Anxieties have been running high during this past pandemic year, and with that comes mental health struggles for many people.
It’s probably no surprise that things like anxiety disorders and depression have been increasing recently, but there’s another mental health issue many people may not know is also on the rise: eating disorders.
“We anticipated a lull in people coming in because of the pandemic, and that has not been the case. The treatment center I work at has been full the entire pandemic,” says Dr. Megan Riddle, a psychiatrist and a courtesy faculty member in the Psychiatry and Behavioral Sciences Department at the UW School of Medicine.
Riddle specializes in treating eating disorders and trains other physicians in eating disorder treatment.
Eating disorders “love an unstructured environment,” she explains; that is, they thrive in times of stress (like the pandemic). When someone is struggling to cope, eating disorder symptoms offer a rigid structure that, while unhealthy, may seem at the time like a better alternative than uncertainty.
Some people may be experiencing a relapse of symptoms they thought they’d resolved; other people may be experiencing disordered eating for the first time. If either of these is you, here’s what you need to know about eating disorders and how to seek help.
What are eating disorders?
Many of us will experience the collision of food and stress at some point in our lives, Riddle explains. That is totally normal and not the same as having an eating disorder.
“We all use food to cope in some degree, whether that’s skipping food when anxious or reaching for the extra donut when it’s been a rough day,” she says.
Eating disorders are much more severe and pervasive. They involve fixating on food and excessive control of eating patterns. People with eating disorders will often think about food way more often than other people, and food is often a source of anxiety or distress.
Two of the most well-known eating disorders are anorexia nervosa, which involves significant weight loss or lack of weight gain paired with restrictive eating; and bulimia nervosa, periods of binge eating followed by purging via vomiting, laxative use or excessive exercise.
There’s also a specific type of bulimia, called diabulimia, that impacts people who have diabetes.
There are other types of eating disorders, too: orthorexia, which is an obsession with “clean” or “healthy” eating; atypical anorexia, which is restrictive eating in someone who isn’t at a low weight; binge eating, which is similar to bulimia but without the purging; avoidant restrictive eating, which involves excessively limiting the types foods you eat; and others.
Who is at risk for an eating disorder?
The stereotype often presented in the media is of a thin, middle-class, straight white woman who develops an eating disorder, often anorexia. Riddle wants people to understand that, in fact, anyone can get an eating disorder — and stereotypes about eating disorders may contribute to people not getting the help they need.
“Eating disorders cross all ethnicities, all body types, all genders, but people who are already marginalized often get overlooked. For example, data shows medical providers aren’t thinking about an eating disorder in someone who has a ‘normal’ BMI,” Riddle says.
Transgender people and others in the LGBTQ+ community, BIPOC people, and people in larger bodies are all equally or more at risk for eating disorders than straight, thin white women, yet they often don’t seek care or, if they do, aren’t taken seriously.
“Some of the most ill patients I’ve cared for are folks who are living in larger bodies, not the super underweight patients who tend to get flagged for care much earlier. There’s a problem with patients not being believed when they say how little they eat when they live in a larger body,” Riddle says.
What are the symptoms of eating disorders?
Each eating disorder has a unique set of symptoms, but there are a few general symptoms that Riddle says people should pay attention to.
The first is how much time you spend thinking or worrying about food.
“If a lot of your day is structured around what, when and how much you’re eating, that can be a sign that something’s up,” she says.
Next is having rigid structures about what you eat and when you eat it; for example, deeming a lot of ordinary and healthy foods “bad” or “unsafe” or always eating the same meals at the same time and getting anxious if unforeseen events throw your schedule off track.
Another potential sign of an eating disorder is if eating brings up a lot of unpleasant emotions or makes you feel out of control or ashamed. Purging, either by forcing yourself to vomit, taking laxatives or overly exercising, can also accompany those feelings.
There are many physical symptoms people can experience, too, such as noticeable weight fluctuations, stomach problems, sleep problems or dizziness and fainting. Other signs can indicate your body isn’t functioning the way it should because of a lack of nutrients, such as anemia, poor blood circulation, missed periods or wounds that take too long to heal.
People who have an eating disorder are also at higher risk for developing anxiety, depression or other mental health problems.
Why are eating disorders dangerous?
In a society that glamorizes “clean” eating and values thinness as the ideal body type, it’s important to know that eating disorders are nothing to glorify. In fact, they can be deadly if left untreated.
Among mental health disorders, anorexia has the highest mortality rate second only to opioid use disorders, and other eating disorders also carry an increased risk.
While part of this is due to the way eating disorders can take a physical toll on the body — resulting, if left untreated, in things like sudden cardiac arrest — a significant mortality risk for people with eating disorders is suicide, Riddle says.
“Sometimes it’s not necessarily that they want to kill themselves, but that life feels overwhelming and there’s some draw to having an exit strategy,” she says.
How are eating disorders treated?
First, one important fact: eating disorders are treatable.
“I see my patients get better all the time. It’s not an easy journey, but folks do get better,” Riddle says.
She cites statistics that say around 80% of people who get treatment for an eating disorder will see significant improvements or complete recovery, while around 20% of people will go on to develop a chronic problem.
What treatment looks like depends on how sick someone is, Riddle says. If someone has only recently developed symptoms or is otherwise mostly functioning in their day-to-day life, they may be able to get the support they need via outpatient therapy and check-ins with their primary care provider (and perhaps a dietitian).
For people who are more severely ill, inpatient care may be necessary at first to help get them stabilized. At inpatient care, people are given regular meals and observed while eating (to make sure they eat), because getting someone’s body nourished again is the top priority, Riddle explains.
Along with supportive meals comes therapy and helping people learn how to cope and manage difficult emotions.
“Eating disorders really serve this coping role and can help folks manage difficult emotions, so we have to give them something else to help them cope if we’re taking away their eating disorder behavior,” Riddle explains.
Once regular nutrition and coping strategies are established, the next step is helping someone unpack any traumatic experiences they had that may have contributed to the development of the eating disorder, along with addressing and treating any coexisting disorders such as anxiety or depression.
The most important part of eating disorder treatment is that people get it, Riddle says, because it’s extremely difficult to recover without support.
If you’re wondering if you’re starting to develop an eating disorder, Riddle recommends reaching out to your doctor either for a referral or to talk with them directly about your symptoms. If you’re someone who has had an eating disorder in the past and is experiencing a relapse, she recommends reaching out to any doctors you worked with before who helped you.
“My philosophy with patients is, ‘I hope to never see you again AND relapses are totally normal work in eating disorder recovery.’ It doesn’t mean you failed, it just means you need a little extra help right now,” she says.