The loneliness, stress and lack of control many people have felt during the COVID-19 pandemic created the ideal conditions for a rise in eating disorders.

“All these things are the perfect storm to create relapses or to notice symptoms emerging,” said Kathryn Smith, a licensed professional counselor with Rising Phoenix Counseling Services in Grants Pass.

Locally and nationally, therapists and doctors are seeing more patients struggling with anorexia, bulimia and binge-eating.

Smith, who is in recovery from an eating disorder herself, said there’s a common misconception that eating disorders are about food and weight.

“It’s a coping mechanism to control external stress and our internal emotional distress,” she said.

Depression, anxiety and addiction ― all risk factors for eating disorders ― spiked during the pandemic.

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Loneliness and isolation, additional risk factors, increased as people practiced social distancing to help control the spread of the virus.

“People had a lack of structure, feelings of uncertainty and a lack of control,” Smith said. “Eating disorders are isolating. Further isolating is a problem.”

Teens and adults who were stuck at home had more time to mull over negative thoughts and engage in secretive behaviors like severely restricting their food intake or binging, then purging through laxatives or vomiting.

“Eating disorders thrive in secrecy. There’s a lot of shame involved,” Smith said.

Dr. Chad Brown, a pediatric and adult psychiatrist with Rogue Valley TMS who also has his own practice, said isolation and disruptions to people’s routines had a big impact.

“I have seen an exacerbation of eating disorders that were previously under control to the point that some people had to go to residential treatment,” he said. “I’ve had no patients with eating disorders who didn’t have their eating disorders exacerbated ― especially when people started isolating more. That’s when I started to see it get worse.”

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Brown said even people with no prior history of eating disorders started to develop an unhealthy relationship with food. Some turned to food to provide comfort.

“They were eating to soothe their anxiety,” he said.

Brown and Smith said there is a shortage of local providers who can help with the spike in eating disorders.

Headquartered in Colorado, the Eating Recovery Center doesn’t have in-person treatment centers in Oregon, but it does offer telehealth visits.

Online therapy and telehealth visits provide another way for people to access treatment when they live in underserved areas like the Rogue Valley.

Calls for help jumped 90% in January and February of this year compared to 2020, said Dr. Avanti Bergquist, a psychiatrist at the Eating Recovery Center’s Seattle center.

She said everyone has a threshold for developing an eating disorder that is influenced by genetic, personality and environmental risk factors.

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“COVID and the shutdown just threw them over their threshold,” Bergquist said.

Perfectionists with unrealistically high expectations for themselves are at risk for eating disorders. Obsessive-compulsive tendencies are another risk factor, along with a personal or family history of depression, anxiety or addiction, according to the National Eating Disorders Association.

Those mental health issues can both predate and be worsened by eating disorders.

“Eating disorders, especially binging and purging and abstaining from food, are addictive behaviors and there’s also an obsessional component,” Brown said.

Bergquist said some people with more time at home decided to exercise more and eat healthier. Then their behavior gradually became more obsessive and dangerous.

“It just kind of snowballed from this innocent idea to try and be more healthy,” she said.

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The dangers of eating disorders

Eating disorders have a wide range of effects on the whole body, according to the National Eating Disorders Association.

Without enough calories, the body breaks down its own tissue for fuel.

“Muscles are some of the first organs broken down, and the most important muscle in the body is the heart,” the association says on its website. “Pulse and blood pressure begin to drop as the heart has less fuel to pump blood and fewer cells to pump with. The risk for heart failure rises as the heart rate and blood pressure levels sink lower and lower.”

Purging with laxatives or by vomiting depletes important chemicals called electrolytes that carry signals in the body. Electrolyte imbalances can lead to seizures, muscle cramps, an irregular heartbeat, heart failure and death, according to the National Eating Disorders Association.

Vomiting erodes tooth enamel and can damage or rupture the esophagus.

Binge-eating can rupture the stomach and increase the body’s resistance to insulin, leading to Type 2 diabetes.

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Laxative abuse can damage nerve endings and leave the body dependent on them to have a bowel movement.

People who restrict their food intake over a long period of time can develop complications of anorexia, including dry skin, brittle hair, kidney failure, anemia, an inability to fight infections, osteoporosis and broken bones, hypothermia and death.

Although the brain only weighs 3 pounds, it consumes up to one-fifth of the body’s calories. Without enough food, the brain doesn’t have the energy it needs. People have trouble concentrating and obsess over food, according to the National Eating Disorders Association.

“People will show symptoms of depression and anxiety. It’s hard to think and hard to focus,” Bergquist said.

During eating disorder treatment, patients often work with nutritionists to understand healthy, adequate eating.

Recovery is possible

Therapists said the first step in recovering from an eating disorder is to reach out for help.

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Brown said people who are already in therapy should talk about their food struggles with their therapist. If not, talk about issues like disordered eating, depression and anxiety with your primary care doctor.

Help is available online, but beware of sites that are actually forums to promote eating disorders and competition to become the most skinny, local therapists said.

The National Eating Disorders Association website nationaleatingdisorders.org has a screening questionnaire and information about warning signs and symptoms, risk factors, types of eating disorders, getting help, prevention and more.

The association’s Helpline phone and text number is 1-800-931-2237. For crisis situations, text NEDA to 741741 to be connected to a trained volunteer at the Crisis Text Line.

Smith recommends reducing social media use, and avoiding or deleting accounts that promote impossible body standards.

“People have been spending more time on social media. There’s a direct correlation between social media use and eating disorders. You’re comparing their perfect life to yours,” Smith said.

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She said people should avoid commenting about what others eat or their weight gains or losses.

“If you wouldn’t compliment someone for losing weight because of cancer, don’t compliment someone for losing weight because of an eating disorder,” Smith said.

She said many people gained weight during the pandemic, even if they engaged in healthy eating and exercise.

During stressful times, the body produces more of the hormone cortisol, which can trigger weight gain, anxiety, depression and other issues.

Smith said many people who gained weight are anxious about reentering society with the additional pounds. She said people need to be more kind to themselves.

“People say, ‘My clothes don’t fit.’ You deserve to be comfortable ― so buy some clothes. Just do it. You don’t have to spend a lot of money. This is your body and it got you through a pandemic. Your body did what it’s designed to do,” Smith said.

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She said despite the skinny body held up as the ideal in modern Western culture, people have a natural set point for their weight. Trying to manipulate that set point through excessive calorie restriction will just prompt the body’s metabolism to slow down.

“Your body is keeping you alive. It hunkers down if it thinks there’s a famine,” Smith said.

That’s why diets don’t work and people eventually gain back the weight they lost ― and often more, she said.

Brown said treating underlying depression and anxiety with medication can help lift people to the point where they can work on their eating disorders more successfully. People should still go to therapy to learn coping strategies, he advised.

People with eating disorders or in recovery from eating disorders need to take care of themselves with adequate food, water and sleep, Smith said.

Meditation, deep breathing, taking a walk, stretching, reading, doing a puzzle and other activities can help people recharge, therapists said.

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As the pandemic wanes, Bergquist said the conditions that worsened eating disorders won’t disappear overnight, and everyday stresses will still remain.

“I really think people should take it slow at getting back to, hopefully, normalized life and continue to give yourself grace. Things are not back to normal and we cannot go hard at everything the way we did before the pandemic,” she said.

Bergquist recommended keeping in mind some of the lessons learned from the pandemic, such as the importance of spending time with loved ones.

Some people, including students out of school for the summer and adults still working from home, continue to face isolation.

“I think it’s important to have social interactions and the more we can go out and see people in real life, I think doing that is going to be helpful rather than spending all your time at home and on the computer,” Bergquist said.

She said everyone needs people who they care about, and who care about them.

“Having that support is one of the things that really decreases the risk of having a mental health issue develop,” Bergquist said.