- Significant increase in referrals for all types of eating disorder, both among new patients and those whose conditions have either worsened or relapsed
- 61% increase in enquiries at private clinics around anorexia and 26% increase in Binge Eating Disorder enquiries
- Priory consultant Dr Lorna Richards says Binge Eating Disorder is just one significant issue that has emerged under lockdown
- People focusing on food can be a way of trying to exert control over an uncertain situation, she says
An expert has spoken of a significant increase in eating disorder referrals – and explained how focusing on food and weight, either by over-eating or restricting food intake, can be seen by those with eating disorders as a way to “cope” with the pandemic.
Dr Lorna Richards cited a number of factors for the rise including “fear and uncertainty, fuelling anxiety symptoms”, a feeling of not being in control, social isolation, and changes to people’s routine and home lives.
“There has also been widespread concern about lack of activity, and about weight gain during periods of lockdown, which have seen the nation both dieting, and exercising, en masse,” she said.
“Eating disorders have thrived in this environment, as the focus on eating and weight control becomes a way of coping.”
Last year Priory Group saw a 61% increase in the number of enquiries it received about treatment for anorexia nervosa at its private clinics, compared to 2019, and a rise of more than a quarter (26%) in the number of enquiries it received regarding treatment for binge eating disorder.
Dr Richards specialises in adult eating disorders at Priory’s Woking Hospital and Priory’s Lifeworks and has been involved in the development of NHS national guidelines and policy around eating disorders.
She says that for some people, focusing on food, either by restricting, over-eating or using other weight control measures such as purging and over-exercising, can be used as a way of “coping” and provide “a sense of control or mastery”.
She added: “Since the early summer of 2020, I have seen a huge increase in referrals from people with pre-existing disorders who have deteriorated since the pandemic emerged.
“I have also seen an increase in new patients - specifically people, who, during the first lockdown, were starting to develop eating disorders for the first time. For those who are vulnerable to developing an eating disorder, there have just been too many challenges and they are ongoing.”
Dr Richards comments came as Sir Simon Stevens, chief executive of NHS England, spoke of a growing number of young people being referred for eating disorders needing urgent help.
He told the Commons health and social care committee: “The area, frankly, in mental health services where we are seeing a real pressure is increasing urgent referrals for eating disorder services.”
Dr Richards, who treats adults, said: “Inpatient treatment has also been more challenging due to infection control measures; patients have not been able to have leave or visitors, and staff need to wear masks. It is difficult, but sometimes in-patient treatment is the best way to provide the level of care that people need.”
What is Binge Eating?
Dr Richards says: “We all need a degree of certainty and security, and the more things that are uncertain to us or feel unsafe, the more we feel a need to ‘control’. We do it in different ways. Some might be more obsessionally tidy, or ‘helicopter’ around their children, or try to maintain control in relationships or the workplace.
“Those with eating disorders turn to controlling their diet or using food in unhealthy ways like binge eating, purging or exercising. It can provide a structure, routine and focus for the day, as well as a distraction from anxious thoughts.”
She said shopping habits had also changed, with families doing large online shops, and this had an impact. “For someone with binge eating disorder this can feel overwhelming and increase the likelihood of binge episodes.”
Dr Richards added: “Binge eating disorder affects adults of both genders. Bingeing means eating an objectively excessive amount of food and there is an element of compulsion to it, so you feel like you can’t control yourself.
“There are two key triggers; when people are restricting their intake in an attempt to lose weight, this triggers a hunger response with an increased risk of overeating when food becomes available.
“The other trigger is psychological; people may binge eat to manage difficult emotions or indeed to numb them. When people are planning a binge, it can be a fantastic distraction from other things that are going on. It is usually done in secret and there is a huge amount of shame, with people believing that others judge them as greedy and lacking all self-control. The shame that everyone with an eating disorder feels often prevents them from accessing help.”
Dr Richard’s advice:
: Anyone who notices that they are focusing more on eating and weight, whose eating habits or weight have changed or is concerned in any way should reach out for help
: Children, young people and adults can consult the Beat charity’s website and local support groups, and should speak with their GP who may refer them for online therapy
: Eating disorders are serious illnesses and can lead to significant problems with physical and mental health as well as relationships, and the ability to study or work
: The longer you leave it the more entrenched the eating disordered way of thinking and behaving becomes and it is harder to make changes and you are less likely to fully recover.
Watch videos of Dr Lorna Richards talking about eating disorders
· https://www.youtube.com/watch?v=aDJi6-91GkQ&t – Dr Richards on eating disorders during the pandemic · https://vimeo.com/336104400 - Dr Richards on eating disorders and self-identity |
Acceptance
“Changing a difficult situation isn't always possible. So, accept what you cannot change and focus on the things you do have control over - such as regularly connecting with colleagues over video conferencing or online meetings.
Use music
“Put on headphones to listen to music can have many benefits, such as helping you relax and focus on something away from work and the outside world. Turn off rolling news and social media platforms such as Twitter, and just check in once a day. Stretch your legs and take a walk, even just to the garden, the kitchen or another room in your house before returning to your desk. Moving around and changing your environment, even slightly, can clear your mind and re-energise you.”
Coping with panic
Dr Donna Grant, consultant psychiatrist at Priory Hospital Chelmsford, offers some tips to help cope with panic at this time:
“Observe your thoughts and tell yourself that your mind is reacting to these thoughts and anxiety. These feelings are
normal - it's just the body's alarm system doing its job when it doesn't need to.
“Learn to control your breathing. People often hyperventilate during a panic attack. This means taking deeper breaths than normal which results in you feeling short of breath, causing a feeling of dizziness, disorientation and chest pains. By learning to slow your breathing down, you can help prevent the uncomfortable physical symptoms and stop the panic cycle. Try to get a slower and more stable breathing rhythm by breathing in for three seconds, holding your breath for two seconds, and then breathing out for three seconds. As you breathe, ensure that your stomach expands as you take each breath as this helps to ensure the breathing isn't shallow, which can add to the problem.
Learn to use positive coping statements
“When you are feeling anxious and panicky it can be helpful to have 'coping statements' which can be used to remind you that panic is not dangerous and isn't harmful.
Such statements could be:
- Panic is simply high levels of anxiety
- By remembering these symptoms are nothing more than anxiety, I can prevent further symptoms occurring
- My anxiety and panic will pass naturally given time. It doesn't last forever
Reminding yourself of these facts can help to prevent further panic cycles happening.
Keep a journal
Pamela Roberts, a Priory psychotherapist based at Priory’s Woking Hospital, adds that for those who might be self-isolating: “Ensure you are working in a well-ventilated room and following basic self-care, so healthy eating, sleep, lots of hydration, and try to keep to a routine. Set up a ‘buddy group’ with family or friends and regularly check in online or with Facetime.
“If you feel low, journaling can be a helpful way to unload emotions. Go with the flow. Tell yourself ‘what I am doing is enough’. Be good to yourself. If you have slept badly, accept you'll be in a low, more anxious mood. Your energy will be low. Try and relax and focus on positive things knowing that every effort is being made globally to bring this situation to a close, but it will take time. Being able to relax will help you through. When you're tense you tend to dwell on things and make them worse. If you are able, get into your garden and get daily doses of sunshine. Maybe look at some free online courses offered by the Open University. The mental health charity Mind has some very useful advice on self-isolating and your mental health. For support with grief, anxiety, or mental wellbeing, you can call or text an organisation like the Samaritans, or you can access therapy online with a trained therapist.”
Tapping
Priory expert Steve Clarke, a psychotherapist and hospital director at the Priory¹s Life Works Hospital in Woking, Surrey, explains EMT: ‘Emotional Freedom Technique (EFT) - Repetitive finger tapping can sometimes help to release negative emotions such as anxiety. It has been called a psychological version of acupuncture in that it involves making contact with a number of acupuncture points. The specific points to tap are the end-points of the major meridians (meridians are believed to be channels of subtle energy which flow through our body). So, whilst focusing on your negative emotion you tap on a meridian point (collarbone, under the arm and top of the head try to avoid the face at these times) three to seven times, repeating your negative thought in your head. After each emotion, take a deep breath and exhale. Continue this until you feel calmer and relieved. When you feel more relieved, repeat the technique whilst you tap through a positive round, repeating more uplifting phrases.”
Nourishment
Dr Bijlani says: “Make time for a nourishing lunch with adequate hydration. Food and drink can greatly affect your physical and mental health. Stop working at the usual time you would if you had travelled to your office and then try and fit in some social calls to friends or family before you prepare your evening meal. Avoid drinking too much alcohol or eating unhealthy foods out of boredom. Try and keep to boundaries such as only drinking alcoholic beverages in limited quantities at the weekend. Having to spend endless time each day in our homes with others under the lockdown situation is certainly going to affect our relationships with them, regardless of whether they are our loved family members or not. Emotions can be “infectious” and if those around us aren’t able to keep calm and cope well, we could end up getting stressed, fed up, irritable or low ourselves. It’s important for each of us, where we can, to take responsibility for our own health so that we can help keep up a reasonable level of optimism and engender a healthy environment in our homes which we share with others. Try and do some things together, such as sharing the preparation and eating of meals and daily walks together while also maintaining respectful boundaries and giving each other space apart for private time alone. Work as a healthy community. Try and be sensitive, flexible and forgiving without losing your own sense of self or identity. The best way to keep your mood swings under control is to look after yourself by keeping to your usual routine of sleep, diet, exercise and other activities. If you have been prescribed medication for your mental health, then take it as advised.”
About Priory and MEDIAN
Priory is the UK’s leading independent provider of mental health services. We treat more than 70 conditions, including depression, anxiety, addictions and eating disorders, as well as children’s mental health, across our nationwide network of sites. We also support autistic adults and adults with a learning disability, Prader-Willi Syndrome and brain injuries, as well as older people, within our specialist residential care and supported living facilities – helping as many people as possible to live their lives.
Priory is part of the MEDIAN Group, one of Europe’s leading providers of high quality mental health and rehabilitation services. The MEDIAN Group comprises 290 facilities with 5,000 beds caring for 28,000 people in the UK, 120 facilities with 20,000 beds caring for around 250,000 patients in Germany, and 15 facilities with 2,000 beds caring for 13,000 people in Spain, with more than 29,000 employees overall.