Eating disorders thrive in anxious times, and pose a lethal threat

For most of her 34 years, Stephanie Parker didn't recognize she had an eating disorder.

At age 6, she recalls, she stopped eating and drinking at school — behavior that won her mother's praise. "It could have started sooner; I just don't have the memory," says Parker. In middle school, she ate abnormally large quantities, then starved herself again in the years after.

This spring, it all came to a head: She was confined and alone in her New York City studio apartment, as COVID-19 ripped through the city. The pandemic fomented fear and, for Parker, called up past trauma and aggravated the obsessive compulsive disorder that had started to become apparent years earlier. She realized then her relationship with food was life-threatening.

"The OCD and anxiety ... just made my eating disorder more intense, and for me that meant I would become obsessed with cleaning everything and then checking in with myself to see if I deserve to eat," says Parker. It wasn't just that cleaning frenzies on an empty stomach left her with no energy to pick up a fork. "I would become scared of food — I got scared that food would make me sick because it wasn't clean enough."

Eating disorders are thriving during the pandemic. Hotline calls to the National Eating Disorders Association are up 70-80 percent in recent months. For many, eating is a form of control — a coping mechanism tied to stress. Food scarcity and stockpiling behavior can trigger anxieties about eating, or overeating among some.

"We know that eating disorders have a strong link to trauma," says Claire Mysko, CEO of NEDA. "Many people with eating disorders have past experiences with trauma, and this [pandemic era] is a collective trauma."

It's also a lethal threat. Eating disorders have the second-highest mortality rate of any psychiatric diagnosis — outranked only by opioid use disorder.

A survey in International Journal of Eating Disorders in July found 62 percent of people in the U.S. with anorexia experienced a worsening of symptoms as the pandemic hit. And nearly a third of Americans with binge-eating disorder, which is far more common, reported an increase in episodes.

"Many people in our study ... were talking about concerns that their eating disorder would get worse because of a lack of structure, a lack of social support, living in a triggering environment. And now that sense of structure has just kind of gone out the window," says Christine Peat, a co-author of the study. "And with that can go the structure you had around your meals and your snacks."

A boom in teletherapy, Peat says, has helped some people continue to receive care, but it has left many people behind — 45 percent of respondents — without care.

Often eating disorders are misunderstood as a white woman's disease. That's meant early signs are often missed among men or boys (who make up a quarter of eating disorder cases) and particularly among people of color. The gap in access to care also cuts along race: "We know, unfortunately that people of color are only receiving treatment at about half the rate of their white counterparts," Peat says.

In fact, says Parker, race was the primary reason she didn't think she had an eating problem until very recently. "The language used around eating disorders was about white girls having eating disorders," says Parker, who is Black. "It was about the emaciated-looking type girls or the girls that I heard throwing up in the bathroom."

Besides, Parker was athletic, and she appeared healthy. So for decades, she ignored her own compulsive anxieties and behavior as just some version of normal. "For me, in my head, I felt like ... I don't fit into any of those categories — so therefore, this is not affecting me."

Race, she says, was also a barrier when choosing a therapist.

"As a woman of color dealing with this eating disorder, I originally wanted to find another woman of color who specialized in eating disorders who could do teletherapy appointments with me," Parker says. Not being able to find one, because there are so few, made her sad.

"For me, part of the reason I kept myself in hiding about this was that I didn't feel like I was connected to the people I was seeing," she says, "because they didn't look like me."

Nonetheless, she adds, the therapy she's getting has really helped: "I can actually feel emotions and talk about them. I feel great — I just went out to dinner last night."

Even for those further along in their recovery, pandemic life has made it difficult to retain balance.

"Eating disorders are isolating to begin with, and here we are, isolating ourselves even more," says Ryan Sheldon, a model in Los Angeles. For Sheldon, 32, who has a binge-eating disorder, lots of time at home alone reminds him of a time, several years ago, when he racked up $40,000 in credit card debt, largely from spending on fast food.

Grace Segers is facing down similar ghosts. Segers, a political reporter for CBS, has spent her days during the pandemic working from home, next to a kitchen stocked with items she used to binge and purge: Ice cream and frozen entrees.

It's almost as if she's haunted by a reflex to return to an old way of coping, she says. One weekend recently, she was nearly overcome by a desire to give in: "I was literally sitting on the bathroom floor saying to myself over and over again, "I don't want to do this; this isn't going to make me feel better."

It is, she says, a constant struggle. "It's always there if the conditions are right — or wrong, rather — for me to have a relapse. And so I feel like I can't let myself become complacent about it

To find out more or get help in dealing with an eating disorder, you can contact the National Eating Disorder Association online, or text "NEDA" to 741741 to reach a trained volunteer at the group's crisis text line.

Copyright 2020 NPR. To see more, visit https://www.npr.org.

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