By Guest Blogger Jessie Tucker Mitchell, MA, LCMHCA, NCC

Sixteen-year-old Anna* struggled with an eating disorder (ED) all through eighth and ninth grades. She woke at 5 am to run 90 minutes every morning, restricted her food intake to 600 calories a day, and made herself vomit after meals several times a week. Her weight dropped quickly and her BMI plummeted to 14, a dangerously low level. Only with intensive treatment did she begin to renourish her body and grow comfortable with food and weight gain. By the time she started tenth grade, she had reached a point in her recovery where she felt hopeful and capable of change.

Then came Covid.

Anna’s school closed in March, and she was forced to stay home, her typical high school life of friends, ball games, and sleepovers grinding to a halt. Texting and Tik Tok could help her feel socially connected only to a certain extent. Online learning became monotonous, the technology sometimes difficult to understand and often not working at all. Her parents stayed glued to the television at night, watching the terrifying news coverage of the coronavirus. Then her mother lost her job, and her father’s hours were cut. Overnight they went from feeling economically comfortable to worrying about paying for groceries and losing their home. Anna overheard their tense conversations, and she felt powerless to help them.  Everything was out of control. And so she turned to the one thing that she knew she could control: Her weight.

By the time Anna began therapy, her BMI had dropped below 15 and she was severely restricting food intake again.  She had eliminated all carbs and sugar and counted calories obsessively. The number on the bathroom scale every morning determined her mood for the day. She hated her stomach and checked it constantly in the mirror, and wore baggy clothes to hide her perceived flaws. Her parents noticed that she snapped at them for minor mistakes, and she stopped telling jokes, stopped joining them for movie night; they found clumps of her hair in the shower and a stockpile of laxatives in her nightstand. She stayed awake late into the night, doing jumping jacks and stomach crunches in her room. All of the signs were there: Her anorexia had returned full-force. That’s when they sought counseling again.

Quarantine creates the perfect storm for eating disorders – not just for teens and children, but for adults, too. The combination of increased stress, isolation, and fears of weight gain due to less activity can intensify concerns about weight and shape.  Loved ones may notice the individual’s withdrawal from family and friends, her sadness, and her increased anxiety about a variety of issues. Parents feel hopeless and desperate and also guilty, worried that if they seek professional help, they will be blamed for the ED.  In truth, multiple factors contribute to the development of an ED and the exact combination is difficult to assess. In the meantime, we do know that quick, early treatment is key to preventing the illness from completely taking over the patient’s life, and parents are encouraged to set aside their fears and seek professional help as soon as possible.

It’s worth pointing out that anorexia nervosa has the highest mortality rate of any mental illness, including bipolar and major depressive disorders. And one in five of anorexia deaths is due to suicide. This illness is a crisis – as are all other EDs, including bulimia (characterized in part by binging and purging while maintaining a normal or above normal body weight) and binge eating disorder (characterized in part by eating large quantities of food in a short period and not purging). And EDs do not affect just girls; an increasingly large number of males are being diagnosed as well.

I wish I could say I’m not trying to scare parents out there … but in truth, I kind of am. I have been shocked by the stories I hear clients tell about people or events that trigger their dysfunctional eating behaviors. One girl recalls a PE teacher checking height and weight in class and then calling out each person’s BMI for everyone to hear. A fourth grader’s parents announced that she needed to go on a diet with them. A middle-aged woman tells of an aunt who always poked her in the stomach as a child and referred to her as “big-boned.” And one 15-year-old client specifically traces her ED back to a poster she saw at school that listed “good foods” and “bad foods” (two labels that make me cringe, as I believe no food is “bad”). Again, as mentioned earlier, determining the exact cause of an ED is impossible, but certain factors definitely contribute, and if society as a whole can intervene and stop sending damaging messages that effectively lead to self-destruction, then many lives can be saved – many lives can be lived more fully and genuinely enjoyed. And maybe I’m biased, but I believe therapy helps: The client learns coping skills and self-acceptance, challenges long-held beliefs about food, and finds a safe place where even her greatest fears can be expressed and overcome.

It’s a new year, a time for resolutions and reassessments. The traditional goal of “losing weight and eating healthy” can actually backfire and have a lasting negative impact on our kids. If you believe your loved one struggles with body image issues and disordered eating, take action as soon as possible. It could be the most powerful way you ever show how much you care.

*All personal information has been altered to protect confidentiality. The case of Anna is a disguised/composite portrait.

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