These are unprecedented times. We are seeing, as a psychotherapy group practice, that a majority of our clients that don’t have an eating disorder are suffering from either restricting, overeating or binging. The Covid pandemic has spawned a pandemic of eating disorders. Heightened fear and uncertainty are causing clients to increasingly use eating disorder behaviors to cope. It seems to be a collective response all around. The stress, exacerbated by increased isolation and no answers, is heavy and burdensome. It is clear that all of our clients are focusing on food, in large part, because of fears of shopping in public, or possible future food shortages. People are nervously eating and mindlessly eating. People are not eating. People are extremely anxious and worried.

Eating Disorder Triggers

Our clients that are in ongoing eating disordered specialization treatment are experiencing setbacks. People are feeling trapped, separated, and isolated. Add in continuous focus on diet culture, and people are attempting to control their bodies more than ever. We see a running theme of stuffing and filling the body with excessive food due to feeling out of control, and feeling not enough. Getting caught up in achieving a media manipulated ideal of thinness is unrealistic and dangerous. The constant pursuit of an unrealistic body can result in dangerous eating disordered behaviors, and constant dissatisfaction with the body.

Binge Eating On The Rise

Current stresses amplify people’s negative body image. It can easily be a distraction to focus on that, since other things are more out of control. Binge eating is a very difficult problem to address alone. The habit of binge eating serves a purpose to reduce unpleasant emotions. Once the person is done with the binge episode there is tremendous shame and guilt. This becomes a pattern that, under stress, the brain reinforces. That pattern then becomes increasingly difficult to break.

Types Of Eating Disorders

Years ago I chose to specialize in eating disorders because I saw the trend of them increasing into a mental health crisis, and not many qualified clinicians to offer treatment. The Diagnostic and Statistical Manual of Mental Disorders (DSM) only listed three for many years. They have changed Eating Disorders (ED) to Feeding and Eating Disorders (FED), and now they list eight. These are:

1. Pica
2. Rumination Disorder (RD)
3. Avoidant/Restrictive Food Intake Disorder (ARFID)
4. Anorexia Nervosa (AN)
5. Bulimia Nervosa (BN)
6. Binge Eating Disorder (BED)

7. Other Specified Feeding or Eating Disorder (OSFED)
8. Unspecified Feeding or Eating Disorder (UFED)

The Pandemic Of Eating Disorders Is Ruining Lives

Succumbing to one of these disorders is devastating to the victim, and their families and friends. It’s heartbreaking to watch someone you care about waste away, or become obese. Suddenly, they’re slipping away after every meal to purge. The usual joy of gathering to eat becomes fraught with neurotic behaviors, and denials of the obvious problems. I am passionate in my desire to educate people about eating disorders. Recognizing the signs and symptoms is crucial. Early treatment intervention significantly increases successes in beating an eating disorder. Entrenched eating disorders are much more difficult to reverse. Untreated eating disorders can often have fatal outcomes.

Sharing Real Experiences

I have shared clinical eating disorders information in other articles, which is useful and helpful. But, there’s nothing like real life examples to give an issue depth and clarity. I’m going to share with you actual interactions I, and our group practice therapists have with eating disorder clients. All personal information is anonymous to protect their privacy and confidentiality.

Client #1 – Currently BED

Client #1 is in her 50’s, and grew up with 3 siblings and 2 parents who battled with their own mental health issues. Client #1 experienced severe trauma throughout her life, starting in childhood at the hands of her mother. Her traumatic experiences continued into adolescence and young adulthood, and included other family members and acquaintances. During these adolescent years, Client #1 began to struggle with her weight and negative thoughts about herself, which she describes as debilitating. It was at this time that she started to develop an eating disorder, including binging and purging. These behaviors continued to go on for years as Client #1 developed her career, eventually got married, and had a child.

She experienced a worsening of symptoms, over a year ago, and decided it was time to get help. This client had had enough pain and suffering, and chose to deal with her eating disorder, and her past traumas. Client #1 was admitted into an inpatient eating disorder program, and completed all the steps of treatment that were offered to her. About 5 months ago, she started out patient individual therapy as recommended by her psychiatrist. She was in a much more stable place now after months of intensive therapy. Client #1 continued to work on herself and her treatment goals. It had been over a year since this client had engaged in binging and purging behaviors, and then Covid and quarantine happened.

Today, Client #1 has reported she has not succumbed to any purging, yet she has had binge eating episodes. She reports, since the quarantine, she is experiencing overwhelming feelings of fear and uncertainty which brings her to a place of total despair. During these times, Client #1 describes a feeling of no control, and going into a robotic state while participating in a binge. The additional fears and stressful components of the quarantine have been devastating for her. She continues to participate in virtual individual sessions, and is attempting to implement coping tools that she has been taught. Though treatment and coping tools have been helpful in the past, this client currently reports feeling she could end up back where she was a year ago. Everyday just feels overwhelming right now. Thankfully, Client #1 is continuing with our expert support.

Client #2 – Disordered Eating

Client #2 is a young female in her 20’s. She was living in her college dorm 2 hours from home. Then Coronavirus hit and she needed to come back home. The first time I engaged this client on the phone, I could immediately sense her anxiety. She was very forth coming with what she called, her terrible episodes. Her fourth and most recent episode happened several weeks ago when her boyfriend of 1 year broke up with her. Each previous episode, which usually had lasted at least a few days, had been triggered by a specific stressful event. During these episodes, Client #2 describes being unable to consume any food at all. She reports this last episode as so terrible with the addition of having to leave college due to the quarantine. This client began to describe a vicious cycle of negative thoughts and emotions that are filled with debilitating fear and serious health consequences.

These episodes begin with client #2 experiencing a major increase in her general anxiety symptoms. She reports, for as long as she can remember, always struggling with anxiety and self-doubt. Client #2 is burdened with memories of her parents constantly fighting. She recalls her father being physically abusive to her and her mother. At a young age, she suffered living through a vicious divorce, with the court system involved. Client acknowledges witnessing and experiencing a lot of physical and emotional trauma at the hands of her father, and continues to have a very conflicted and stressful relationship with him today. Though Client #2 now has much more control over interactions with her father, she continues to struggle with the dynamics of their relationship. To this day, client feels her father continues to try and brainwash me and feels constantly triggered by him.

Client #2 describes one of these episodes: she feels extreme nausea, loses all appetite, and becomes consumed with negative thoughts that can bring her down a dark rabbit hole. Client reports she logically knows she needs to eat, but feels like she physically can’t consume anything. As her body becomes weaker, her fearful thoughts begin to spiral. When she has forced herself to eat a small amount of food, she will become more nauseous and unintentionally start to vomit. During one of her previous episodes, her mother had to bring her to the hospital after she became extremely weak and dehydrated.

This client reports everything feels more intensified now due to Covid and the quarantine. There is added fear that she will be unable to get help, as she fears going to the hospital. Though client is not currently in an episode, she reports a huge increase in her anxiety symptoms, while realizing her appetite generally continues to decrease. She reports she is certain her amplified symptoms and feelings are directly related to the quarantine, including all of the uncertainty for the future. Client #2 technically has disordered eating. Through her intensive outpatient therapy with Sirona Therapy, she is dealing with her anxiety, and not going into a full eating disorder.

Client #3 – BED

Client #3 is a female in her late teens, who began outpatient mental health treatment for Binge Eating Disorder within the last year. By early 2020, this client had full awareness of her thinking process, her behaviors, and her triggers leading her to overeating and binging. She described extreme stress with her parents, tied to a contentious divorce. A divorce that both parents shared all details of with her. It is quite clear that since the beginning of Covid-19, this client became isolated, depressed and anxious. Client #3 had to do remote learning for her senior year of high school, and had to make critical decisions on which college she would hopefully attend in the fall. All without the support of her school staff, that she reached out to hoping for tremendous emotional support.

The last three months have been excruciatingly difficult for her. Client finds herself in the home with one very distressed and angry parent, and having to speak to the other bitter parent from a distance. All while knowing all their dirty secrets. As a result of these three months of stress, this client currently feels extremely overly sensitive, uncomfortable in her own skin, and invalidating her own feelings. This has led to Client #3 being incredibly insecure, and leaning on food for control. The recent challenge in the treatment is about safety. Intense work over the last few weeks, Involving journaling, has helped her to focus on her target goals, and what she is feeling. With our help, she is doing excellent work to find healthy alternatives to fill her void. A void that she admits she uses food to try and fill.

Client #4 – BED

This client is a young woman in her early 20’s with a diagnosis of binge eating disorder. In her mid teens she suffered with anorexia nervosa, and that transitioned into bulimia nervosa. Client has refused to deal with her eating disorder in her treatment up until now. The self-injurious behaviors we’re focusing on and addressing are cutting, excessive drinking, mood swings, and agitation. Client #4 comes from an exceedingly dysfunctional family with a bipolar father and an emotionally troubled mother. Manipulation runs rampant. This is a young lady who’s emotions have been stifled and stunted, and she was never allowed to have anywhere near a voice. Her treatment path has been learning to be tolerant, patient, and compassionate with herself. She is working at calming and progressing her life to meet her own needs. Client is learning to do this without using food as a weapon to deal with uncomfortable emotions, anger, and anxiety.

At this point, one year later in her treatment, she is actively engaged and aware of her symptoms and her triggers. Client is beginning to learn self care. For the first time, while under high stress, she did not engage in negative actions after an older adult made a comment regarding her weight. She stayed in her thinking and didn’t emotionally cave into eating disordered behaviors. Client #4 has advanced to tolerating and giving emotional space to uncomfortable emotions, in order to prevent disordered eating. She texted her friend and called her friend instead of obsessively counting calories, or obsessing about over exercising in order to lose weight. She did not ask her boyfriend if she looked thinner or heavier.

This tough situation gave this client the opportunity to grow and re-frame this triggering moment. Doing so allowed her to ultimately take much better care of herself. Before this point in her treatment, she would have started obsessing about the comment made. Then she would’ve downloaded an app to count calories and track her running, in order to burn off those calories and lose weight. This is a wonderful example of her tremendous improvements gained from seeking out, and staying with specialized eating disorder therapy.

Stemming The Pandemic Of Eating Disorders

This is only four of many cases we’re working with. They’re all very individual in their circumstances and therapy needs. However, the common theme is the extraordinary stresses of fear, uncertainty, and confinement. This is leading people to use eating disordered behavior as a dysfunctional coping mechanism. Note the other commonality; three out of four of these clients are dealing with Binge Eating Disorder. My last article highlights that this is the most prominent ED we’re seeing an increase in.

Our hearts go out to all in these challenging times. We understand how food can be a comfort. All of us at Sirona Therapy have had to catch ourselves overindulging in sweets, treats, and overeating since March. Please be aware, for yourself, family, and friends if this is becoming a problem. If you’re concerned there is a problem, get that person into treatment sooner than later. No one will want to be dealing with a full blown eating disorder, on top of everything else.

If you would like more information about our programs, or need help:

Jennifer L. Zauner, LCSWR
Clinical Director

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