Access to evidence‐based care for eating disorders during the COVID‐19 crisis

Abstract

The COVID‐19 pandemic has forced an abrupt change in the delivery of clinical services, including for individuals with an eating disorder. We present this Virtual Issue as a resource for the eating disorder community to showcase research published in the International Journal of Eating Disorders that provides information on effective strategies to help address the challenges arising from COVID‐19‐related disruptions. Articles included describe original research or systematic reviews on obstacles to health services use and strategies to improve access to care; technological tools to provide or enhance interventions; patients' and clinicians' attitudes or perspectives on using digital tools for clinical care; factors influencing therapeutic alliance; and ideas for improving reach and uptake of digital interventions. We hope that readers will find ways to observe and record their own experiences during this global crisis; the experiences of people at risk for developing or exhibiting an eating disorder; and the experiences of those who care for people with an eating disorder. These lived experiences will be invaluable in formulating hypotheses for future studies in service of advancing the understanding of eating disorders and improving interventions and policies for reducing the burden of suffering attributable to eating disorders.

Eating Disorders During the COVID-19 Pandemic

“…Eating disorders and related mental health symptoms may be exacerbated by the COVID-19 pandemic due to increased economic tensions resulting in food insecurity (limited access to food due to economic hardship) (Weissman, Bauer, et al, 2020). Both low and very low food security are associated with the possibility to meet the criteria of binge eating disorders and bulimia nervosa (Lydecker & Grilo, 2019;Rasmusson, Lydecker, Coffino, White, & Grilo, 2018).…”

“…In individuals with ED, the COVID-19 pandemic is most likely to contribute to the worsening mental health of such individuals, for example quarantine enforcement may magnify the general consequences of anorexia nervosa i.e. isolation and loneliness where many patients with anorexia nervosa are already physically and emotionally isolated (Fernández-Aranda et al, 2020;Touyz, Lacey, & Hay, 2020;Weissman, Bauer, & Thomas, 2020).…”

“…The situation then raised the urgency that individuals with ED be assured of receiving care, although the policy of staying at home and "social distancing" during the COVID-19 pandemic led to sudden changes in clinical services, including in individuals with ED (Weissman, Bauer, et al, 2020). Only urgent visits and inpatient treatment for severe ED cases are provided in COVID-19 context, and in many health settings, then online care has been recommended (if possible) rather than face-to-face (Fernández-Aranda et al, 2020).…”

The challenges ahead for patients with feeding and eating disorders during the COVID-19 pandemic

“…Family members' maladaptive emotional reactions caused by the quarantine stress may result in aggression and/or splitting and fragmentation [15]. Moreover, the orders of staying at home and the limited food selection choices in stores may make it look rational for some individuals to skip meals or restrict their calorie intake, which will subsequently worsen the preexisting restrictive tendencies [9].…”

“…Additionally, it is established that in families with food shortage, the family members may grow a sense of shame regarding their appetite or a sense of guilt about eating without concerning to take food from others in the family. These guilt feelings may be worsened in underweight patients who are encouraged to eat more than their family members to support weight restoration [9].…”