66% increase in hospital admissions for eating disorder patients in the last year in Ireland
The Covid-19 pandemic has profoundly disrupted daily life and the restrictions imposed by lockdown and other virus-containment measures have greatly impacted physical and mental health. The impacts of these restrictions may be particularly felt by individuals suffering from mental health conditions, such as eating disorders1.
Research suggests that the Covid-19 has led to an increase in body-related concerns and has exacerbated eating disorder symptomology. A national study conducted in Australia observed a 27% increase in food restriction and a 34% increase in binge eating (despite no previous history of disordered eating) since the Covid-19 outbreak 2, while a study in the UK reported a 50% increase in appearance-related concerns and a 60% increase in food/eating preoccupation 3.
In Ireland, an article published in the Irish Medical Journal reported a concerning 66% increase in hospital admissions for eating disorder patients in the last year4. The report also outlined that the individuals admitted for acute care were more underweight and unwell than admissions in previous years. Furthermore, Bodywhys, the Eating Disorder Society of Ireland revealed a 110% increase in users of online support groups, a 48% increase in calls to their helpline service and a total of 1, 460 emails responded to between March and November (2020). It is evident that more people are struggling with these issues as a result of the lockdown period and the severity of these struggles have increased.
“I can’t have a hug or hear and see them tell me I’m ok and safe when the eating disorder feels like it is winning” (5 pg. 45)
It is hypothesised that disruption to daily activity, loss of routine/structure, limitations on exercise, changes in access to food and boredom are giving rise to greater rumination, body checking and eating disorder-related thoughts5,6. Additionally, restrictions have impinged on protective factors such as social support, access to health care and sleep, which typically help buffer against eating disorders6. Increased screen time, particularly social media is also considered problematic because of increased exposure to diet culture and idealised body-related content online which are associated with negative outcomes for body image7. Narratives around lockdown weight loss/gain on social media, increased focus on food preparation and public health recommendations to exercise and eat healthy can make it harder for individuals with eating disorders to ignore eating-disorder related thoughts5. Additionally, elevated stress and anxiety associated with the pandemic is thought to contribute to the aggravation of eating disorder symptoms. Researchers in the UK found that, 1 in 2 reported overeating in response to their mood during lockdown8. Additionally, recommendations to limit grocery shopping and food insecurity may encourage stockpiling and may negatively trigger symptoms among individuals with Bulimia Nervosa and Binge Eating Disorder3.
Research has documented tensions between attempts to cope and manage eating disorders while battling isolation, increased anxiety/depression and loss of structure. Aptly conveyed by one participant in a qualitative study, “I can’t have a hug or hear and see them tell me I’m ok and safe when the eating disorder feels like it is winning” 5 pg. 45.
72% of individuals with eating disorders felt that the lockdown had some positive effects
This study also found that despite the adverse effects of lockdown, 72% of individuals with eating disorders felt that the lockdown had some positive effects, such as providing more time to slow down, self-reflect and practice self-care 5. One participant noted “ I have had the mental space to acknowledge that I do actually have a problem. I have started recognising my own ED thought patterns and behaviours and am working on challenging them” 5 (p28). According to the authors, this positive reappraisal or “finding silver linings” in challenging times is not typically associated with eating disorders and suggests that individuals are attempting to actively cope with the challenges. However, despite these active efforts to manage disorders, individuals are still experiencing exacerbated eating disorder symptoms, which suggests that that it is even more important to ensure appropriate supports and services are provided to help individuals cope in these difficult times.
To note:
The research base is very small and is limited by cross-sectional studies (which don’t allow cause and effect to be established) and self-report data (which rely on participants’ subjective perceptions and could be biased). Further research is required to ascertain the extent of Covid-19’s impact on eating disorder symptomology and to quantify the pathways by which this influence occurs.
Take home
Research suggests that Covid-19 has exacerbated eating disorder symptomology and demands for services and supports have increased. There is a pressing need to identify ways to support individuals though this difficult time of lockdown and in the future as we move towards easing of restrictions.
References
1. Flaudias V, Iceta S, Zerhouni O, et al. COVID-19 pandemic lockdown and problematic eating behaviors in a student population. J Behav Addict. 2020;9(3):826-835. doi:10.1556/2006.2020.00053
2. Phillipou A, Meyer D, Neill E, et al. Eating and exercise behaviors in eating disorders and the general population during the COVID-19 pandemic in Australia: Initial results from the COLLATE project. Int J Eat Disord. 2020;53(7):1158-1165. doi:10.1002/eat.23317
3. Robertson M, Duffy F, Newman E, Prieto Bravo C, Ates HH, Sharpe H. Exploring changes in body image, eating and exercise during the COVID-19 lockdown: A UK survey. Appetite. 2021;159(November 2020):105062. doi:10.1016/j.appet.2020.105062
4. Barrett E, Richarson SC. Eating disorders during the Covid-19 pandemic. Ir Med J. 2021;114(1):233.
5. McCombie C, Austin A, Dalton B, Lawrence V, Schmidt U. “Now It’s Just Old Habits and Misery”–Understanding the Impact of the Covid-19 Pandemic on People With Current or Life-Time Eating Disorders: A Qualitative Study. Front Psychiatry. 2020;11(October):1-8. doi:10.3389/fpsyt.2020.589225
6. Rodgers RF, Lombardo C, Cerolini S, et al. The impact of the COVID-19 pandemic on eating disorder risk and symptoms. Int J Eat Disord. 2020;53(7):1166-1170. doi:10.1002/eat.23318
7. Rodgers RF, Melioli T. The relationship between body image concerns, eating disorders and internet use, part II: An integrated theoretical model. Adolesc Res Rev. 2016;1(2):95-119. doi:10.1007/s40894-015-0016-6
8. Pascual-sanchez A, Nicholls D, Patalay P, et al. You-COPE: Mental health consequences experienced by young people aged 16-24 during first months of the COVID-19 lockdown. 2020;(July):1-11.
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