Eating Disorders, Exercise Addiction, & a Pandemic.
Commonly Known Types of ED & Their (Brief) Diagnostic Criteria:
Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Binge-Eating Disorder (BED).
- Anorexia Nervosa (AN): is characterized by an individual’s refusal to maintain healthy body weight, intense fear of gaining weight, and significantly distorted perception of one’s body image. There are 2 types: 1 is the restricting type- meaning there is no engagement in binging or purging behaviors (weight loss is accomplished by significant dieting, fasting, and/or excessive exercise); 2 is the binge/purge type- meaning that there is engagement in binge/purge behaviors (eating a significantly increased food intake in a small time frame, vomiting, use of laxatives, diuretics, and enemas). *crossover between each type is not uncommon*. There are 4 severity levels: (mild, moderate, severe, and extreme), based on an individual’s BMI. AN typically begins during adolescence and young adulthood.
- Bulimia Nervosa (BN): is characterized by binge eating (consuming a significant amount of food within a 2-hour period; a sense of lack of control of food intake; followed by compensatory behaviors (vomiting, use of laxatives, diuretics, enemas, and excessive exercise)). There are 4 severity levels: (mild, moderate, severe, and extreme), based on the frequency of inappropriate compensatory behaviors. *typically individuals with BN are in the ‘normal to overweight’ range of the BMI*
- Binge-Eating Disorder (BED): is characterized by periods of binge eating (consuming a significant amount of food within a 2-hour period). A ‘binge’ is characterized by, with special attention to feelings: the pace of food intake, not associated with compensatory behavior, and is distinct from obesity. There are 4 severity levels: (mild, moderate, severe, and extreme), based on the frequency of binges.
Who is at risk?
- According to the DSM, typically adolescence and young adults, are those with cultural influences, job requirements, childhood obesity, early pubertal maturation, genetics, individuals with weight concerns, body image issues, low self-esteem, depressive and anxiety symptoms.
Exercise Compulsion/Addiction
- While spending more than a few minutes more on social media due to the pandemic, I have seen numerous posts about major accomplishments individuals have shared (quitting an unpleasant habit, using this time to ‘be lazy’ for themselves, using this time to transform their bodies and lifestyles) as well as bringing attention to the point of, “we are all going through an unexpected amount of stress right now and I do not HAVE to make any major accomplishments during this time, it’s okay if you don’t or didn’t”.
- I combined ‘compulsion and addiction’ above because both are relatable for this topic.
- Exercise compulsion or addiction is exercise that significantly interferes with important activities and daily living, such as: occurring at inappropriate times or settings, interfering with your social life, continuing to exercise despite weather, illness, injury, or against medical advice (AMA). Individuals experience intense feelings of guilt, depression, anxiety, and irritability if they are unable to exercise. They often find it uncomfortable not engaging in physical activity or if they are resting, use exercise as a way of managing their emotions, engage in secretive exercise, or continue to over train themselves, and they view this behavior as permission to eat or their way of purging.
What to do?
Educate yourself so you are able to recognize the signs (as many of them can be unrecognizable early on), support them and listen to their concerns (every individual has their own unique story, so please do not assume), avoid judgments, ask how you can help them through this, encourage them to participate in professional help, and lastly, do not treat them as if their ED and/or addiction is all who they are. It may take up a good chunk of their life at the moment, however, they are not their ED and/or addiction.
*tip* Watch the language you use during this, as it can go a long way, e.g., instead of saying, “they’re anorexic/an addict” say “they are struggling with anorexia/an addiction”. The difference you may ask? The former subtracts the person from the equation, whereas the latter identifies a person who is struggling with XYZ. (Hint: this connects back to what I mentioned earlier about their ED not being all of who they are, and the former statement of, “they’re anorexic/addict”, is consistent with their ED and/or addiction being all of who they are.
Research in a Nutshell:
-Baenas et al completed a research study that showed: a quarter of participants that became more symptomatic during lockdown; increased concerns about their physical health; experiencing an increase in anxiety, depression, impulsivity, and suicidal ideation; deterioration was higher in those with AN- followed by those with Other Specified Feeding or Eating Disorder (OSFED) *not mentioned*; food supply triggers and confinement led to food hoarding, therefore triggering binge/purge methods.
-Raykos et al, examined surveys across several countries that have shown worsening eating disorder symptoms during the first wave; help lines noted increase of those seeking help; the prevalence of depressive symptoms in the US during COVID increased to 3 times higher than pre-COVID. Factors included lack of structure, reduced physical exercise, social isolation, and face-to-face therapy. Virtual therapy showed improvement of symptoms.
-Rodgers et al, however, this group of researchers found 3 pathways that the pandemic exacerbated ED risk: 1.) daily routines significantly disrupted with the outdoor restrictions, leading to a significant decrease in social supports, 2.) an increased exposure to ED related media, as well as increase of video calls, and 3.) fear of contracting COVID-19 influencing changes in dietary habits and overall increase of stress of isolation.
– Taquet and colleagues found an overall 15.3% increase of EDs in 2020
References:
Baenas, Caravaca‐Sanz, E., Granero, R., Sánchez, I., Riesco, N., Testa, G., Vintró‐Alcaraz, C., Treasure, J., Jiménez‐Murcia, S., & Fernández‐Aranda, F. (2020). COVID‐19 and eating disorders during confinement: Analysis of factors associated with resilience and aggravation of symptoms. European Eating Disorders Review, 28(6), 855–863. https://doi.org/10.1002/erv.2771
Compulsive exercise. National Eating Disorders Association. (2018, February 22). Retrieved January 3, 2022, from https://www.nationaleatingdisorders.org/learn/general-information/compulsive-exercise
Diagnostic and statistical manual of mental disorders : DSM-5. (5th ed.). (2013). American Psychiatric Association.
Raykos, Erceg‐Hurn, D. M., Hill, J., Campbell, B. N. ., & McEvoy, P. M. (2021). Positive outcomes from integrating telehealth into routine clinical practice for eating disorders during COVID‐19. The International Journal of Eating Disorders, 54(9), 1689–1695. https://doi.org/10.1002/eat.23574
Rodgers, Lombardo, C., Cerolini, S., Franko, D. L., Omori, M., Fuller‐Tyszkiewicz, M., Linardon, J., Courtet, P., & Guillaume, S. (2020). The impact of the COVID‐19 pandemic on eating disorder risk and symptoms. The International Journal of Eating Disorders, 53(7), 1166–1170. https://doi.org/10.1002/eat.23318
Taquet, Geddes, J. R., Luciano, S., & Harrison, P. J. (2021). Incidence and outcomes of eating disorders during the COVID-19 pandemic. British Journal of Psychiatry, 1–3. https://doi.org/10.1192/bjp.2021.105