Exploring the impact of the COVID-19 pandemic and UK lockdown on individuals with experience of eating disorders

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic may raise unique challenges for individuals with experience of eating disorders. Many factors have potential for detrimental impacts on psychological wellbeing and eating disorder recovery, including: Disruption to living situations, 'social distancing' restrictions, difficult access to healthcare, and societal changes to food behaviours and technology usage. To date, little is known on the impact of the pandemic on this population, particularly within the UK. Method: A mixed-methods online survey was developed for the purpose of this study. Data was collected from 129 individuals currently experiencing, or in recovery from, an eating disorder during the early stages of the UK pandemic lockdown. Participants were aged between 16 and 65 years, with 121 participants identifying as female, 7 male and 1 participant preferring not to disclose their gender. Results: Findings suggest that the pandemic is having a profound, negative impact upon individuals with experience of eating disorders. Eight key themes were generated: Disruption to living situation, increased social isolation and reduced access to usual support networks, changes to physical activity rates, reduced access to healthcare services, disruption to routine and perceived control, changes to relationship with food, increased exposure to triggering messages, and positive outcomes. The results suggest detrimental impacts on psychological wellbeing including decreased feelings of control, increased feelings of social isolation, increased rumination about disordered eating, and low feelings of social support. Conclusions: Individuals with eating disorders are at significant risk of negative impacts of the pandemic. There is a vital need for interventions to support this population. Inequalities in healthcare provision were identified, emphasising a need for a more cohesive approach to remote treatment across UK healthcare services. Positive aspects of technology use were identified but the results suggest a need to address and/or limit the potential for negative impacts of public messages around food and exercise behaviours, and to co-design technologies with end-users to facilitate effective treatment.

Eating disorder pathology and compulsive exercise during the COVID‐19 public health emergency: Examining risk associated with COVID‐19 anxiety and intolerance of uncertainty

“…Our findings are consistent with existing work documenting associations between trait intolerance of uncertainty, ED pathology, and compulsive exercise (Brown et al, 2017;Kesby et al, 2017;Scharmer et al, 2020). Results indicating that higher levels of COVID-19 anxiety and intolerance of uncertainty were associated with more severe ED pathology are also consistent with recent work evidencing COVID-19 increases in ED behaviors (e.g., Branley-Bell & Talbot, 2020;Phillipou et al, 2020) and publications predicting increases in ED risk associated with COVID-19 anxiety (e.g., Cooper et al, 2020;Rodgers et al, 2020). However, findings that neither COVID-19 anxiety nor COVID-19 intolerance of uncertainty were associated with compulsive exercise are surprising given established links between compulsive exercise and anxiety (Meyer et al, 2011) and intolerance of uncertainty (Scharmer et al, 2020).…”

“…Currently, research examining the impact of COVID-19 on ED pathology and compulsive exercise is limited. Preliminary work evidences COVID-19 related increases in compulsive exercise and ED behaviors (Baenas et al, 2020;Branley-Bell & Talbot, 2020;Papandreou, Arija, Aretouli, Tsilidis, & Bulló, 2020;Phillipou et al, 2020;Schlegl, Maier, Meule, & Voderholzer, 2020;Termorshuizen et al, 2020); however, more work is necessary to understand factors impacting risk.…”

Impact of the COVID-19 Pandemic on Disordered Eating Behavior: Qualitative Analysis of Social Media Posts

“…Similarly, despite evidence that most ED patients express favorable attitudes toward teletherapy [ 14 , 19 ], some may question treatment quality or view telehealth as “second best,” and willingness to engage in treatment may be reduced [ 18 ]. In two separate investigations related to the telehealth transition, ED patients reported feeling like a burden or an inconvenience following dismissal from or suspension of treatment due to the COVID-19 pandemic [ 10 , 11 ]. Some individuals further endorsed the belief that telehealth was not equivalent to in-person treatment [ 10 , 11 ] and reported emotional distress and negative body image stemming from the video requirements of telehealth [ 10 ].…”

“…In two separate investigations related to the telehealth transition, ED patients reported feeling like a burden or an inconvenience following dismissal from or suspension of treatment due to the COVID-19 pandemic [ 10 , 11 ]. Some individuals further endorsed the belief that telehealth was not equivalent to in-person treatment [ 10 , 11 ] and reported emotional distress and negative body image stemming from the video requirements of telehealth [ 10 ]. Additionally, acceptance of telemedicine may vary by ED subtype, with evidence suggesting that individuals with the anorexia nervosa subtype may be least content with the transition to remote treatment [ 12 ].…”

“…In combination with increased media consumption during periods of social distancing, it is likely that greater attention to weight- and food-related content may trigger or exacerbate ED symptoms, given the negative influence of the thin ideal frequently romanticized on social media [ 23 ]. In one study, more than half of participants with ED reported the worsening of ED symptoms following increased exposure to food and exercise social media content since implementation of public health prevention and lockdown measures [ 10 ]. Although some ED patients, particularly those in recovery, may modify social media accounts to turn attention to positive or recovery-focused content [ 7 ], those with untreated ED and those at risk for ED may be especially harmed by these media trends.…”