Like many essential employees, Jessica, a grocery worker and graduate student in Atlanta, has been "extremely overworked" during the coronavirus pandemic. Overwhelmed by stress, she's fallen back into bad habits to cope.
Jessica, who is being identified by her first name only to preserve her anonymity, has struggled with bulimia for over a decade.
"I'm bingeing just so I don't snap like a stressed-out rubber band. I know I can't purge, because that's unhealthy," Jessica said. "So I find myself halfway through this cycle I've spent years trying to break."
The pandemic has heightened stress among many Americans, which has only been exacerbated by isolation and lack of frequent social contact. It has been the perfect storm of negative factors for individuals with eating disorders, or those who are in recovery.
"I think in many ways it's been disastrous," said Cynthia Bulik, who is the founding director of the UNC Center for Excellence in Eating Disorders, about the pandemic. Bulik co-authored a study published in July analyzing the early effects of the pandemic on people with eating disorders in the U.S. and the Netherlands. The study found the side effects presented by life in lockdown, including "a lack of structure, increased time spent in a triggering environment, lack of social support," resulted in a worsening of symptoms for individuals with eating disorders and a higher risk of relapse for those in recovery.
"This is just one of the tragedies that's following on the heels of the COVID crisis," Bulik said about the uptick in eating disorder cases, which can affect anyone regardless of race, gender, age or weight.
Chelsea Kronengold, the communications manager for the National Eating Disorders Association, said the NEDA Helpline has seen a 40% increase in contact since March 2020.
"Throughout the pandemic, NEDA is seeing an increase in calls focused on suicidality, self-harm and even the need for child protective services," Kronengold told CBS News in an email. Kronengold explained "eating disorders thrive in isolation," and the isolation imposed by working from home, social distancing measures and a break in routine "can put an extreme strain on people suffering from eating disorders."
Many individuals working from home have lost the structure to their days that helped them to establish better eating patterns, Bulik said.
"Time has lost its meaning in the pandemic and everything is just so amorphous, so it's much harder to superimpose recovery structure on an amorphous life," Bulik said.
Increased isolation also leaves more time for checking social media, which can be incredibly triggering for individuals with eating disorders. Meredith, who lives in Washington, D.C. and works in marketing, told CBS News that she was overwhelmed by advertisements for fasting apps.
"January and February are particularly hard months to be trapped at home because every social media user is inundated with fitness and diet ads," she said. Meredith, who is in her mid-twenties, explained the "boredom" of the pandemic era "leaves more time for scrolling aimlessly on Instagram and TikTok," which are crawling with influencers with certain body types.
Marita Cooper, a postdoctoral fellow at the Johns Hopkins University School of Medicine, said social media can be a serious trigger for individuals with eating disorders, particularly given the prevalence of memes about gaining weight during the pandemic era. Cooper was the lead author of a July study which found the "potential impact of the pandemic on individuals with EDs is staggering and necessitates concerted intervention efforts."
"The COVID weight gain discussion has been really problematic," Cooper said, referring to the so-called "COVID 15" or "quarantine 15," a play on the often-mocking phrase the "freshman 15," which refers to 15 pounds college freshmen put on.
Food insecurity levels have also risen in the U.S. during the pandemic, as millions of people have lost their sources of income, which can be triggering for individuals prone to bingeing and purging. Bulik noted that most of the cheapest food available is also unhealthy, which can lead to a greater risk of bingeing or feeling guilty about what they eat.
"That ends up being a horrible perpetuating cycle," Bulik said, where people continuously eat unhealthy foods and then react in maladaptive ways.
At the beginning of the pandemic in particular, many Americans took to hoarding food, believing they would be in quarantine for a few weeks or months. This was problematic for individuals who relied on eating certain foods as a way to manage their eating disorders, and now had more difficulty accessing these foods.
"Many people with eating disorders feel safe with a particular range of foods, and they have those foods on their meal plan," Cooper said. "When there's reduced access to those types of foods, that can be really triggering."
Stockpiling foods can also create an unsafe environment for individuals with bulimia or binge eating disorder, who are now trapped in a place where the temptation to overeat is omnipresent. People who are food insecure may take to bingeing frequently because they don't know when they will be able to eat their next meal, said Erin Parks, a clinical psychologist, researcher, and co-founder and chief clinical officer for Equip, a virtual eating disorder program.
"Those become kind of survival behaviors if you're food insecure," Parks said.
However, the news is not entirely bleak for individuals struggling with eating disorders. The study co-authored by Bulik found a positive consequence of the pandemic was "perceived increase in social support that helped challenge their eating disorder behaviors and increase motivation to recover."
Thy Vo, a 29 year old journalist living in Colorado, said her disordered eating habits were "vastly better" in light of the pandemic. She has struggled with bingeing and especially purging behavior for seven years.
At the start of the pandemic, she struggled with eating in front of her boyfriend, as she could not hide her behaviors when they were both stuck at home all the time. Although it initially strained her relationship, the conditions forced by the pandemic ultimately helped her, including participating in an online group for individuals with eating disorders.
"Eventually, being at home all the time helped me normalize my eating habits, which helped tone down all my ED thoughts significantly," Thy Vo said. "Being forced to sit down and eat all my meals with my boyfriend three times a day was torturous but ultimately helped."
The increased time at home has also helped some adolescents with eating disorders, who have been able to receive support from their families, and be held accountable. It is more difficult for young people to slip into disordered eating habits when they are constantly surrounded by family members.
Parks said children and adolescents are "more likely to recover" if they have adults in their life supporting them. She added that an increased reliance on telehealth had made it easier for family members to attend multiple sessions of counseling per week, instead of having to physically travel to different appointments.
"The benefit of telehealth is that everyone can come," said Parks, encouraging people to "truly bring in their whole village" to address an eating disorder. Equip offers virtual family-based treatment, which utilizes what Parks described as the "radical idea that families are best equipped to help their loved one recover from an eating disorder."
However, even with the greater use of telehealth and the potential for familial support, there will likely be long-term damage from the pandemic for individuals with eating disorders. Bulik said she looked forward to doing a one year follow-up study on how respondents were coping several months into the pandemic, and see whether people were still reporting a stronger resolve to recover or closer ties with their families.
"I think pandemic fatigue might be eroding those positives," Bulik said.
People can recover from eating disorders, with support and treatment. But the road to recovery for many has been derailed by the pandemic, and it might be hard to get back on track.
"There's this assumption that EDs might go away after life goes back to normal," Cooper said. "But this is not something that's going to magically go away."
If you or someone you know is struggling with body image or eating concerns, the NEDA toll free and confidential helpline is available by phone or text at 1-800-931-2237 or by click-to-chat message at nationaleatingdisorders.org/helpline. For 24/7 crisis support, text "NEDA" to 741-741.
The NEDA has also put together a list of free or low-cost COVID-19 resources: https://www.nationaleatingdisorders.org/help-support/covid-19-resources-page.
F.E.A.S.T. is a nonprofit organization providing free support for caregivers with loved ones suffering from eating disorders.