The COVID-19 pandemic profoundly impacted daily life, inflicting widespread trauma. Those with pre-existing mental illnesses like eating disorders faced magnified challenges. This study uniquely leverages personal eating disorder recovery blogs to strengthen understanding of pandemic experiences from patients’ perspectives
Batchelder, E., Dellasega, C. & Levine, M. P. (2023). Eating Disorder blogs during Covid-19: A window into recovery progress. QMiP Bulletin, 36, 28-43. https://doi.org/10.53841/bpsqmip.2023.1.36.28
Key Points
- The study analyzed 9 eating disorder recovery blogs before and during the COVID-19 pandemic to understand the impact on recovery.
- Bloggers who were less stable pre-pandemic tended to not improve or relapsed during the pandemic. Those more stable pre-pandemic showed some variability.
- Common pandemic-related challenges were changes to treatment programs, isolation, food availability, and family dynamics.
- Understanding pandemic experiences can inform better patient care and support for eating disorder recovery.
- Limitations include a small convenience sample and lack of diagnosis confirmation.
Rationale
- Eating disorders are increasingly common, serious mental illnesses that can be exacerbated by crises and adversity (Klump et al., 2009; Mitrofan et al., 2019).
- The COVID-19 pandemic has broadly impacted mental health (Cullen et al., 2020) and may specifically worsen eating disorder symptoms due to disruption in routines, decreased support, and other pandemic-related stressors (Rodgers et al., 2020).
- Individuals with pre-existing conditions like eating disorders may be disproportionately affected by crises like the pandemic (Chatterjee et al., 2020; McGinty et al., 2020).
- Blogs provide insight into lived experiences and responses to events like public health crises (Tausczik et al., 2012).
- This study analyzes eating disorder recovery blogs before and during the pandemic to understand its impact.
Method
- 9 publicly available eating disorder recovery blogs with posts from November 2019-February 2020 (pre-COVID) and March 2020-June 2020 (during COVID) were analyzed using qualitative thematic analysis.
- Inclusion criteria required the blogs be recovery-focused, in English, not associated with treatment centers, and have the appropriate pre-pandemic and pandemic timeline posts.
- Blog posts were extracted, de-identified, and entered into Word documents.
- The research team independently reviewed the transcripts to identify recurring words, phrases, themes, and tone pre-pandemic versus during the pandemic.
- Consensus was reached on key COVID-specific themes, sub-themes, overall tone, and bloggers’ recovery status.
Sample
- 9 publicly available eating disorder recovery blogs were analyzed.
- The bloggers were all women based in the United States.
- Their specific eating disorder diagnoses were not reported.
Results
The pandemic introduced distinct challenges of treatment disruption, heightened isolation, evolving food worries, and shifting family dynamics that collectively challenged eating disorder recovery and stability.
Here is a summary of the four key themes from the study related to the impact of COVID-19 on eating disorder recovery:
Loss of support and therapy due to institutional shutdowns
- Bloggers discussed disruptions to their treatment programs and hospital closures that forced them back home and removed access to care.
- They described facing physical distancing barriers that eliminated previous social interactions and support amongst peers in treatment.
- Some demonstrated turning to eating disorder behaviors to try to gain control amidst the uncertainty.
“The hospital has had to close, and I am back home for the foreseeable future.”
More isolated than most
- Bloggers reported pandemic isolation reducing their social connections, leading some to return to disordered eating to cope.
- Increased time alone resulted in heightened self-criticism and focus on perceived body image issues for some.
- One previously stable blogger described experiencing full relapse due to isolation and pandemic stress.
“Being left with no support has been hard for me…”
Nurturing the physical self
- The uncertainty around obtaining preferred foods emerged as a distinct pandemic worry that caused some bloggers increased stress around meals.
- One discussed the frustration when a planned food exposure activity was disrupted by inability to actually obtain the needed food due to stockpiling.
“Some arseholes are stockpiling and I can’t find pasta for love nor money.”
Mixed support: Family and virtual influences
- Bloggers reported both struggles and successes with family support throughout the pandemic.
- One described barriers to grieving her grandfather’s death with separated family members.
- Another shared how consistent virtual communication was vital to maintaining her stability amid isolation.
“Communication has been such a vital aspect of my survival during this quarantine.”
Insight and Depth
- This study uniquely leverages personal eating disorder recovery blogs to provide insight into the lived experience of the pandemic’s impact.
- While previous research has surveyed individuals or speculated effects, this analysis of personal accounts strengthens understanding of real-world challenges and nuances.
- It illustrates the pandemic’s potential to exacerbate illness and relapse, especially for those less stable pre-pandemic. This reinforces eating disorders as serious, relapse-prone illnesses.
- The words of those directly impacted can better inform patient care and support. Their articulation of challenges can increase empathy and understanding from clinicians and loved ones.
Strengths
- Analyzes personal eating disorder recovery blogs, providing insight into lived experiences
- Includes same bloggers pre-pandemic and during, enabling analysis of trajectory
- Rigorous qualitative methods including independent coding by three researchers with consensus
- Public blogs assume consent for analysis of shared information
Limitations
- Small, convenience sample limits generalizability
- Limited demographic details available
- Did not verify eating disorder diagnoses
- Various pandemic impacts and shutdown policies by region may introduce variance
Clinical Implications
- Supports past findings that the pandemic may spur eating disorder relapse or worsening, especially in those less stable pre-pandemic
- Suggests need to proactively support patients during crises, given high risk of adversity impacts
- Informs patient care based on real-world challenges named by patients themselves
- Future studies should explore mitigating relapse risk during crises and instability
References
Chatterjee, S.S., Barikar C.M. & Mukherjee, A. (2020). Impact of Covid-19 pandemic on pre-existing mental health problems. Asian Journal of Psychiatry, 51, 102071. https://doi.org/10.1016/j.ajp.2020.10207Ref
Cullen, W., Gulati, G. & Kelly, B.D. (2020). Mental health in the Covid-19 pandemic. QJM, 113(5), 311–312. https://doi.org/10.1093/qjmed/hcaa110
Klump, K.L., Bulik, C.M., Kaye, W.H., Treasure, J. & Tyson, E. (2009). Academy for eating disorders position paper: Eating disorders are serious mental illnesses. International Journal of Eating Disorders, 42(2), 97–103. https://doi.org/10.1002/eat.20589
McGinty, E.E., Presskreischer, R., Han, H. & Barry, C. L. (2020). Psychological distress and loneliness reported by US adults in 2018 and April 2020. JAMA, 324(1), 93–94. https://doi.org/10.1001/jama.2020.9740
Mitrofan, O., Petkova, H., Janssens, A. et al. (2019). Care experiences of young people with eating disorders and their parents: Qualitative study. BJPsych Open, 5(1), e6. https://doi.org/10.1192/bjo.2018.78
Rodgers, R.F., Lombardo, C., Cerolini, S. et al. (2020). The impact of the Covid-19 pandemic on eating disorder risk and symptoms. International Journal of Eating Disorders 53(7), 1166–1170. https://doi.org/10.1002/eat.23318
Tausczik, Y., Faasse, K., Pennebaker, J.W. & Petrie, K. J. (2012). Public anxiety and information seeking following the H1N1 outbreak: Blogs, newspaper articles, and Wikipedia visits. Health Commun, 27(2), 179–185. https://doi.org/10.1080/10410236.2011.571759
Socratic Questions
- How might culture or demographics influence the experience of eating disorder recovery during crises like the pandemic?
- What responsibilities do mental health systems and governments have to protect continuity of care during public health emergencies?
- How could technology and innovation help bridge gaps in support and treatment when face-to-face options are limited?
- What can friends and family members do to promote stability for loved ones with eating disorders during unpredictable times?
