Patients share many of the negative side effects of isolation.
As mandated quarantine due to the COVID-19 virus continues, a picture of the effects of isolation and confinement is emerging. As noted in these pages before, these effects include increased depression and anxiety. Less is known, however, about the effects of confinement among persons with eating disorders. Further risk factors may contribute to the likelihood of developing an ED, such as increased time spent using social media and the toxic influences of the objectification of the thin ideal on the Internet. Isolation and loneliness are common consequences of AN, and may be exaggerated by the imposed quarantine.
Problems with emotional regulation can trigger ED symptoms (binge-eating episodes and consequent purging behaviors), while a consequence of increased external control may be reduced food intake. Another risk factor involves treatment: In the context of COVID-19, and in many healthcare settings, only urgent visits and inpatient treatment for severe ED cases are provided. When possible, online treatments, rather than face-to-face visits have been recommended.
A pilot study provides some answers
A small pilot study has provided new information about ED patients confined to home during the COVID-19 pandemic (Eur Eat Disord Rev. 2020; 28:239). Dr. Fernando Fernández-Aranda and colleagues at the Eating Disorders Unit, University Hospital of Bellvitgel, Barcelona, Spain, used a telephone survey to monitor the first two weeks of confinement among 32 ED patients (13 with AN, 10 with BN, 5 with Other Specified Feeding and Eating Disorder (OSFED) and 4 with BED). The mean age of participants was 29.2 years (range: 16 to 49 years of age), and most were female (90.6%).
Increased uncertainties
Most of the patients expressed worries about increased uncertainties in their lives, such as the risk of COVID-19 infection of themselves or their family and loved ones, the possible negative impact on their school or work, and their continuing treatment. Almost 38% (12 of 32) reported increased impairment from their ED symptoms, and 6.2% (18 of 32) reported additional symptoms of anxiety. Four patients noted that stress made it very difficult for them to control their “grazing” behavior and emotional eating.
Connecting with others while in isolation
How did patients handle communication with others while isolated at home? Investigators found that patients with AN were ambivalent about using social media and video calls. One negative aspect of using video calls for AN patients was the patients’ increased body awareness, which prompted self-criticism they perceived as harmful to their recovery. Some patients modified what was visible through their social media accounts and were far more comfortable with positive and recovery-based peer-support accounts. Others, however, believed it was safer to avoid forms of communication that could potentially trigger harmful reactions.
The effects on caregivers
Caregivers demonstrated a strong awareness around the issues of isolation and increased communication challenges for their loved ones with AN, as well as for themselves. However, they were resourceful in learning and sharing ideas. A need for routines and structure was highlighted as crucial for patients as a way to cope with change and for preventing boredom, which often led to increased preoccupations with their EDs. Carers described their increased role in the support and management of their loved one’s recovery during the pandemic. They shared creative ideas such as designing meal plans at home and helping patients undertake therapeutic activities, such as constructing restaurant challenges at home. Strategies for staying at home and self-isolating resulted in an increased burden for carers and changed family dynamics. Balancing the needs of the family member with an ED (for stability) with flexibility to adjust to the needs of the entire family, particularly children, was seen as crucial and challenging for parents. They expressed the difficulty of balancing multiple caregiving needs and work adjustment, confusion, and the risk of suicide.
Stress among healthcare professionals
Two words become important for professionals treating ED patients during the pandemic: self care. This means disconnecting from work when possible and taking care of themselves even while they are taking care of their patients (Hong Kong Counselling & Development Centre, Hong Kong Baptist University; Brooks et al., 2020). The severity of these symptoms increased with the duration of the quarantine and can persist over many years (Brooks et al., 2020). Healthcare professionals have concerns about becoming infected with the virus themselves, causing their hospital units to be understaffed and/or infecting their loved ones (Brooks et al., 2020).
Several studies have suggested practices that can help reduce such stress: (1) good communication with colleagues, (2) team supervision, (3) expressed appreciation from clients and superiors and society, and (4) awareness that they are doing something meaningful (Binder et al., 2020). Above all, structuring the day and developing a connected and healthy lifestyle will do much to reduce the continuing stress that professionals face each day.
