Mental health disorders do not make exceptions for age, wealth, or other factors – people in every demographic suffer from depression, PTSD, anxiety, and eating disorders.One of the most insidious things about eating disorders, in particular, is that they can appear in people and have very few external symptoms. You may know someone with an eating disorder, without you being aware of it.
Particularly during isolation, mental health disorders creep into our minds much more easily and quickly. Being alone or without our normal friends, we internalize our self-destructive thoughts and tend to judge ourselves too harshly. You might feel extremely alone, or that you should be achieving something extraordinary during lockdown when simply surviving and getting through the day can be monumentally difficult.
Let’s look at the subtle signs of anorexia nervosa, how to spot it in yourself or others, and why it’s so critically important that it is addressed, especially in quarantine.
Behavioral Signs of Anorexia Nervosa
The physical signs of anorexia nervosa typically only occur after the disorder has been affecting the individual for some time. This is why the psychological and behavioral indications of the disorder are so important to look for.
People with eating disorders often behave in ritualistic patterns when it comes to exercise or food. Additionally, they may be avoidant when it comes to social gatherings – during the lockdown, this is not going to be as prevalent an indicator, so the other signs should be your go-to.
High Amounts of Self-criticism
One hallmark of eating disorders is general unhappiness with one’s body and weight. Behavior like spending excessive time in front of the mirror, comparing their body to someone else, or vocalizing their displeasure with their overall physical appearance is very common.
Anorexia nervosa warps your view of your own body, making you less satisfied with how you look. When you’re isolated away from other people for long periods, this self-doubt creeps in and gets a very strong hold on the decisions you make and the thoughts you have, driving you deeper into self-critique, anxiety, and depression.
Anxiety About Food
People with anorexia nervosa are extremely focused on what, how much, and when they eat. There may appear to be a ritualistic habit involved in how they eat, such as only eating after everyone else in the home, or only eating alone in their room. In some cases, people with anorexia nervosa comorbid with orthorexia, meaning they may also only eat one food in particular, like certain vegetables, or exclude an entire macronutrient like fat or carbs.
Eating disorders are very rarely about food at their core – rather, they are usually an indication that the person wants to gain control over something in their life. They are often precipitated by feelings of spiraling or immediately following a profound loss pr trauma, or concurrent with depression and anxiety. External stressors can be the source of the internal conflict that drives an eating disorder, and the person’s desire to feel in control manifests as restricting their eating habits.
Withdrawal From Social Activities
When you’re suffering from a mental health disorder, it can be difficult to will ourselves to see our friends and family. Often we simply don’t have the energy or the will to do it, but it’s also likely that we feel as though we’re a burden or that they shouldn’t see us as we perceive ourselves. With an eating disorder, this is even more prevalent, as the patient is highly critical of how they look or act. They may wear baggy clothing, lots of layers, or otherwise, try to hide their body when they do interact with other people.
During quarantine or isolation, chances are good your loved one is already withdrawn, due to the circumstances of the pandemic. During this time, their mind becomes an echo chamber for their disordered thoughts. This can be extremely detrimental to their mental wellbeing and can drive the formation and progression of an eating disorder far quicker than normal.
These are not the only psychological signs of anorexia nervosa, but they are the most common. Additionally, look for:
- Mood swings
- New or worsening depression
- Lack of interest in hobbies or friends
- It should be noted that if you or your loved one engaged in online gaming or chat before, disinterest will include a marked reduction in this behavior, even though it’s an accessible form of socialization during isolation
- New or worsening anxiety
- Changes in sleep patterns – sleeping far longer than normal or being awake in the middle of the night and sleeping during the day
Physical Signs of Anorexia Nervosa
Once the disorder has progressed long enough, the physical manifestations of anorexia nervosa will emerge. If you’re in the same house as the person suffering from the disease, you will likely have an easier time identifying these, but some you’ll still be able to see over video chat or distanced visits.
Weight Fluctuations Without Apparent Cause
Possibly the most well-known outward manifestation of anorexia nervosa is extreme weight loss. Advanced cases of anorexia nervosa cause a person to essentially starve themselves, becoming emaciated. They often will hide the amount of weight being lost. As we spoke about before, look for baggy clothing, particularly if they’re not normally known for that type of dress.
Unexplained weight loss can be a sign of many underlying conditions, but if you already suspect a potential eating disorder, you need to ensure you’re monitoring it. During a lockdown, it’s imperative you video-chat with your loved ones regularly.
Symptoms of Malnutrition
Unless you’re in the home with someone who has anorexia nervosa, these symptoms can be harder to spot. The primary signs of malnutrition are:
- Gaunt appearance
- Tired eyes
- Dry, mottled skin
- Constantly complaining of or indicating coldness, especially in the hands and feet
- Difficulty sleeping or sleeping too much
- Fatigue and general lack of energy
- Hair loss, and brittle nails
- As the condition worsens, bowel problems and heart palpitations from an electrolyte imbalance
You can spot telltale signs of these symptoms over video chat if you know what to look for. A chronically cold person will be wearing layers, even indoors. You should be able to see the quality of their skin’s appearance, or the tiredness in their eyes – if not, are they wearing excessive makeup?
If you can identify signs of malnutrition, it’s absolutely the time to get involved with a therapist. Physical symptoms of an eating disorder can be causing systemic damage that can lead to highly dangerous health states and need to be treated immediately.
Seeking Mental Health Counseling During the Pandemic
While many eating disorder treatment specialists are closed to in-person meetings right now, the popularity of Zoom and Skype have made virtual visits incredibly accessible. Many counselors have an online practice in addition to their in-person clinic hours, even before the pandemic, so now it should be fairly easy to find someone who can fit your budget, availability, and who is in your area. Even if you can’t find someone in your town or nearby, distance doesn’t mean anything when you can connect over the internet.
Often for a counselor to make an anorexia nervosa diagnosis, they may refer you or your loved one to a physician. While the prevalence of virtual telehealth services is extremely high right now, you may need to go into the office physically to see your doctor for the first time regarding a potential eating disorder. This is because they might need to monitor the progression of the disease, as it could be causing severe physical harm.
Seeing a therapist for the first few times can feel as if nothing major is happening so it’s important to temper your expectations. A counselor will need multiple sessions of backstory and information to start helping you with an eating disorder and any concurrent mental health problems. This is why going regularly – and often at first – is the best thing you can do to establish a schedule of treatment that can help you.
It’s also a good idea to check with your therapist to see if they can meet at short notice. Particularly for people who suffer from addiction or eating disorders to be able to get help when negative thoughts or compulsions arise.
Knowing When Virtual Visits Aren’t Enough
While the ability to access a counselor at distance is a highly powerful tool in the modern age, it might not be enough for someone who is extremely affected by eating disorders. This is doubly true for those who have concurrent mental health disorders, like PTSD or depression, and even more so for those suffering the later stages of physical damage. An anorexia nervosa diagnosis can be done remotely, but it might not be able to be treated remotely.
For times like these, there are safe, comfortable solutions for you and your loved ones., Residential treatment facilities are still available in quarantine which are all-encompassing places of recovery and rest. Residential treatment centers for eating disorders combine all of the aspects needed for a full recovery and place them at your disposal under a single roof.
Medical providers are available at these facilities to help resolve the physical concerns that might arise due to chronic malnutrition, ensuring that you can focus on your psychological recovery.
Nutritionists work with your physical therapists to ensure that you approach food not as an enemy or a stressorbut as an essential part of life. Likewise, exercise can be mindful and compassionate.
Importantly, there are therapy sessions, both individually and within groups. Working with your therapist often continues after you’re out of the residential treatment and so can group meetings, which are a fantastic resource to find people who are going through the same thing as you. By understanding that you’re not alone in the way you think and what you’re dealing with, it can make it easier to accept that change is possible and that you can live a healthy life in recovery.
Day Treatment Is Available as Well
For those who do not rise to the need for residential treatment, most eating disorder facilities now offer outpatient counseling as well. Through these programs, you will get help with nutrition and exercise, group and individual therapy, and the tools to seamlessly integrate these therapies into your life outside the clinic.
During the COVID-19 pandemic, it’s more important than ever to secure a healthy environment during residential treatment. This includes a rigorous quarantine period before we admit new people, daily temperature checks, rigorous handwashing, and sanitizing techniques, and other health-forward approaches to business.