
Dr Kate Corrigan and Dr Roisin McManus are Registrars in Willow Grove Adolescent Unit and Dr Aileen Murtagh is our Assistant Medical Director with Special Responsibility for Adolescent Mental Health Services. For more information on Willow Grove, click here.
Learn more about EDs
What is an ED?
EDs are potentially life-threatening mental health disorders that can affect all aspects of a persons’ life and wellbeing. People with EDs may use control of their food and weight as a way to cope with emotional distress. People of all ages and all backgrounds can be affected by ED, but it is particularly common in young females and adolescents. The table below describes some eating disorders including Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder and Avoidant Restrictive Food Intake Disorder. Orthorexia is a relatively recently introduced term, but lacks formal diagnostic criteria in current manuals.
A persistent reduction in food intake leading a person to become significantly underweight. This is associated with an intense fear of gaining weight or becoming fat. The person does not recognise that their low body weight is dangerous. They over-value their body shape and weight to the point that they neglect other aspect of their life such as relationships or school work.
Repeated bouts of eating large amounts of food in one sitting (binging) associated with a sense of lack of control. Inappropriate compensatory efforts to avoid weight gain such as purging via vomiting, laxative use, or excessive exercise. Over-valuing body shape and weight.
Binge Eating Disorder
Repeated bouts of binge eating associated with a sense of lack of control. There is no purging to avoid weight gain. The binge eating is a coping mechanism for difficult emotions. The person typically binges high-calorie food quickly alone and in secret. They will often feel ashamed or disgusted in themselves afterwards. The person may trial multiple diets however often it leads to weight gain.
Avoidant Restrictive Food Intake Disorder
This is a relatively new diagnosis. It is similar to anorexia in that there is a persistent reduction in food intake, leading to a person becoming significantly underweight. However, there is no associated fear of gaining weight or distress about body shape or size.
This is a relatively new term that does not yet have formal diagnostic criteria; however, general awareness has increased. It involves an unhealthy obsession with eating only ‘clean’ or ‘pure’ foods. As with other EDs, the eating behaviour is used to cope with negative thoughts and feelings. Individuals can feel extremely anxious after eating food considered ‘impure’. It is associated with cutting out increasing amounts of food groups (meat, carbs, sugar, dairy and so on). This obsession with healthy diet can impact negatively on work or relationships. Their emotional wellbeing can be overly dependent on their healthy diet.
What are the consequences of having an ED?
EDs affect people physically and emotionally. They have the highest mortality and morbidity of any mental health problem. They are potentially life-threatening and can affect all the body systems. Physical complications include heart problems, such as abnormal heart rhythms or dangerously low blood pressure and heart rate, and they can lead to sudden death. There is also a risk of fertility problems, fractures, dry skin and hair loss, growth of soft downy hair on the face, and a slowing down of the digestive system leading to stomach pain and constipation.
Emotionally, EDs can make it hard for people to socialise and function normally in their daily lives (school, work, hobbies and so on). EDs negatively affect sleep, concentration, self-esteem, mood and enjoyment of life. They are associated with other mental health conditions, including anxiety and depression.
How are EDs treated during a global pandemic?
Healthcare providers have had to evolve rapidly to continue to provide care to people struggling with an ED, and the pace of change has been remarkable. There has been inevitable disruption to services during this change, which can be a source of stress for service users. Changes to service delivery include a shift towards remote working with many appointments delivered by telephone or video. The use of tele-appointments can interrupt the therapeutic rapport, recognised as crucial to recovery from an ED. People with EDs can struggle with their visual image on the screen, avoid video consultations or switch the camera off, prohibiting a visual assessment of their physical health. However, services have adapted quickly to meet these challenges and increased demand, with a focus on compassion and empathy to put the service user at ease.
Are people with an ED more likely to be infected by COVID-19?
Fortunately, young people infected with COVID-19 tend not to acquire severe disease. However, people with compromised immune systems and medical comorbidities, seen in severe malnutrition, are more likely to become unwell with COVID-19, highlighting the need to protect and treat this group.
Find more information and support
Find more information and support
You can talk to an experienced mental health nurse through our Support and Information Line, which operates from 9am to 5pm from Monday to Friday, with a call-back facility outside of these hours. Call 01 249 3333 (normal phone costs apply).
We also have more information and resources about EDs available here.
You can find information on EDs from the Health Service Executive (HSE), which also provides the HSE Clinical Programme for Eating Disorders App.
Bodywhys is the eating disorder association of Ireland: you can find out more about it here. Bodywhys has a resource for parents on supporting someone with an ED which you may find helpful.
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