By Judith Banker MA, LLP
Founder & Executive Director, Center for Eating Disorders
These are extraordinary times for many of us around the world. The confluence of the coronavirus pandemic, ongoing economic upheaval, and massive socio-political turbulence has a daily impact on all aspects of our lives. Our relationships are affected, as well as our jobs, school, financial security, health, mood, sleep, and even our own identity or sense of self.
Families may be spending more time in close quarters as they shelter in place together—or they may not be able to see each other at all due to health risks and social distancing, or travel restrictions. Young adults may find themselves living back at home with their parents after building independent lives. Friends and family may be entering into more heated arguments with sharp divisions emerging about socio-political issues, about how to stay safe from coronavirus (or, as in the U.S., even about whether coronavirus is real), and about how to manage finances, job/school decisions, and social life. Marital relationships may be strained.
One can’t fully analyze the impact of a crisis while one is tumbling through it—and certainly many of us are still in the throes of the current one. People with eating disorders and those more recently in recovery, and their loved ones, are definitely feeling the impact. In fact, based on my work with clients and their loved ones since the early days of this pandemic one thing is clear:
People with eating disorders and other mental health challenges are prone to experiencing a resurgence of symptoms and/or a pull to relapse in the face of the current global pandemic and related stressors.
If you are supporting or participating in treatment with a child (adolescent or adult) with an eating disorder, the current global context presents incomparable challenges. Obviously, not all are doomed to experience this pull to relapse. There are mitigating factors for some. If your child and family are thriving and moving forward during this time, it is cause for gratitude and celebration. But for those who are experiencing increased strain, this post aims to help you not feel so alone.
Unique challenges are presented by the pandemic. You can probably list the challenges as easily as I can. To name a few:
*Increased levels of anxiety and depression
*Fear of contagion and illness
*Death/loss of significant others; separation due to hospitalization or care facility guidelines
*Social isolation and acute loneliness
*Strangeness of social distancing practices; virtual relationships
*Reduced access to treatment or adjusting to changes in treatment delivery from in-person to virtual platforms
*Lack of access to or increased exposure to favorite foods/brands, as well as changes in meal/snacking styles and environments
*Lack of access to beloved hobbies and activities due to safety guidelines and closures
*Loss of employment, financial upheaval, and school closings
*Lack of predictability about the future regarding school, career, finances, social planning
*Close quarters living with family; lack of privacy and alone time
*Family separation, sheltering in place in different locations
*Marital/sibling/family tensions creating further tension and insecurity
*Young adults challenging social distancing guidelines
Bottom line, the rug has been pulled out from under many of us. It may be that most of the outlets and support structures your child relied upon as part of their recovery have been dismantled. Your life and the life of your child in many ways may have been completely derailed. What can you do?
The following are 6 guidelines I have gleaned from the past months of working with clients with eating disorders and their families since the onset of the coronavirus pandemic. (For simplicity, I use the term “child” to refer to both adolescent and adult children.)
1. Normalize your child’s regression or pull to relapse as a natural response to all of the recent losses and changes. Remember: the world is in the midst of a pandemic and related upheaval. Most of us have not experienced anything of this scale and impact before. Anxiety and depression levels have increased for most people across the board, and especially those dealing with mental health issues already.
You may feel these effects yourself. Be aware that weight may fluctuate more than usual, moods may be more variable, sleep may be disturbed, old food restrictions and superstitions may re-emerge, body image distortion may worsen, motivation may weaken, and self-esteem may suffer on all fronts. In addition, your child’s ability to concentrate, to complete tasks, to remember or complete their regular responsibilities may be challenged. Yours too. Reframe these changes as the “pandemic effect” and appreciate that it is happening for many people at this time.
2. Sympathy and empathy go a long way—toward your child and yourself. It can be extremely discouraging or even frightening for your child to find themselves slipping back to earlier stages of recovery. This is not a failure on anyone’s part, rather it is an indication of the profound impact of living through a global pandemic and social-political turbulence. Do not hesitate to explore a return to treatment or ways to intensify current treatment. Pursue a higher level of treatment if indicated. As always, assure your child they are not to blame. And neither are you.
3. You may need to provide more emotional and refeeding support for your child than you did pre-pandemic. Go back to basics and focus on fundamental refeeding/eating/thought stabilization, meal plans, and support techniques that worked in the past. Going back to basics is a familiar, well-worn path that can help restore some stability and feelings of control and competence. Relax expectations. This may be a time for damage control rather than forward momentum. Focus on simply getting through each day.
4. Physical contact, comfort, reassurance, and companionship may be needed now more than ever. If your child needs more time with you, more hugs, or more reassurance that you love them, try to meet those needs as best you can. You may have the same needs. Increased physical contact can help you, too. Be sure to seek extra support and comfort for yourself in whatever ways feasible.
5. Nothing is more important than your child’s health and well-being–and your own–during this time. School and work are not as important as you and your child’s state of mind and body. Most people are noticing they are not able to meet pre-pandemic levels of productivity. They report feeling exhausted and overwhelmed. Students are not able to study or learn as well during this time of pandemic. Providing caregiving when your life is turned upside down can be especially taxing. Relax your expectations around your own productivity as well as your child’s. Take advantage of small ways of taking care of yourself. Grab a socially distanced walk alone or with a friend. Confide in allies. Be generous and kind with yourself and avoid criticizing your own parenting. If possible, seek extra guidance from your treatment team—schedule more frequent sessions or extra sessions when needed.
6. Explore new pursuits for you and your child that can provide some scaffolding for recovery until life returns to some level of normalcy. Activities that used to be satisfying to your child may not be accessible or may now trigger anxiety. Some children (adult children too) are regressing emotionally. That is a normal response to stress, especially if there is someone around who is safe and can be relied on. As always, lean into activities that fit with your child’s current emotional and physical state, activities that can provide some escape from the eating disorders circuit—crafts/art projects, board games from earlier years, free-form music or dance projects, movies or old favorite TV shows, family walks (un-timed) or casual gardening. Anything silly or carefree. Help them paint their room a crazy color or dye their hair. Adopting a pet—while adding some responsibility—can be an excellent way to bring joy and companionship into your child’s life.
Getting through to the other side:
A mantra in my work with clients and families is to “meet the client where they are”. These are unstable times and your child’s behavior and mental state will reflect that instability. More than ever, you may see significant variability in your child’s emotional state and behaviors. Try not to be alarmed at the level of regression they may be manifesting.
If you are living in a country or region that has achieved some level of success in the battle against the coronavirus, be aware that even as life resumes some level of normalcy your child may experience residual high levels of anxiety/depression or even symptoms of post-traumatic stress disorder that affect their social, school, job functioning.
We have a long road ahead. It will take time for a feeling of safety and normalcy to resume even after we beat the coronavirus. There is uncertainty as we see some countries continue to struggle with the rates of coronavirus. Political and social unrest will continue over issues related to systemic racism. No one is able to predict how and when our lives will feel familiar again. In treatment and at home, we all need to organize around being there for each other, relaxing some of our standards around achievement and productivity and do what we can to be emotionally present and available to each other.
Eating disorder symptoms tend to slip back in or pull one down when there is a time of increased anxiety/depression—times of uncertainty, extreme change or loss, or lack of safety. Children need reassurance and comfort and ways to soothe the generalized anxiety and depression they may feel because of the way things have changed. Young adults need to be comforted and reassured that you grasp how hard this is on them and that you will be there for them until they are back on their own two feet. And you need that same reassurance and support.
Wishing safety and good health to all.