Whether we’re stuck at home or expected at work, the COVID-19 pandemic is affecting our wellbeing. The virus itself is unsettling, the isolation of quarantine depressing. These days, even grocery shopping provokes anxiety.

So, how do we handle the stress? Many of us fall back on coping mechanisms, behaviors we developed over the years that soothe us or give us a sense of control.

Much of the time, we can give in and enjoy a few cookies or a glass of wine and move on. But, for people with eating disorders, disengaging is harder. The consequences can be life-threatening.

About more than just food

Despite their name, eating disorders are about more than just food. These complex medical conditions, including anorexia nervosa, bulimia nervosa and binge eating disorder — can lead to serious health issues and even death.

People develop eating disorders for different reasons, such as genetics, brain chemistry or societal pressures to have and maintain a certain body type, said Dr. Sashalee T. Stewart, psychiatrist at Novant Health Psychiatry — SouthPark, in Charlotte.

Whatever the cause, people with eating disorders have one thing in common: To safely recover, they need the support of medical and psychological experts.

A dangerous time

Due to COVID-19, people with eating disorders have had less access to the therapists, nutritionists and others who’ve provided support.

“Worrying about what might happen if they can’t connect with support systems they relied on so heavily causes anxiety and can lead people to spiral into a very dark place,” Stewart said. “So, this is dangerous time for people with eating disorders.”

Social pressure

One big stressor: spending so much time at home exposes us to more messages about dieting and weight loss via social media and TV.

“While many people equate weight loss with health, that’s simply not true. Thinness does not always equal healthiness,” Stewart said. “But now, those messages are more in-your-face than ever.”

This pressure reinforces ideas about food, weight and body image that people have been working so hard to change. And, the fact that it’s growing harder to control our exposure to these messages becomes triggering in itself.

Empty shelves

In the last few months, we’ve all encountered the aisles of empty shelves at grocery and big-box stores. Frustrating, yes, but for some, a lack of available food can pose a serious challenge.

When they’re in treatment for eating disorders, patients work with nutritionists to develop eating plans, which usually include ‘safe foods,’ things they know are OK to eat.

“Now, when they shop, they’re wondering how they’ll cope if their safe foods aren’t available,” Stewart said. “Also, because it’s more difficult to reach their nutritionists, identifying alternatives causes even more anxiety.”

Everything’s connected

Serious mental health diagnoses, like depression, anxiety or obsessive compulsive disorder (OCD), often come hand-in-hand with eating disorders. If they’re not stabilized, situations like the COVID-19 pandemic can trigger unhealthy behaviors associated with these illnesses.

For example, going to grocery stores — facing those lines of face-masked shoppers, rules dictating how to move up and down aisles and urgent posters about hand-washing — can make OCD symptoms flare up.

“People with OCD often benefit from exposure therapy, which helps them grow more comfortable with the idea that germs are everywhere, that they normally aren’t deadly,” Stewart said.

“Now, suddenly, seeing people dying from this virus, knowing it actually is harmful, all the thoughts they’ve been working to let go of in therapy are being reinforced.”

Struggles with OCD and depression — which are so intimately connected with eating disorders — can lead people to fall back on their old, unhealthy coping mechanisms.

“It’s a continuous loop,” Stewart said. “You can’t parse any of these things out — they’re all interlocked.”

Tips and strategies

Stewart offered the following tips to help people with eating disorders, and all of us struggling to avoid unhealthy behaviors, during and beyond the pandemic:

• Stay connected. If you’re in treatment, this might include your treatment team. Novant’s behavioral health staff is offering video visits to patients in treatment. And, because online appointments are so helpful for many patients, they’ll continue to be offered after everything is reopened. Online forums and support groups, where people facing similar challenges can share thoughts, problems and solutions, are also helpful.
• Avoid people who make you feel worse about yourself. “Positive people can help keep you accountable in an encouraging way,” Stewart said. “But having those people in your corner is not only for accountability. Support systems are for support. For encouraging you and helping you celebrate all your victories.”
• Create and maintain a routine. Structure helps prevent all your days from running together. Try getting up at the same time every day, dressing in “real” clothes and setting small goals. “Knowing you have something to do and achieving it is good for your overall mental health.”
• Practice staying in the moment. Whether through mindfulness meditation, doing yoga or going for walks, it’s essential to unplug from all the negativity on TV or online and just be with yourself. You’ve heard it before: put down your phone.
• Offer yourself some compassion. Complete this sentence: Practice makes ___. “My clients always answer: ‘perfect.’ But I disagree,” Stewart said. “No one is perfect. Practice makes you better.” Instead of beating yourself up, embrace the process and forgive yourself if you fall short of a goal. “Leave yourself some wiggle room,” Stewart added. “Tomorrow is another day.”