The Impact of the COVID-19 Pandemic on Individuals With Eating Disorders: the Role of Emotion Regulation and Exploration of Online Treatment Experiences

Abstract

Objective: The Covid-19 pandemic has wrought disruption to everyday life and services, and emerging evidence suggests that those with eating disorders (EDs) are likely to experience marked distress and exacerbation of their symptoms. However, little is known around the most relevant factors to symptom change; whether certain emotion regulation and coping strategies are linked to better outcomes; and how people with EDs are adjusting to psychological interventions moving online. Method: In a mixed-method design, we collected qualitative and quantitative data from 207 (76 males) UK residents with self-reported ED, who described and ranked impacts of the pandemic on their symptoms. Regression analysis examined whether emotion regulation strategies were associated with self-reported symptom change, ED symptomatology, and negative emotional states. Thematic analysis explored participants’ experiences of the pandemic, particularly factors affecting their ED, coping strategies used, and experiences of psychological intervention. Results: Most participants (83.1%) reported worsening of ED symptomatology, though factors affecting symptom change differed between specific EDs. Emotion regulation, such as having fewer strategies, poorer emotional clarity, and non-acceptance of emotions, explained nearly half of the variance in emotional distress during the pandemic, and to a lesser extent also predicted ED symptomatology and symptom change. Qualitative findings indicated that difficult emotions (such as fear and uncertainty), changes to routine, confinement and unhelpful social messages were triggering for participants during the pandemic. While some participants described employing positive coping strategies (such as limiting social media exposure), many reported using ED behaviours (among other maladaptive strategies, like alcohol use) to cope with the pandemic. Finally, loss of treatment support, feeling underserving of support and experiencing a ‘detached connection’ online were further exacerbating factors for these participants. Discussion: Our results show that people with EDs have been strongly affected by the pandemic, and that while beneficial for some, online treatment may need some improvement. Our paper discusses implications for online treatment such as taking into account personal circumstances and, in a time where people have limited control over the antecedents of negative emotion, the need to develop skills to manage emotions when they arise.

Impact of COVID-19 Confinement on Adolescent Patients with Anorexia Nervosa: A Qualitative Interview Study Involving Adolescents and Parents

“…Future studies should clarify the reasons that determine whether the pandemic is more of an opportunity or a challenge for eating disorder patients. First studies indicate that differences in emotion regulation and coping skills as well as personality factors may play a crucial mediating role [ 44 , 45 , 46 ].…”

Virtual Online Home-Based Treatment During the COVID-19 Pandemic for Ultra-Orthodox Young Women With Eating Disorders

“…With the outbreak of the covid-19 crisis and the resulting lockdown, the need emerged to find solutions for the continuation of treatment in adolescents and young women with EDs (45)(46)(47). This need led to the adaptation of ED-related treatment to a long-distance online home-based telemedicine format (45)(46)(47).…”

“…Current studies indicate an exacerbation of both behavioral and emotional ED-related symptoms with the advent of the COVID-19 pandemic and subsequent lockdowns (46,48). Patients face in these conditions difficulties related to greater involvement of their families with their eating, and having more unplanned free time, alongside changes in their sleeping routine and screen time, and decreasing outside physical activity (46,49).…”

“…Increased eating pathology may be viewed in these circumstances as a means of dealing with a reduced sense of control, in an attempt to regain control over their eating and weight (45,46). Many patients also report greater anxiety and depression, deterioration in their quality of life, and severe feelings of uncertainty (45,47,50).…”

COVID-19-Related Stress and Anxiety, Body Mass Index, Eating Disorder Symptomatology, and Body Image in Women from Poland: A Cluster Analysis Approach

“…Although knowledge about the symptoms of eating disorders and negative body image during the COVID-19 pandemic has increased in diverse populations [ 13 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ], research and knowledge on the symptoms of eating disorders and body image in Polish women remains limited (Polish studies published so far have concerned either the period before the pandemic [ 31 ] or a general problem of nutrition behaviors before and during COVID-19 lockdown [ 32 ]). Given the likelihood that the pandemic, attendant restrictions, and their consequences have been a source of chronic and severe stress and anxiety [ 4 , 5 , 6 , 7 , 8 , 9 ], and, as earlier research indicated, may have had an impact on body image and eating disorder symptomatology [ 10 , 13 , 14 ], it is vital to develop a fuller understanding of this issue in Polish women.…”