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Eating disorders: challenges of the pandemic
Dr Joanna Silver posted an article in Eating disorders
This week is Eating Disorders Awareness Week. Eating disorders are complex mental health conditions. People with eating disorders use food as a way of managing difficult feelings and maintaining control, particularly when life seems uncontrollable. In March 2020, the world changed in a blink of an eye when the COVID-19 pandemic struck. Dr Joanna Silver, Counselling Psychologist, discusses the additional challenges the pandemic brought for many people with eating disorders. Food challenges In the early days of the pandemic there were many reports of food shortages. This was extremely anxiety provoking for people with eating disorders who rely on ‘safe foods’ and found that these foods were out of stock. Some people who suffered from binge eating disorders reported that the emphasis on stockpiling foods in case they ran out led to many binges. Some people with eating disorders find it easier to eat out with others and the inability to do this was hard for some. Staying at home Various orders to stay at home over the past two years have been challenging. Routines are usually helpful for people with eating disorders and many people felt scared to be at home with their daily routines so changed. Many children struggled with school being suddenly cancelled and felt out of touch with their peers. Some children found it difficult having so much time at home and became invested in losing weight as a project and a way of gaining a sense of achievement. Teachers are often excellent at picking up the early signs of eating disorders in children, and many eating disorders went unnoticed during the pandemic. Some people really struggled when the gyms closed and felt an extra pressure from social media to use lockdown as an opportunity to ‘get fit’. Managing feelings Many people felt out of control during the pandemic and experienced a variety of feelings, including fear, loneliness and uncertainty. This led many to turn to food as a way of maintaining an illusion of control. Treatment challenges Recent analysis from the Nuffield Trust showed a quadrupling in the number of under-19s waiting for treatment for eating disorders since the start of the pandemic, with more than 2,000 on the waiting list. For some people, treatment abruptly stopped at the beginning of the pandemic which was extremely disruptive. Others were offered remote treatment. Some people really struggled with this and found it difficult to connect to professionals online. Treatment for an eating disorder often involves being weighed by a professional and remote treatment often meant that people had to weigh themselves which was challenging for some. Despite these challenges, it is important to note that many people find remote treatment extremely effective. Even though many services are now seeing people face to face, many people opt for remote therapy as they find that it is more accessible and flexible. Conclusion Sadly, the pandemic has really impacted people with eating disorders and there has been a great demand on eating disorder services. Dr Agnes Ayton, the chair of the eating disorders faculty at the Royal College of Psychiatrists, said in a Guardian article in January: “The hidden epidemic of eating disorders has surged during the pandemic, with many community services now overstretched and unable to treat the sheer number of people needing help. We are at the point where we cannot afford to let this go on any longer." Early intervention is so important in the treatment of eating disorders and I would really encourage people to seek help for themselves or others if they are worried. I would recommend your GP as a first port of call as well as BEAT which is an excellent charity. -
Content Article
My role as a lead therapist for eating disorders
Dr Joanna Silver posted an article in Stories from the front line
Dr Joanna Silver describes her role working with adults and children with eating disorders. An important part of her role is to work closely work with the multidisciplinary team and other health professionals to make sure the complexities of treating people with eating disorders and related conditions are understood and to ensure the patient is kept safe. In my current role I oversee the therapy programme for the Eating Disorders Unit (EDU) and see in-patients, day-patients and out-patients for individual and group therapy. I work with both adults and children with eating disorders, depression and anxiety, and use evidence-based therapies including cognitive behavioural therapy (CBT). A case study Lucy* is a 25-year-old interior designer who is seeking treatment for anorexia. She was an inpatient on our EDU. Throughout the whole admission there is a strong focus on patient safety. One of Lucy’s goals was to gain weight to a safer weight, but the increases were very gradual to avoid refeeding syndrome. At the beginning of her stay and all throughout we carried out regular risk assessments to check her risk to herself and also to others. Lucy had her bloods monitored throughout and was regularly observed for physical symptoms. In terms of the therapy, our focus was looking at the role that anorexia played in Lucy’s life. To do this we did a collaborative formulation which was continually evolving. This helped Lucy to make more sense of her illness and understand what it meant to her. Lucy was able to articulate that her anorexia made her feel ‘special’ and also was a way of managing difficult feelings such as feeling upset and angry by her parents’ divorce. Lucy was also able to identify that feelings were not spoken about in her family, so she did not have the ability to identify and name feelings. Lucy did very well in therapy managing both the physical and mental challenge of gaining weight. Over time, Lucy found different ways of managing her feelings such as talking to others, distracting herself and writing a journal. An essential part of our work is relapse management and ensuring that patients learn from their ‘blips’ instead of viewing them as failings. Key learning points I am flexible in tailoring treatment to patients’ needs and it is important to build a warm and trusting therapeutic relationship with patients. As part of my role I work closely with the multidisciplinary team and regularly present to other healthcare professionals about the complexities of treating people with eating disorders and related conditions and to ensure the patient's safety is always met. Here are some of my suggestions when treating children and adults with eating disorders: It is important to remember that whilst sometimes people with eating disorders can look very emaciated and frail, at other times they can be a normal weight and look well. It is therefore vital that health professionals do not solely use weight to diagnose an eating disorder. People with eating disorders often have a great deal of shame and so may not readily disclose their symptoms and instead may present with physical problems such as bowel problems. It is helpful if health professionals ask question such as "do you ever restrict your food" or "do you ever experience guilt after eating". Treatment for an eating disorder involves monitoring both the physical and psychological health of the patient. In order to ensure the physical safety of patients, tasks include monitoring electrolyte levels, assessing for risk and assessing patients nutritional and fluid levels. Eating disorders are complex mental illnesses in which patients use food in different ways to cope with difficult feelings. Health professionals should aim to build a positive therapeutic relationship with patients and should have a non-judgmental and accepting attitude towards them. *Name and details of patient have been changed to preserve confidentiality.
