Managing an eating disorder can be particularly difficult under lockdown and experts say that severe cases of disordered eating have generally been on the increase. They recommend adapting treatments and becoming more aware of destructive habits.   

“There’s a lot of emotions that we bring to eating, regardless of whether someone has an actual eating disorder or not,” says registered dietician Lila Bruk. 

She goes on to explain that there is a range of behaviours in the category of disordered eating, some of which may be condoned as socially acceptable. She says, “if we look at disordered eating, the spectrum runs very far – from someone who might feel like occasionally they overeat or eat past the point of feeling comfortable to someone with a full-blown eating disorder.” 

Dynamics of lockdown  

According to the South African Depression and Anxiety Group the most common eating disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder. While anyone can develop these disorders, they are often seen as developmental illnesses presenting in adolescence or as a response to trauma.  

Linde Viviers is the consultant clinical psychologist at Akeso Crescent Clinic’ s Eating Disorder Unit in Johannesburg. The unit offers multidisciplinary treatment, and according to Viviers, they have observed higher levels of requests for treatment of severe cases.  

She says, “the dynamics and the impact of the lockdown may bring existing vulnerabilities to the surface.”  

Eating disorders develop over time and may only be presenting fully now, or lockdown may mean that family members are noticing behaviours and seeking help for a person who has previously kept these secret.  

Viviers explains that people with active eating disorders or those in recovery may be more vulnerable now, because lockdown can amplify feelings of anxiety and loss of control that are commonly at the root of these disorders. Being in close quarters with family members could increase destructive behaviours if they are coping mechanisms for interpersonal tension.  

She adds, “daily routines and structures around working, eating, sleeping, and exercise may have changed which may also lead to a relapse.” 

Bruk says that she also expects that eating disorder behaviours would intensify, particularly where people spend more time alone or caught up in overthinking. She says, “especially for bulimia very often feelings of loneliness and abandonment tend to exacerbate symptoms.”  

Healthy eating made more difficult 

Bruk says she is seeing an increase in people eating for comfort or reasons other than hunger, and that the lockdown has made healthy eating more challenging across the board. Food insecurity, which has been exacerbated by income loss attributed to the national lockdown, has also made it infinitely more difficult to eat a balanced and healthy diet. 

Amanda* in Johannesburg, has been hospitalised for anorexia before. She says that she was “originally anxious about the lockdown and eating habits” because of the fluctuation in her diet.  

“I went from not eating at all to eating pretty much anything nice I can find,” she says. 

Akisha* from Pietermaritzburg, says that the lockdown has meant a decrease in her eating disorder behaviours, for instance, because cooking at home makes her more aware of what she is eating.  

“There are always people at home watching my behaviours and for the first half of the lockdown I had a three-week streak of no purging.”  

While treatment for disordered eating and diagnosed eating disorders varies from person to person, Bruk advises that “there needs to be someone they can connect with” during the lockdown period. Viviers says that professional support should be continued, including virtual or in-person therapy as well as nutrition and weight monitoring with a dietician 

While Akisha has found support with friends and online communities, she feels issues like eating disorders are ignored or not dealt with in her Indian South African households.  

She says, “unfortunately given the dynamics at home it is impossible to go to a psychologist and seek professional help because of the stigma attached and the fact that it would mean I was not a perfect child.” 

Balance and routine key 

On a practical level, Viviers says “one of the most important treatment strategies is to keep to a daily structure or meal plan.” This includes eating at regular times, ideally spaced 2,5 to 4 hours apart and together with people if possible. Balanced and appropriate exercise and positive affirmations can help create a healthier connection between the mind and body.  

Amanda affirms that she has had to adjust her methods of staying balanced, by meal planning, forcing herself to eat and “motivate myself every single day that even though we are in lockdown, I need to keep healthy so that I can make it through.” 

Bruk says, “it is important to try as much as possible to link the outcome of the food with the food itself.”  

She advises that despite lockdown, one should create an environment that encourages good food choices, and awareness is key. Keeping a food diary about the content, timing and associated mood of meals is an important tool to pick up destructive patterns and be able to make better decisions instead of falling into automatic decision making patterns.  

In anorexia cases, for instance, says Bruk, “they’ll keep choosing the same foods because that’s what they feel safe with even though maybe it isn’t the best option for them.”  

While lockdown conditions can put more pressure on those recovering from or dealing with an eating disorder, the management can be adapted. If you are struggling with disordered eating or think you may have an eating disorder, please reach out to a doctor or a mental health support structure. – Health-e News