My working theory about life under quarantine is that everyone, no matter their situation, has had to face an internal challenge they didn’t expect. Maybe you didn’t realize you had a strong need to fill your calendar with plans until everything got cancelled, or you’ve had an uptick in anxiety from losing so much personal control over your own life. When life is as quiet as it has been under lockdown, suddenly those low-level frequencies become a lot louder and a lot harder to ignore. One thing I didn’t expect to come crashing back into my life was my history with my eating disorder.
For years now I’ve been unpacking my college experiences with disordered eating, slowly learning how to invest in my body and appreciate it instead of being disappointed by it or, more often, trying not to think about it altogether. One day almost two years ago now, in a rushing realization, I took a walk in the grass with my shoes off and for maybe the first time in my life I was thankful for the legs and feet and skin and nervous system that made all of it possible, regardless of their aesthetic components. Little by little, I started to believe in my body. I started scheduling in time for breakfast, a meal I’d traditionally neglected, every morning, because I knew it would help my body feel its best and it deserved that.
I didn’t know that the COVID-19 pandemic would become such a challenge to the new peace I had found. Everywhere I looked, triggers would activate alarms in my head that hadn’t sounded for years: having to stockpile two weeks’ worth of food, my normal daily step count taking a nosedive as my usual haunts all closed down, and posts all over social media panicking about the “quarantine fifteen” and listing all the ways to stave it off at home.
Suddenly, I was back to being forced to think about my weight, eating habits, and exercise patterns on a daily basis again. Shelter in place orders meant I was confined to my apartment, but I felt far more trapped by the resurgence of thoughts urging me to do anything necessary to avoid gaining weight in the pandemic, thoughts that I would immediately feel guilty for because everywhere I looked there more deeply important things going on than my physical appearance.
Quarantine has been a uniquely lonely time for so many of us in so many different ways; this has been one of the loneliest parts for me.
I felt a hint of relief when, as I was scrolling through Twitter one day, I saw words on my timeline that looked just like the ones I had been struggling to form. “I’m so used to constantly distracting myself with things — emails, running around the city, work, Hinge notifications (or lack thereof), cute dogs on the street,” author and comedian Ginny Hogan writes in her essay for The Bold Italic. “Now, directing my thoughts toward something healthy is significantly more challenging.”
Reading Hogan’s account of her quarantine experience made me feel so much less alone for how I had spent mine. It was all there: being paralyzed by how much easier it had become to track the contents of each meal, an overwhelming lack of distractions, an exhaustion with fitness accounts trying to rebrand quarantine as the ideal time to get in shape. If two of us felt this way, I thought, there had to be more.
A Perfect Storm For Eating Disorders
“2020 is so hard for those struggling with ED (eating disorders),” says Edie Stark, a Licensed Clinical Social Worker, psychotherapist and eating disorder consultant based in San Diego. “Not only have a lot of coping skills like socializing, going to school, or in-person therapy been taken away, but the amount of social media and regular media we consume is up. With more down time, higher rates of isolation and less structure, eating disorders can thrive.”
Dr. Morgan Francis, a Scottsdale-based Licensed Professional Counselor with a doctoral degree in Clinical Psychology who specializes in treating eating disorders, sees the connection between cancelled events and social media uptick as a perfect storm for eating disorders. “Typically we look forward to traveling, seeing our friends, going to a concert. Those events increase our dopamine, a neurotransmitter responsible for pleasure, feeling good, and happiness. So when we see a decline in the stimulus of dopamine in our environment then we’re going to look elsewhere for it.” Our brains, she says, aren’t always great at differentiating between good sources and bad sources, which can drive us right into unhealthy habits like social media overuse. “Instead of getting a hug or having physical contact we might be spending more time on our social media, which can be impairing.”
The fact that there is so much public attention going towards avoiding weight gain and the dreaded “quarantine fifteen” while we grapple with a pandemic, Dr. Francis says, only goes to show the massive grip that diet culture and fatphobia have on our culture.”We’re in a pandemic, and our bodies are trying to keep us healthy. They’re trying to keep us alive. It would make sense that we’re eating more because we’re gearing up to undertake a pseudo-war with a virus.” Despite this, we still see massive anxiety and panic around the concept of weight gain in quarantine, which can be highly triggering to people with eating disorders. “We are in a pandemic, lives are being lost, we’re in the middle of Black Lives Matter, there’s an election coming up, and here we are freaking out about gaining weight. And that’s because of the intense amount of pressure put out by society and diet culture that says that there’s something wrong with you if your weight or shape changes.”
A public focus on avoiding weight gain despite a global crisis, combined with isolation and an uptick in social media, means that people who struggle with ED might find themselves feeling under attack.
The “Sick Enough” Mentality
The isolation that so many of us has been facing also makes it extremely easy to hide all sorts of mental struggles we may be having, or even dampen our ability to know that we’re struggling at all. Dr. Francis reference’s Dr. Jennifer Gaudani’s book Sick Enough to describe how far many patients will let their ED take them before getting help. “I think it goes for all mental health… It’s not until someone overdoses that they come in for help. It’s not until someone’s had a panic attack or is on the verge of divorce that they come in to talk to someone.”
“One of the main cognitions the eating disorder holds onto is ‘I am not sick enough,’ says Stark. “Not recognizing how sick you may be is the eating disorder’s way of keeping you sick. EDs thrive off of isolation.”
She says that the media’s portrayal of eating disorders, as well as its embrace of many unhealthy behaviors, can make it hard for people to recognize their own damaging behaviors. “Eating disorders do not have a look, and you certainly cannot tell if someone has an ED from looking at them.” She points to a number of “diet culture” trends that encourage unhealthy eating habits: “Influencers shelling detox teas, ‘clean eating’ and intense workout routines add to toxic messaging we receive every day about our bodies.”
Stark wants everyone to know that eating disorders are serious conditions, and that they could affect anybody. “Any human can have an eating disorder, no matter their size, race, or gender. We live in an incredibly fatphobic world that conflates thinness with health. Health is a lot more complex than someone’s body size.” She says weight stigma can prevent patients from getting properly diagnosed with ED, can delay access to treatment and even lead to harmful treatment. “Fatphobia in health care is horrible and deadly. Every human deserves respect and support no matter their size.’
Dr. Francis says that even if a person doesn’t think they fit the clinical diagnosis for an eating disorder, they should still seek support and help where they need it. “I want them to know that life doesn’t have to be like this. Life doesn’t have to be a prison where all you’re thinking about is ‘what am I eating and how am I going to get rid of it.'”
Safety Vs. Self Care
Around every corner there’s messaging about how to practice self care in quarantine; we’re all going through a lot, and the impulse to prioritize our self-empathy and keep ourselves feeling our best is a good one. However, a simple prompt to embrace self care might not hit the same for someone struggling with ED. “When we’re destroying our bodies we’re not engaging in self care or self love; quite the opposite,” says Dr. Francis. “A person who has a clinical eating disorder won’t understand self love for many reasons. It can seem very foreign, or like a toxic positivity.” She says when she talks about healthy habits for her patients with ED, she’s much more focused on safety than feeling warm fuzzies. “It’s about putting your safety first. Is it safe for me to be around my friend who’s training for a marathon if I’m recovering from orthorexia? Is it safe for me to be around a friend who’s dieting right now? It’s about making boundaries and understanding what’s triggering.” It wouldn’t be dramatic to say that Dr. Francis’ work with her patients is about survival. She says eating disorders are one of the deadliest disorders in the DSM. “It’s very serious and we have to treat it seriously.”
“Self care isn’t always bubble baths and face masks,” Stark adds. “sometimes it’s going to therapy, or setting boundaries with toxic family members.” She says if you have a hard time connecting with self love as a practice to start with the basics. “When something feels unachievable, it’s super hard to be motivated to work towards it. Start with baby steps. If you aren’t getting basic needs met, i.e. sleep, hydration and nourishment, it’s going to feel impossible to engage in the work of self love.”
Building A Quarantine Routine That Works For You
There are a few daily practices Dr. Francis recommends for her patients struggling with eating disorders. One of her rules is to connect with three people a day. “It could be six feet apart, it could be over Zoom or Facetime, but that’s really important.”
She also says it’s key to make sure you’re moving around every day. “And I don’t mean exercise, where there’s a measured outcome,” she says. “I mean breath work, meditation, getting outside, dancing, stretching, doing sun salutations, painting. Allowing the energy that we all store within our bodies to be released.”
Dr. Francis says connecting to our childlike center should be a regular practice. “Engage in play. Allow yourself to call back those times when you were a child and do the activities you loved. Maybe it was coloring, painting, or building legos, listening to music or creating playlists. Find things that you really enjoyed doing as a child and give yourself permission to do them as an adult.”
Stark adds a reminder to control the voices you’re exposed to. “Stay away from social media accounts that promote fatphobic content. Be wary of anyone telling you they can ‘fix you,’ because you’re not broken.” She recommends finding systems of support for yourself. “Find a support team that works for you. Join a peer support group. Get back to therapy. Make sure you’re nourishing yourself and drinking enough water.”
Remember That You’re Not Alone
In the isolation of the pandemic and the anonymity of social media, it can be so easy to feel lost and alone. Stark and Dr. Francis want you to know that if you’re struggling with an eating disorder, it doesn’t have to be your forever.
Both Stark and Dr. Francis recommend getting in touch with a therapist or maintaining your current therapy sessions, even if it means going remote. “You need to get the support of a licensed professional and maybe a registered dietician to get on a treatment plan to help you survive, to help you live.” Stark advises looking for a therapist who is HAES (health at every size) to make sure you have access to someone educated in body diversity and weight inclusivity.
“The struggle is real,” says Dr. Francis. “It’s very hard and I want to validate that for anyone who’s going through this season in their lives. It’s very difficult to navigate and that’s why I think it’s so critical to have a licensed professional to work with.”
Over the course of the COVID-19 pandemic, isolation has been an unfortunate theme for many of us. It can be hard to parse reality from perception, hard to know when we should be asking for help instead of trying to handle things on our own. We can feel like we’re being dramatic, like our problems aren’t worth focusing on because other people might have it worse. The shame that helps to fuel many cases of ED can be the same barrier that prevents us from talking about it, from finding each other and being honest with our loved ones when we need support and understanding.
“I want you to know you’re not alone.” That’s the message Stark has for anyone trying to live under the burden of an eating disorder right now. “You deserve support. You are capable of recovery. It is scary and brave to reach out for support, and you can do hard things. Find a therapist that is specialized in treating eating disorders, talk to your PCP, ask family or friends for help finding a treatment team.”