The rise of eating disorder behaviors during the COVID-19 pandemic

| February 14, 2022
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Since the beginning of the COVID-19 pandemic, many members of the mental health community (including me) have become increasingly concerned about dramatic rises in eating disorder (ED) symptoms that have been reported both in the United States and globally. These include, and are not limited to:

  • excessive and dangerous compensatory behaviors to prevent weight gain,
  • disturbances in the way in which folks are experiencing their body weight and shape,
  • intense fears of gaining weight, and
  • restrictive eating.

The National Eating Disorder Association (NEDA) has reported increases as high as 107% in calls to its helpline at different points in the past two years. In July 2020, the International Journal of Eating Disorders published a survey of people in the United States who had already been diagnosed with anorexia nervosa and the responses showed that many were experiencing significantly worse symptoms. Similarly, nearly a third of those diagnosed with binge eating disorder reported an increase in episodes.

While experts have been working on teasing apart the various factors that underlie this trend, research provides clues as to what has been driving such significant increases in ED and ED-related symptoms.

What are EDs?

EDs are serious but treatable emotional and physical illnesses that can affect people of all genders, ages, races, religions, ethnicities, sexual orientations, body shapes, and weights. National surveys estimate that 20 million female-identified and 10 million male-identified people in America will have an ED at some point in their lives. In general, behaviors and attitudes that indicate that weight loss, dieting, and control of food are becoming primary concerns for a person can be indicators that eating and/or body image issues are developing or getting worse.

Emotional symptoms may include:

  • becoming preoccupied with weight, food, calories, carbohydrates, fat grams, and dieting;
  • refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates etc.);
  • feeling uncomfortable eating around others;
  • engaging in food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch); and
  • skipping meals or taking small portions of food at regular meals.

Physical symptoms may include:

  • noticeable fluctuations in weight, both up and down;
  • stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.);
  • menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period);
  • difficulties concentrating; and
  • abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low white and red blood cell counts).

A more comprehensive list of emotional and physical signs and symptoms can be found on the NEDA website.

The role of social media

We live in a media-saturated world, and research clearly shows that being exposed to, and pressured by, food-, weight-, and body-related ideals by the media tends to increase body dissatisfaction and the incidence of ED behaviors. In fact, a 2011 University of Haifa study found that the “more time adolescent girls spend in front of Facebook, the more their chances of developing a negative body image and various EDs, such as anorexia, bulimia, and exaggerated dieting.”

One of the challenging aspects of living though the pandemic was that in order to be able to be together safely, we had to be apart for long periods in the meantime. For many, this situation meant that social media was one of the only ways to be with friends and family, and many of us congregated on platforms new (such as TikTok) and old (such as Facebook).

Unfortunately, using social media as a main source of socialization can also easily lead to feelings of exclusion. Indeed, seeing friends, family, and even strangers enjoying themselves without us can make us feel like we are not living our lives correctly and that as a result, we are now alone. For some, including those with a propensity towards using ED behaviors, emotions and thoughts such as “I am not attractive/good/thin enough to be invited to do things” can lead to these kinds of behaviors in an attempt to fit in.

Our increased use of social media has also made us all particularly vulnerable to the negative impacts of social media on food-related behaviors and body image. For example, there was and continues to be widespread discourse across all social media platforms about how not to gain weight during COVID or focusing on getting fit during this period. As a result, many people have begun to equate self-improvement during the pandemic with weight loss or changing their eating habits.

Considering these and other negative consequences of social media use, it has become especially important that we all support and promote offline connections and activities within the limits of COVID safety. For instance, we can institute “unplugged” hours in our homes when all electronic devices are shut off or put away. These breaks from social media usage can provide us with much-needed moments of connection and conversations with our supports and loved ones.

Emotional distress about and due to the pandemic

For many of us, the pandemic has imposed the need for constant assessment of risk, with new and changed routines and once-trivial tasks altered due to the pandemic. We have probably all found ourselves asking questions such as, “What is the community transmission in my area today?” and “How will this affect my choices?” or “What is the vaccination rate?” or “Is there a mask mandate here?”

When the risk factors that underly our decisions are constantly changing, no decision ever feels truly safe or routine. This has made for a truly exhausting experience.

Due to these new sources of stress, a recent survey conducted in late February 2021 by The Harris Poll on behalf of the American Psychological Association found that one-third of adults feel so stressed about the coronavirus pandemic that they struggle to make basic decisions, such as what to wear or what to eat. Millennials were reportedly particularly likely to struggle with this issue when compared with other groups, which for many has led to avoidance of social situations, altering eating habits, procrastinating or neglecting responsibilities, and altering physical activity levels.

Additionally, nearly three-quarters of U.S. adults have reportedly experienced various impacts in the last months, such as headaches, feeling overwhelmed, fatigue, or changes in sleeping habits. Moreover, the majority of adults said they have experienced behavior changes as a result of stress in the past months. In conjunction with changes in eating habits and physical activity, more than one-third said they eat to manage their stress, which remains elevated after increasing during the first year of the pandemic.

For all of these reasons, it is unsurprising that some have turned to ED behaviors to manage these new and at times intense pandemic-related stressors. Indeed, according to modern-day research, ED behaviors are related to stress and emotional functioning in many important ways. First, negative emotions—and the desire to avoid or control negative emotions—have been shown to be related to the use of ED behaviors, as well as to the development of most other types of emotional disorders.

Research also shows that emotional events — such as feeling sadness, feeling anxiety, or feeling stress — are often the immediate triggers for ED behaviors. Furthermore, engaging in ED behaviors is a difficult emotional experience, and many people develop depression and anxiety in reaction to their ED behaviors. Thus stress and unwanted emotions such as those we have experienced during the pandemic can create the context in which EDs develop, and emotions are a part of what drives ED behaviors on a daily level. In addition, emotional experiences become worse as a result of having an ED.

Using ED behaviors to manage stress and unwanted emotions tend to interfere in people’s lives in many meaningful ways. They often cause us to experience frequent, strong emotions; they can bring up negative reactions to our emotions; and they can make us engage in many forms of emotional avoidance.

ED support at Student Health and Well-Being

If you or someone you know is living with these kinds of emotional and behavioral experiences in the context of ED behaviors and you would like to receive help and support, the Student Health and Well-Being staff is committed to enhancing the well-being and personal development of all Hopkins students. We strive to be sensitive to the diverse needs of our student body and specialize in treating the mental health concerns that are prevalent in a diverse university population. Our goal is to assist students in addressing the difficulties they encounter, including ED and ED-related concerns, and to empower them to make the most of their educational opportunities. Below are some Hopkins-based resources that are specific to ED concerns.

Additionally, any person can contact the NEDA helpline for support, resources, and treatment options, for themselves or for someone else. It’s available via online chat, call, or text.

National Eating Disorders Awareness Week

National Eating Disorders Awareness Week (NEDAwareness Week) is an annual campaign to educate the public about the realities of ED. This year, NEDAwareness Week will take place between February 21 – February 27, 2022.

During NEDAwareness Week 2022, the Counseling Center will also partner with the Center for Health Education and Wellness for an event on “Cultivating Body Acceptance.” This workshop will take place on Monday, February 21 at 5pm EST in the Ralph O’Connor Recreation Center. All Hopkins students and trainees are welcome to join. For questions or accommodations, email Molly Hutchison, [email protected].