Self-isolation a nightmare for people with eating disorders

Social isolation, limited access to essential items, chaotic and overcrowded supermarkets, uncertainty about the future.
 
This new reality of the coronavirus pandemic is enough to make anyone anxious. But for those with an eating disorder, the impacts can be dire.
 
‘People living with an eating disorder during this time have indicated a significant increase in eating disorder behaviours and thoughts due to the high levels of stress and uncertainty associated with COVID-19,’ Juliette Thomson, psychologist and manager of the Butterfly Foundation’s helpline, told newsGP.
 
Over the past month, Ms Thomson says the national helpline has been inundated with calls from people with eating disorders, as well as carers, who are now facing a unique set of challenges and triggers.
 
It is estimated that 4% of Australians are currently experiencing disordered eating, with between 60­–80% of those also experiencing co-occurring anxiety disorders.
 
Being encouraged to stay at home can mean a breakdown in routine, less external distraction and a fractured support system, leaving people alone with their thoughts for increased periods of time. That can soon lead to feelings of helplessness.
 
‘Their days often involve thoughts centred around food, exercise and routines; they have higher energy needs [and] may experience extreme worries, especially around food or body image, along with rigid thoughts about types of acceptable foods,’ Christie Arbuckle, a clinical psychologist from Eating Disorders Victoria (EDV), told newsGP.
 
‘The current climate may see an exacerbation in these thinking styles as people search for elements still within their control due to a state of uncertainty.’
 
Ms Arbuckle says this may be confounded by increased anxiety over access to adequate grocery items, overcrowded supermarkets and limited access to essentials. 
 
‘People with an eating disorder often report generally feeling uncomfortable in a supermarket, as well as finding it stressful to make decisions about food purchases when shopping,’ she explained. 
 
‘Seeing empty shelves of staple items can lead to increased anxiety, worry and concern, along with confusion as to which items may be appropriate substitutes in a meal plan. For some it may see them feeling overwhelmed.’
 
This could lead to purchasing excess food, potentially leading to hoarding and stockpiling. Meanwhile, being unable to access ‘safe foods’ can result in not eating at all, and rationing food may lead to severe calorie restriction.
 
For those prone to binge eating, stockpiling food in the house can create a particularly challenging environment that leads to bingeing or not eating according to routine.
 
‘The other tricky one for people with restrictive eating disorders like anorexia, [is that] the primary treatment model is the families refeeding them in order to regain the weight that they’ve lost,’ EDV Chief Executive Belinda Caldwell told newsGP.
 
‘So for families who are in the middle of doing that process, which is extremely tough at the best of times, it’s quite anxiety-provoking for them if they can’t get access to enough food to support that weight gain.’
 
Ms Thomson says it is important the community works together to ensure people have access to a variety of different foods, and ‘disengage from hoarding or stockpiling as much as possible’.
 
The introduction of priority assistance programs by Australia’s major supermarkets has been hailed as an important step, with lobbying by eating disorder organisations allowing those with mental health issues to have priority access to home deliveries.
 
While there is no specific data as yet to suggest those with eating disorders are at an increased risk of contracting coronavirus, there is concern that malnourishment impairs the immune system, making them more vulnerable to the virus and putting carers at risk.
 
Delayed diagnosis is also a possibility, as those with chronic malnourishment may not mount a typical febrile response.
 
Eating disorders have the highest mortality rate of any mental illness, and patients can deteriorate rapidly.

However, as healthcare resources become increasingly strained during the coronavirus response phase, Ms Caldwell admits there is anxiety that eating disorders may get deprioritised.

‘They will still need medical monitoring,’ Ms Caldwell said.
 
‘It’s important that GPs are really aware if they’re seeing people that they’re checking if they have an eating disorder, because it will just complicate things.
 
‘The problem is if they need medical admission for their eating disorder. That’s going to put unnecessary burden on the health system.’

In what has been lauded as a ‘life-saving’ initiative, the Federal Government allocated $74 million for mental health services as part of a $1.1 billion package to support Australians through the pandemic. Telehealth expansion ensures patients can receive bulk-billed care.
 
As a first point of contact, GPs may need to continue seeing patients with a confirmed or suspected eating disorder face-to-face to adequately assess physical wellbeing and ensure their safety.
 
‘It is essential that people keep in touch with their professional supports, whether this be a psychologist, dietitian, GP, psychiatrist or other health providers, to ensure that their health is being monitored and connections are healthily maintained,’ Ms Arbuckle said.
 
GPs can access resources developed for primary care professionals by the Victorian Centre of Excellence in Eating Disorders and EDV about coronavirus and eating disorders.
 
The RACGP has more information on coronavirus available on its website.
 
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