Mental health1
How to take care of your mental health during a pandemic
02:56 - Source: CNN
CNN  — 

Cara Lisette has spent more than half her life battling anorexia. Now under the coronavirus lockdown, she says she is also fighting to find the few foods she considers “safe” to eat.

Lisette, a 29-year-old nurse, says she was originally diagnosed with an eating disorder at age 13. After years of relapse-and-recovery cycles, she became unwell once more last June and took time off from work in December, shortly before the outbreak of Covid-19.

After seeking help from her doctor, she says she was offered a place on an outpatient treatment program, where she took part in therapy groups and ate three meals a day under supervision. But when the UK government announced a lockdown to help prevent the spread of coronavirus, the service was closed down for 12 weeks.

The pandemic has exposed new challenges for Cara Lisette, a 29-year-old nurse from Southampton.

“It’s been really difficult because a lot of what we are doing there is meal support,” she says. Without that help, “I’m just having to wing it at home by myself.”

“I feel like I’ve had a big chunk of my treatment stolen from me.”

The coronavirus pandemic has left Lisette and many others suffering with eating disorders facing new challenges and exacerbated pre-existing problems for others.

Support groups estimate that some 1.25 million people in the UK are living with an eating disorder. In the US, that number could be as high as 30 million.

The National Eating Disorders Association (NEDA), a leading US eating disorder nonprofit, reports that it has seen a 56% increase in its instant messaging service over the past week. The service provides people with an alternative to having to speak over the phone.

“It seems like people don’t feel as comfortable to make phone calls when they are in quarantine with others,” said Kylee Siaw, a spokesperson for NEDA.

In the UK, eating disorder charity Beat says it has seen a 35% increase in people contacting its services since the UK lockdown was announced. Beat spokesman Tom Quinn says the number of people reaching out via social media has increased by 80%, and the number of people using its online groups is up by 51%.

“Everyone who is contacting us is talking about coronavirus and how that’s impacting their eating disorders,” says Quinn.

Quinn says the charity has been contacted by many people who had previously considered themselves “recovered” from their eating disorder, but who fear that the pandemic has put them at risk of relapsing.

‘Shopping is really difficult’

Megan Birchall, 18, from Oldham in northern England, has had anorexia since she was 15. She says the food-related panic sparked by coronavirus has been “so triggering.”

Before the pandemic, she says she was making good progress, and considered herself to be in recovery. But under lockdown, her eating disorder has once again come to the fore.

Megan Birchall has had anorexia since she was 15.

Birchall lives at home with her father, who she cares for part-time, alongside her job working at an archive. As a result, she does most of the grocery shopping.

“Shopping is really difficult,” she says, explaining that standing in line gives her anxiety “because there’s so many people about.”

Like many people with anorexia, Birchall relies heavily on so-called “safe foods,” which are items people with anorexia consider safe to eat based on food group, fat and sugar content, and calorie count.

For each individual, safe foods differ. For Birchall, they are yogurt and dairy products. Because the lockdown sparked panic-buying and stockpiling across the UK, she says she has been unable to find any at her usual store. That means she has to shop around, which “triggers” her anxiety, she says.

She’s also struggled to find vegetables and fresh food, forcing her to turn to frozen food and snacks.

“It feels like I’m forcing myself to eat cardboard for the sake of it,” she says. The limited options available have put her off eating altogether.

“Anything around food, it’s just been so much more stressful than it normally is,” she says.

Birchall had been seeing counselors every two weeks, but now, under lockdown, all of her appointments are over the phone. That’s hard for her to do quietly, especially since her father doesn’t know the extent of her eating disorder. “The walls are so thin,” she explains.

Stressful to rely on others

Like Birchall, Lisette, from Southampton on the south coast of England has found it near-impossible to get hold of the “safe foods” that would enable her to stick to her prescribed meal plan during the lockdown.

Her safe foods – baked beans, spaghetti and other canned and packaged food – all sold out quickly as panic-buying spread. She says this made her want to buy multiples of the same product when they became available. But having lots of food in the house makes her anxious.

“If I find some things that I’ll eat, I want to buy them because I don’t know when they’ll be next available,” she explains. But she also worries that she is “taking it away from other people that need it.”

As an asthma sufferer, Lisette is following the UK government’s guidance to self-isolate for 12 weeks to protect herself from coronavirus. As a result, she has to rely heavily on her boyfriend to do the shopping, which she says is “really stressful.”

“I just have to give him a list of things that I want and hope that he can find them, not necessarily knowing what the alternatives are going to be,” she says. “Today I was eating something different for lunch and … I was thinking about it for about four hours in the night.”

These illnesses thrive in isolation, says Cynthia Bulik, founding director of the University of North Carolina’s Center of Excellence for Eating Disorders.

“Individuals who are sheltering at home can find themselves stuck in the whirlpool of their own eating-disordered thoughts, without social support of lifelines to help anchor them in a recovery mind-set,” she explains.

“People’s lives have been interrupted and disrupted,” she adds. “People’s treatment and recovery plans have been interrupted.”

Bulik says that amid the coronavirus pandemic, many people with eating disorders are concerned about weight gain, gym closures and getting regular exercise.

Lisette says being at home gives her a lot of time with her thoughts to think about food, calories and exercise. “I find having a lot of time on my hands makes me want to exercise more. One, because of the eating disorder and two, because [it’s] a way to pass time. I’m probably exercising more now.”

Bulik says that for their part, clinicians are trying to be “extremely careful” to ensure their patients are eating healthy, balanced meals.

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“When you are not able to weigh someone in your office and you are working with them virtually, you need to develop new strategies to ensure that they are safe and continuing to work toward recovery,” she adds.

While Lisette speaks to a nurse, occupational therapist, and support workers several times a day, and has weekly video calls with her therapist and dietician, not being able to visit the clinic in person has affected her “massively,” she said.

Birchall was on dietician-supervized meal plans before the pandemic but says the uncertainty it has sparked means she doesn’t want to eat.

“We have no control right now, so you sort of latch on to the one thing you can [control],” she explains. “It really is just awful to feel completely like you’ve just been knocked back … I definitely do think I’m losing weight.”

If you or someone you know has an eating disorder, Beat (in the UK) has phone and chat services available on its website and NEDA (in the US) has phone, text, and chat services available on its website.