By Kerrie Leonard, PhD Student & Dr. Elizabeth Blodgett Salafia
Appreciation for medical professionals took on a new, special meaning this year as the world dealt with the coronavirus (COVID-19) pandemic. Nurses, doctors, and other important medical professionals have been critical in the frontlines battling the virus. Their efforts are being recognized and praised as many hospitals were filled to capacity and healthcare workers worked tirelessly to help others. The current priority of every healthcare professional is treating COVID-19 patients, but they may not be thinking of another harm as a result of this pandemic: eating disorder relapses and increased disordered eating behaviors. During this time as well as beyond the pandemic, healthcare professionals need to be cognizant of how the pandemic may be harming those clinically diagnosed with an eating disorder and the increased disordered eating behaviors among non-clinical individuals. The COVID-19 virus is not directly related to food, but inadvertently the pandemic may affect or trigger harmful eating behaviors.
One trigger for disordered eating which is relevant right now is the scarcity mindset, or the feelings of resources being scarce. We have seen empty shelves at grocery stores and people hoarding goods and supplies. Although there is no real food shortage in the United States, it feels as though food is scarce. This can create anxiety in those with or without eating disorders, leading to hoarding food, binging, or restricting food intake. Indeed, there is a connection between food insecurity and eating disorder pathology, such that the more food insecure someone is, the higher levels of binge eating, and other disordered eating behaviors occur (Becker, Middlemass, Taylor, Johnson, & Gomex, 2017). Disrupted schedules, pressure to eat healthily, pressure to cook more meals at home, and worrying over food can also be triggering during this time.
The COVID-19 pandemic has been a traumatic experience for many people; young and old; students and working adults; people of color (POC) and non-POC. However, it is important to note that the trauma experienced may not be equal among all. Trauma is closely intertwined with eating disorders: rates of eating disorders are significantly higher in those who have experienced trauma and post-traumatic stress disorder (PTSD) (Mitchell, Mazzeo, Schlesinger, Brewerton, & Smith, 2012). Also, higher food insecurity is associated with higher levels of traumatic exposure (Becker et al., 2018). Various types of trauma are related to the development of eating disorders, including food deprivation, physical assault, emotional abuse, sexual abuse, bullying, etc. (Brewerton, 2007). Firsthand experiences of trauma are not the only link to eating disorders—even seeing internet and television news coverage of distant traumatic events has been shown to be associated with disordered eating (Rodgers, Franko, Brunet, Herbert, & Bui, 2012). The underlying mechanism linking traumatic events to eating disorders is still slightly unclear, but it is known that trauma disrupts the nervous system. In turn, individuals may find it difficult to regulate their emotions which may lead them to disordered eating behaviors as a coping method (National Eating Disorders Awareness (NEDA), 2018).
Further, current pregnant mothers living through the COVID-19 pandemic may unintentionally put their child at risk for later developing an eating disorder. Favaro et al. (2011) found that in utero exposure to virus infections (e.g., influenza, chickenpox, rubella, and measles) between 1970 and 1984 were associated with an increased risk of developing anorexia nervosa. Additionally, St-Hilaire (2015) found that pregnant mothers’ stress as a result of exposure to a natural disaster (e.g., 1998 Quebec Ice Storm) was associated with their child’s disordered eating behaviors in early adolescence. The stress of the COVID-19 pandemic on pregnant mothers can lead to negative outcomes later for their children, although results of those studies may not be generalizable to the current event.
As we may see a spike in disordered eating behaviors and relapses of eating disorders during this time, it is important to highlight that many physicians may feel underequipped to deal with patients who have disordered eating symptomology. In a 2010 study, 78% of family physicians reported having patients with an eating disorder yet felt uncertain about how to treat them (Linville et al., 2010). Also, a review found that medical professionals held negative attitudes towards eating disorder patients (Thompson-Brenner, Satir, Franko, & Herzog, 2012). Further, when race/ethnicity or gender is added into the equation, POC, men, or transgender individuals may receive even less attention because eating disorders are commonly viewed as a White women’s issue. Now, more than ever, we need medical professionals to be knowledgeable and mindful of eating disorders and include disordered eating in their assessments during this time and beyond. Similarly, it is necessary for medical professionals to participate in trauma-informed care. Even as life is slowly returning to the way it was, the unwanted effects of the pandemic can last for much longer. Although the battle against COVID-19 may be subsiding, the fight against the repercussions will continue on.
About the authors:
Kerrie Leonard, is a PhD Student, Developmental Science,Human Development and Family Science, at North Dakota State University.
Elizabeth Blodgett Salafia, PhD, is a professor at North Dakota State University, with research interests in Family and peer influences on adolescents disordered eating attitudes and behaviors.