For Emily Roll, a performance artist in southeast Michigan, the beginning of 2020 offered a glimpse of hope for an anorexia recovery that was a long time coming. After 15 years of struggling with an eating disorder, Mx. Roll began seeing a nutritionist and therapist. They were spending each day busy on their feet: doing yoga, working as a medical actor at a hospital, barista-ing at a coffee shop. That meant little time or energy for overexercising and undereating.
“Then the pandemic happened and threw a huge wrench in my recovery,” Mx. Roll said. “The rationing of food, the loss of a regimented schedule. It all happened so quickly. It was the perfect ground for unhealthy coping mechanisms to start sucking me in.”
Now Mx. Roll is not working, so the days are unstructured and lack the comfort of meals with neighbors. Mx. Roll feels anxious when friends report that, because of the pandemic, they are in the best shape of their lives. “I keep having to remind myself that exercise and productivity don’t define your worth,” Mx. Roll said.
Roughly one in 10 Americans struggle with disordered eating, and the pandemic has created new hurdles for those managing difficult relationships with food. Working from home means spending the day next to a fully stocked refrigerator. Grocery trips are less frequent, creating a pressure to load up. Social meals are out of the question. And many individuals feel an enhanced degree of uncertainty and angst, which can exacerbate existing mental health challenges.
“When the world feels out of control, people want to have control over something,” said Jessica Gold, a psychiatrist at Washington University in St. Louis who treats patients with eating and other mental health disorders. “Often, it’s what you put in your mouth.”
In March and April, the National Eating Disorders Association, or NEDA, saw a 78 percent increase in people messaging its help line compared with the same period last year. Crisis Text Line, a nonprofit organization that provides mental health support by text, saw a 75 percent increase in conversations about eating disorders in the two months since March 16, to around 700 conversations from around 400 conversations weekly. A vast majority of those texters — 83 percent — were women, and more than half were under the age of 17.
“There are jokes circulating about people’s fear of weight gain during the pandemic,” said Claire Mysko, the chief executive officer of NEDA. “There are influencers putting out messages about what you should and shouldn’t be eating. On top of that we’re seeing pictures of empty grocery shelves. That can be a trigger to people with eating disorders.”
Community is often a critical component of healing from an eating disorder, so the isolating nature of the pandemic has been especially difficult for those in recovery. For Katelin, a sophomore at Wesleyan who asked not to use her full name because of concerns about privacy, the transition from college to a quarantine routine was intense: no more big group meals in the cafeteria, no more exercise classes with friends. Just hours of class on Zoom and the quiet of her family house in New York.
The start of New York’s stay-at-home order, which came as she was recovering from bulimia, quickly renewed old anxieties about food. “Right away I had purging urges in a way I hadn’t in a long time,” she said. “It wasn’t like my routine fell away slowly. Everything immediately collapsed.”
Her stress was exacerbated by public health advisories about limiting trips to the grocery store; typically, she finds it comforting to have fresh fruits and vegetables available for snacking. Even worse were the social media posts she saw from friends worried about gaining weight while sheltering in place.
For Chelsea Kronengold, 27, a staff member at NEDA, the term “self-isolation” was itself a trigger. Ms. Kronengold has struggled with binge eating for years. Her disorder was always at its worst, she said, when she cut herself off from friends and family. So when New York announced social distancing guidelines, she began to worry about eating meals in her apartment alone.
Ms. Kronengold decided to fly to Florida to quarantine with her parents in late March. She said that she has found it comforting sitting down to dinner with family each night at 6:30, giving her relationship with food a sense of structure.
But for some young people, especially college students, leaving the comforts of campus to quarantine with family has been a challenge to their mental health.
Chelsea Albus Rice, a college social worker at Washington University in St. Louis who often helps students with eating disorders, has seen many of her patients struggle as they returned from campus to their hometowns. They lost the sense of independence they established at school, where they could create their own routines for healthy eating. One patient agreed to let her mother weigh her at the end of the semester to track her recovery progress. But now that she is sheltering in place at home, it feels as if her family is tracking her eating patterns day by day.
“Having the watchful eye of a parent or sibling creates a lot of anxiety,” Ms. Rice said. “There might be a comment from mom like, ‘Do you really need a second helping?’ Students feel like they’re under a microscope.”
Dr. Gold recommends that parents focus on providing opportunities for their children to share their stories and personal experiences, rather than closely monitoring their food intake. She said that it can be helpful for parents to begin by discussing their own vulnerabilities, with open-ended questions like: “I’ve been struggling a lot with my emotions during the pandemic. How has stuff been for you?”
While family members can provide some comfort, many people with eating disorders are finding meaningful support in virtual forums. Early on in the quarantine period, Mx. Roll reached out to five friends who had struggled with disordered eating, and together they created a Facebook group to share stories and advice. Some have added their friends, and the group has grown to over 20 people.
Mx. Roll said that encouragement from the group’s members had helped to find joy in preparing meals during quarantine. “I’ve gotten really into sandwiches,” Mx. Roll said. “It used to be a fear food of mine. Now I’m eating basic stuff like I did in elementary school, which is nice.”
Others have found support by plugging into the communities created by larger organizations. The National Eating Disorders Association has hosted virtual events throughout the pandemic, including webinars and online versions of the organization’s walkathons.
At a recent digital NEDA event, a group of young people gathered to exchange recovery stories, sing “Fight Song” by Rachel Platten and have a dance party. One mother-daughter duo said that it was the highlight of their quarantine.
“Eating disorders thrive in isolation,” Ms. Mysko said. “We’ve realized the need for a sense of connection, and we’re reframing what our community looks like while we’re sheltering in place.”