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What COVID-19 Restrictions Mean to Those in Eating Disorder Recovery

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Editor's Note

If you live with an eating disorder, the following post could be potentially triggering. You can contact the Crisis Text Line by texting “NEDA” to 741741.

The coronavirus is triggering many people, even those whose illnesses are long gone.

As the coronavirus (COVID-19) turned from a worrying new illness into a terrifying global pandemic, I was preparing for a kitchen renovation. By the time I’d finished carefully wrapping my plates, glasses, cutlery and fancy gadgets in sheets of white paper, and storing them all in boxes, it was clear this was not the ideal time to have no means to cook the food I needed to sustain me.

Yesterday I postponed the renovation. Even if we commenced work later in the week as planned, there’s a good chance that the government would introduce more draconian restrictions than are currently in place. Total lockdown would see work grind to a halt and leave me without a kitchen indefinitely.

This prospect unsettled me, probably more than it would most people. I knew I wouldn’t starve. I had a freezer full of food I’d prepared in anticipation of the period when I’d have to rely on a microwave for hot meals. I knew there was a range of prepared foods that could still be delivered to my door. I also knew that my nervousness was different from the generalized anxiety that has resulted in panic buying and empty supermarket shelves.

The reason for my disquiet reaches back many decades. Anorexia nervosa entered my adolescence with a savagery for which my comfortable middle-class childhood had ill-prepared me. It almost cost me my life. Anorexia not only changed me physically but also created a rigid, obsessive, hostile version of myself who, for several years, was more than a little “crazy.” Starvation does that.

Despite the profound effect my illness had on my family and me, I’m proud of my hard-fought recovery and of the life I’ve built for myself since those dark days. Although it has never been easy for me to discuss my illness, I’ve tried to be open about my experience for two reasons.

First, I consider the stigma attached to mental illness to be one of the last widely sanctioned ways of marginalizing a section of society. Discrimination often occurs when peoples’ demons are at their most distressing and destructive, when they are most in need of compassion and care.

These people have no voice. I do.

The stigma attached to eating disorders is particularly shaming, as these are conditions often seen as self-indulgent vanity rather than illnesses. Many people believe eating disorders are trivial and can be easily overcome, even though anorexia nervosa has the highest mortality rate of any mental illness.

The second reason I speak out is that the media shapes most people’s beliefs about eating disorders. And especially when it comes to television, the media focuses on the extremes of the illnesses. Apparently this makes for compelling viewing.

What the wider community doesn’t see or read about is someone like me, who overcame her illness and went on to lead a happy, productive life. I tell my story because it is a story of hope.

And yet, despite how far I’ve come, the coronavirus has reminded me that I need to remain vigilant against an instinctive need for control. I’m a rigid person who likes routine. Whether this is a character trait that predisposed me to anorexia or a result of my illness is a moot point. Bottom line: I’m feeling anxious.

Examining the brains of people with anorexia nervosa has opened up exciting new research into the illness. One focus of the research has been cognitive flexibility, which the last week has shown me I’m still lacking. Set-shifting is one’s ability to move back and forth between tasks, operations or mental sets in response to a change in environment.

Studies have consistently shown that people with anorexia nervosa have trouble with set-shifting, and the majority of studies show that cognitive flexibility remains impaired even when people recover. So maybe that’s why I am currently feeling the way I do.

Whatever the reason, I’m confident I’ll navigate my way through the current crisis. There have been many times over the years when I’ve had other physical ailments and needed to be particularly vigilant about my weight. There have been just as many periods of emotional distress when I’ve had to resist the siren-call of restriction. I will live with my current discomfort and be fine.

But many others around the world are far from fine. I am currently working on a book for the families of people with eating disorders, so recently I joined some online “lived experience” forums for eating disorders. What I’m reading on these websites is heartbreaking.

Not having ever had the condition, I can’t speak to the emotions of those with bulimia, other than to say this: however maladaptive binging may be as a coping mechanism, it is how some people manage their world. People with bulimia are usually advised to limit the amount of food to which they have access. Now people are being told to stock up. The extent to which people can binge is normally restricted to the time they can be alone. Now the advice is to isolate yourself.

Deep in the bulimic mindset is a fear of running out, of not having enough, of not being strong enough to resist what is available. The dangers posed by a world in lockdown are obvious. For many anorexics, restricting food is a way of controlling a world that feels out of control.

The rapidity with which the coronavirus has redefined our day-to-day existence has left even those of us with no psychological vulnerabilities feeling powerless, so imagine factoring that sense of powerless into the struggle to overcome a restrictive diet.

Most people in the grip of anorexia need certainty around their food. In their minds, there are good foods and bad. They want to eat particular foods, and they need to prepare and eat them in a certain way. And then they need to exercise. These patterns may be unhealthy, but all too often the alternative to their ritualistic behavior around food is abstinence. Even people committed to putting on weight are now finding that many of the things they have put in place to facilitate weight gain are impossible. They will need to eat what is available, not what they want or find easy.

Anorexia is such an isolating condition. It thrives on secrecy; so almost inevitably, people with the illness cut themselves off from loved ones, to succumb to the demands of their compulsions. A vital part of recovery is reconnecting with the world, with people who can encourage us, which helps us normalize our relationship with food.

Self-isolation is narrowing people’s focus, and their destructive internal voices are growing louder. I’m sure some people who will look at the perilous state of the world, at those terrible scenes in hospitals and rising infection rates and death tolls, and see concerns about food as self-indulgent narcissism.

Maybe if I had not waged my battle so long ago, I would feel the same way. Instead, I see the impact the pandemic is having on the lives of people already desperately fighting for an existence that most take for granted, and I feel the most profound sadness.

People in recovery will die, but they will not show up in any of the coronavirus statistics. Their struggle is worthy of acknowledgement.

Struggling with your mental health due to COVID-19? Check out the following articles from our community:

Getty image by annwaterru

Originally published: May 1, 2020
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