When Your Loved One Doesn’t Want to Get Better: Understanding Anosognosia in Anorexia Nervosa

Posted on April 11, 2024September 26, 2024 by Alison Pelz, LD, RD, CDE, LCSW

Anorexia nervosa is an eating disorder characterized by severe food restriction, an intense fear of weight gain, and body image disturbance. Anorexia nervosa affects many individuals of all genders, ages, and identities worldwide.

The consequences of anorexia nervosa can be devastating, both physically and psychologically. However, one of the most challenging aspects of this disorder, particularly for family members and caregivers (and even clinicians!), is the phenomenon known as anosognosia.

What is Anosognosia?

Anosognosia, stemming from the Greek words “nosos” (disease) and “gnosis” (knowledge), refers to a lack of awareness of one’s illness. Anosognosia often can feel and look like denial.

Denial is a defense mechanism and psychological response to avoid dealing with anxiety or other uncomfortable feelings. In contrast, anosognosia in mental health conditions is better described as a lack of awareness of their own condition.

Anosognosia can affect individuals struggling with bipolar, schizophrenia, eating disorders, and other psychological disorders.

In anorexia nervosa, individuals may minimize the severity of their condition. They may adamantly believe they are not sick, or that their behaviors are justified, making it incredibly difficult for them to recognize the need for treatment. It can feel like your loved one is being “difficult” and in teenagers it can be especially confusing because during adolescence it is normal for teens to be contrary or contradictory.

Anosognosia causes a person to be unable to achieve one or more of the following:

Accept that they have an illness or disorder.
See the signs and symptoms of their condition.
Connect their feelings and personal experiences back to that condition.
Understand and agree that the condition is serious and needs treatment.

One of the most dangerous aspects of anosognosia in anorexia nervosa is the individual struggling with insight when the condition becomes life-threatening.

This lack of awareness around a loved one’s illness can further complicate the treatment plan and, many times, prevent treatment from occurring altogether.

Parents frequently ask me if they should wait for their child to want to recover.

My answer is always no, because I know that anosognosia is most likely operating, and because the devastating effects eating disorders have.

Let’s face it – no teen really wants the devastating effects of an eating disorder. Contrary to popular belief, no one chooses to have an eating disorder.

How Anosognosia May be Affecting You

It’s already difficult enough to observe as a family member or loved one suffers from Anorexia nervosa, but anosognosia can make it incredibly distressing and frustrating. Despite your pleas, watching as your loved one deteriorates physically and emotionally, while they remain unaware of the severity of their condition, can evoke feelings of helplessness and despair.

To best help your loved one, you must recognize that anosognosia is not a choice but rather a symptom of the disorder.

It is deeply rooted in neurological and psychological mechanisms impairing the individual’s ability to perceive reality accurately. This is completely out of their control, and without professional help,they may be unable to leave behind their problematic and highly dangerous behaviors.

The Role of Brain Connection in Anosognosia

Research suggests that anosognosia in anorexia nervosa may have an anatomical basis.

Brain imaging studies indicate abnormalities in brain structure and function. According to a study published in the European Eating Disorder Review, up to 80% of individuals with anorexia exhibit some degree of anosognosia.

Malnutrition, a hallmark of anorexia, can lead to significant changes in brain chemistry and structure. This potentially contributes to the development of anosognosia. These neurological alterations can impair the individual’s ability to recognize their illness and hinder their motivation to seek help. This perpetuates the cycle of disordered eating behaviors.

The good news is with nutrition rehabilitation, anosognosia diminishes.

Navigating Treatment and Recovery

Supporting a loved one with anorexia nervosa requires patience, empathy, and a comprehensive understanding of the disorder. Here are some ways you can help your loved one on their journey to recovery:

Show Compassion and Understanding

When you are speaking to your loved one about their eating disorder, it’s important to approach the conversation with compassion. You want to validate their experiences and avoid judgments, criticism, and shaming.

Encourage Professional Help

Although it may be difficult for someone with an eating disorder to want to receive treatment, it is still important for you to encourage it. Most success is found in early intervention. When the illness is treated, early on, there are often better outcomes than for those struggling without help for years.

Educate Yourself

One of the best things you can do to support your loved one if they are struggling with anorexia and/or anosognosia is to educate yourself on the facts. This should include the common signs and symptoms, possible treatment options, and debunked myths. This information is powerful in helping you better advocate for your loved one and their well-being.

Foster Open Communication

Create a safe and supportive environment where your loved one feels comfortable discussing their thoughts and feelings. Encourage open communication and active listening, allowing them to express themselves without fear of judgment or criticism.

Practice Self-Care

Supporting a loved one with an eating disorder can be emotionally and physically draining. Take care of yourself and prioritize your own well-being, seeking support from friends, family, or mental health professionals if needed.

Be Aware of Triggers

One of the most important things to keep in mind is that even those deep into recovery can and will experience triggers. You can avoid adding to these by educating yourself on avoiding phrases and conversations, such as calorie counts or weight loss.

Expert Eating Disorder Treatment

If you think that a family member, child, or friend of yours is struggling with an eating disorder, it is important to consult a professional. With proper treatment, individuals can overcome their eating disorder and live a healthier life, both physically and mentally.

I am Alison Pelz, a psychotherapist and registered dietitian with over 16 years of experience. I specialize in treating eating disorders in Austin, TX.

If you or someone you care about is struggling with an eating disorder, don’t hesitate to reach out for help. To learn more about expert eating disorder treatment and schedule a consultation with me today. I am here to help you and your loved ones reclaim their lives and break through the chains of disordered eating.

Are you a clinician? Sign up for my mailing list and CE course!

Sources:

Impaired Awareness and Anosognosia in Mentally Ill: Study Summaries (Mental Illness Policy Org)
Anosognosia Condition and Anorexia (verywellmind.com)
European Eating Disorders Review | Eating Disorders Journal (Wiley Online Library)

5 Tips for College Students in Eating Disorder Recovery

Posted on August 24, 2022August 5, 2022 by Alison Pelz, LD, RD, CDE, LCSW

Starting a new semester (or starting college for the first time) is associated with many positive feelings and excitement. However, along with these positive feelings, college students may experience feelings of isolation, worry, and sadness that often come along with major life transitions.

Unfortunately, these feelings may worsen eating disorder symptoms for college students who are struggling. When you’re already under stress from school and new social situations, it can be tricky to get a handle on your eating disorder symptoms or to move forward in your eating disorder recovery.

Why is it hard for college students to maintain eating disorder recovery?

Increased demands + independence

Returning to college, or going for the first time is exciting! It’s often a breath of fresh air to see friends you haven’t seen all summer, move into your new home for the year, and get into the swing of a new semester of classes. The taste of freedom and independence that college offers is hard to beat!

If you have already experienced some time at college, though, you know that gaining independence also means more responsibility–which at times can be overwhelming. If you’re attending college for the first time, it’s normal to feel both excited at the opportunity for independence and totally overwhelmed by what that independence means.

It can be challenging to set boundaries for yourself while managing-the demands of being a student, your social life, caring for yourself, and recovery. Increased demands often mean increased stress, which often is associated with an uptick in eating disorder symptoms.

Changes in Routine

When in recovery for an eating disorder, changes in routine can be tough to deal with. Routines allow for some comfort and dependability. When we have a routine, we know what to expect and when to expect it. It cuts down on the level of uncertainty or stress we feel about the unknown. College students often find that it takes a few weeks or longer to figure out their new routine.

Routines also have very practical uses in recovery. They affect meal planning, treatment appointments, sleeping habits, and more, all of which play a role in recovery! Navigating a new routine can be challenging, and can feel overwhelming. Giving care and consideration to what your new routine will be and how it works for you is important.

Diet culture on Campus

On a college campus, you’ll be surrounded by other young people, who are also surrounded by the constant messaging on social media about diet and beauty standards.

Gyms on campus may be full of college level athletes training in ways that other folks who don’t need intense conditioning for a sport shouldn’t be pushing themselves to compete with.

You might be surrounded by fear of the “freshman fifteen”, or feel pressure to skip meals to study for exams with other students. The culture around food and exercise on a college campus may not be the healthiest one. It’s important to prepare for that with a counselor beforehand so you have coping mechanisms you can use when the need arises.

Are you wondering what you can do to support eating disorder recovery at the start of a new semester? Here are 5 things college students can do to stay on track with eating disorder recovery.

1. Continue care with your eating disorder treatment team

It’s important to continue the work you’re already doing with your eating disorder treatment team as you transition back to school. The start of a new semester means a changing schedule, routine, and living situation in many cases. Making sure you have the support of your treatment team can help you weather these changes so you can have the best experience possible at schoo.

If you don’t have a treatment team a good place to start is your college health center. Most colleges don’t provide long-term counseling for eating disorders, but they can put you in touch with providers in the community that can support you throughout the school year so you can get the help you need.

2. Establish a routine

Remember, routines help us all, but they especially help folks with eating disorders. Routines give us peace of mind, comfort, and help us stay on track with eating, which is a crucial part of recovery.

Just as I am sure it took some time to establish a summer routine, it will take a bit for you to establish a school routine as you find what works for you and your needs. Be patient with yourself!

3. Get to know other college students

Support is crucial in recovery, not just from your treatment team but from the people you care about. It’s easy to get so into your school routine that you forget about reaching out to your friends regularly. Make sure to check in with yourself often to see if you are getting enough socializing in (or if you are getting too much – alone time is also important for self-care).

If you are new to campus or find yourself feeling isolated consider joining a club. Most campuses have tons of clubs and organizations that cater to a variety of interests and skills for college students. Consider joining a club for fun and a club that has to do with your major to start with so you meet a good mix of people from inside and outside of your academic department.

4. Go to class

This may sound like a no-brainer. But, it feels like since the pandemic more universities still have a fair amount of classes online. If you have a choice, consider taking all of your classes in person. We’ve done enough online for the last two years. It’s also hard enough to concentrate at times, especially in the middle of a lecture, and it can be even trickier to focus when you have all the distractions of home around you.

Actually stepping foot in the classroom can help you get more in the school mindset, and it can also be a great way to meet other college students.

Additionally, I know it is very enticing to skip classes at times (after all, most professors don’t take an attendance grade). It’s always tempting to get a few more hours of sleep or to use your time for something else, but skipping class has some drawbacks. Missing classes often makes us feel more depressed, isolated, and guilty instead of relieving stress.

5. Practice good self-care

What’s your self-care routine? It’s important to remember that you’re worthy of being taken care of. Self-care can include getting your nails done, taking a hot bath, or using a face mask. It can also include things like getting enough sleep, taking your medication, setting boundaries, and having hard conversations.

We often have an idea of self-care as fun little treats or splurges, but self-care isn’t only about spending money. It’s about taking care of your emotional and physical needs.

Self-care can mean different things at different times. Sometimes it might mean decompressing by yourself in front of the TV. Other times it might mean making time for friends and social events with other college students. Try to check in with yourself regularly and ask what your self-care needs are at the moment. Remember, it’s not selfish to take care of yourself- it’s necessary.

Navigating school while in eating disorder recovery can be challenging for college students, but it can be done especially with some planning and the support of a treatment team. If you’re interested in learning more about how I can support you as part of your eating disorder treatment team, contact me here.

5 Ways Journaling Can Help in Eating Disorder Recovery

Posted on February 16, 2022February 15, 2022 by Alison Pelz, LD, RD, CDE, LCSW

What do Oprah Winfrey, Freda Kahlo, Marie Curie, and Anne Frank all have in common? (Besides being exceptional women, that is.)

They all journaled.

When you read about why these incredible women kept a diary, building a strong connection with one’s emotions and thoughts is the theme that comes up.

People who suffer from eating disorders often really struggle to identify and cope with their emotions and thoughts. (And not just people with eating disorders, lots of people struggle to connect with what they’re feeling and why!) Often the eating disorder then becomes the way to cope with those emotions, unhealthy as it may be.

Having a strong journaling practice doesn’t mean that your eating disorder will just evaporate on its own. But keeping a journal is a tool that can help you in your journey in recovery, and support your work in therapy. If you don’t have a therapist or treatment team click here to learn more.

Journaling can help:

Rid unhelpful, repetitive thoughts swarming around in your head.

Simply writing thoughts down sometimes can provide a reduction of these thoughts. The more we hold onto or try to bury our feelings, the stronger they usually become–and the more it feels like they can start to control us. When you take time to get the thoughts out in some way, your mind is able to release them, instead of clinging onto them.

Identify your fears and worries.

Many people who have eating disorders often experience high levels of anxiety. Journaling can assist in identifying those fears and worries in order to evaluate if they are actually reflective of the truth. Learning to identify when our fear those fears are “real” can help both your problem solving skills and your ability to tolerate some levels of anxiety.

Increase a sense of control by reflecting and processing thoughts and feelings.

Giving yourself a space to review and reflect on what you’re feeling without judgement can help take the power out of those strong feelings. Instead of feeling like they are controlling you, learning to reflect & process them helps to teach you that your feelings are trying to communicate something to you, but they don’t have to dictate your life.

Explore and sort out your emotions.

Identifying, understanding and communicating emotions can be hard, especially for those with eating disorders. Often people with eating disorders use eating disorder behaviors to cope with their emotions. Journaling is a tool that can instead help you to navigate your emotions, so you don’t have to rely on your eating disorder to manage them.

Reduce avoidance of problems & stress.

While avoiding problems and stress may seem helpful particularly in the short-term, in the long-term it actually increases feelings of stress, discomfort, and fear. For example, if you are anticipating a tough conversation with someone the longer you put the conversation off the more stressful it becomes. Usually, once the conversation is completed there is a sense of relief. Merely writing about the anticipated conversation is a great first step to reducing avoidance. Eating disorder behaviors often serve as a way to avoid stress and discomfort, so developing a healthy practice to manage stress can help reduce reliance on those behaviors, as well as strengthen your stress management skills in the long term.

Tips to Get Your Journaling Practice Started

Journaling can be downright daunting–especially if you are not used to talking about emotions. But think of journaling as a practice, something that you may feel “not good at” at the beginning, but over time you will become more confident.

Make it part of your daily routine like brushing your teeth. Perhaps journal at around the same time or point in your day. Maybe start off with journaling five minutes a day and increase the length of time as needed or as your confidence builds around journaling.

What to Journal About:

There is no “right way or wrong way” to journal. The point of the journal is to get your thoughts and feelings out on paper. No need for perfect grammar, spelling, or handwriting.

You may start by writing about your day (what you did, thought, and any feelings that came up), or a particular situation that you felt strongly about–whether it was a good or bad feeling.

It may be handy to keep a list of feeling such as this one next to your journal. This can be a good tool to increase your emotional vocabulary, strengthen your ability to identify what you’re feeling, and really understand your emotions.

If you don’t know where to get started with your journaling practice, try one of these journal prompts:

3-5 things you are most grateful and why.
One thing you felt proud about today.
Something you recently did that was hard and how you manage it.
A stressful situation and how you can cope with it.
A letter to a future self.
What do you feel most worried about and why.
What others would say to you about why they care for you.
Eating disorder-specific:
Name 5 ways your eating disorder is helpful and 5 ways that your eating disorder is unhelpful.
If I didn’t have my eating disorder then I would be doing these five things.
If I didn’t have my eating disorder then I would feel these 5 things.
I would want my friends and/or family to know about my eating disorder ar these things.

If you are looking for more ways to support yourself in your journey of eating disorder recovery, talking to a therapist may help. Please call for a free 15-minute phone consultation to learn how I work with clients with eating disorders and loved ones.

4 Tips for Anyone Who Loves an Adult in Eating Disorder Recovery

Posted on November 10, 2021November 9, 2021 by Alison Pelz, LD, RD, CDE, LCSW

When you hear the words “eating disorder” what comes to mind? More often than not, eating disorders are associated with teenage girls. While it is true eating disorders often develop in adolescence, adults can have eating disorders, too.

It’s possible for eating disorders to initially develop later in life, not just during adolescence. It’s also possible that adults suffering from an eating disorder developed it during adolescence and never fully recovered. Life stressors (like a pandemic, for example!) later in life can also cause a relapse of eating disorders.

Eating disorders develop for a variety of reasons including genetics, temperament, gender, and dieting history to name a few.

It is less important why and how the eating disorder developed, and more important to focus on supporting your loved one in their eating disorder recovery.

If you love someone in eating disorder recovery, here are four ways to show your support:

1. Think about an eating disorder like a physical illness.

An eating disorder, like cancer, is not a choice. This is often misunderstood. If it was as simple as just choosing to eat more food, far fewer people would suffer with eating disorders.

If your loved one was going through treatment for cancer you may do some of the following: learn about their diagnosis, take them to treatment appointments, provide support, and check-in with them more frequently.

You can do the same with eating disorders. Eating disorders are dangerous and can cause long-term health effects and even death, and they should be taken seriously. See what you can do to understand that eating disorders (EDs) are a physical as well as mental illness.

2. Get educated on eating disorders.

Learning as much as you can about eating disorders is another way to support a loved one in recovery. Eating disorders on the surface appear to be about food. But, make no mistake, while food issues are part of the eating disorder, eating disorders are psychiatric illnesses that must be treated by experienced clinicians. Here are some resources to learn more about eating disorders:

The National Association of Eating Disorders
The Eating Disorder Sourcebook by Carolyn Costin
Eight Keys to Recovery from an Eating Disorder by Carolyn Costin and Gwen Schubert Grabb
Skills-based Learning for Caring for a Loved One with an Eating Disorder by Janet Treasure, Grainne Smith and Anna Crane

You can also ask your loved one if they would like for you to attend treatment appointments with them so you can get a better understanding of their treatment plan and goals.

There are also resources on social media sites like Instagram that offer helpful information about eating disorders, diet culture, and recovery. Make sure to check that the information you’re getting is coming from a reliable source – there are lots of folks out there who borrow language from body positive and anti-diet circles but who are still pushing intentional weight loss or food restriction. It can be really eye-opening to learn about the root causes of eating disorders, in addition to being a great way to support someone you love with an eating disorder.

3. Learn how to communicate with your loved one in a supportive way.

As with most things, supporting someone in eating disorder recovery requires communication. The best way to find out how to support them is to ask! Ask them directly what would make them feel supported or what they’re struggling with. Find out what they would find helpful or for ways you can provide support (or adjust your support if necessary).

It can be tricky to communicate about such emotionally charged topics. Statements such as these can feel supportive to your loved one.

“I know this is hard.”
“You can do hard things.”
“I am here if you would like to talk about it.”

There are a lot of ways to be supportive, but some statements aren’t helpful for folks in ED recovery. Unhelpful statements that you may be tempted to say (remember the ED is not only about the food)

“Just eat.”
“I don’t know why this is so hard…do what I do [insert advice about food, exercise].”

Remember, eating disorders are not just about the food. Everyone’s body is different, and most of us aren’t qualified to give out medical or nutritional advice anyway – we can leave that to the folks on the treatment team.

Another thing to keep in mind is that mealtime can be particularly stressful for those with eating disorders. Some meals and foods may be easier or harder for your loved one to eat. If you eat with your loved one at mealtime it may be helpful to focus on light conversations that have nothing to do with their eating disorder.

4. Be patient.

Eating disorder recovery is a marathon, not a sprint. Recovery is not linear, in fact, it can get quite messy. It requires lots of learning and unlearning, as well as patience and self-compassion.

Don’t give up, and keep checking in with your loved one. Get support for yourself if you need a space where you can process the emotions of supporting someone through recovery. It’s okay to recognize that supporting someone sometimes means asking for help yourself. The National Alliance for Eating Disorders has free support groups for loved ones.

If you are looking for more ways to support your loved one in eating disorder recovery, talking to a therapist may help. Please call for a free 15-minute phone consultation to learn how I work with clients with eating disorders and loved ones.

Consider Body Acceptance Over Body Positivity

Posted on October 20, 2021September 16, 2024 by Alison Pelz, LD, RD, CDE, LCSW

There’s a lot of buzz in the wellness and mental health worlds about body positivity and body acceptance, but what do those terms even mean?

Body acceptance is the idea that it’s not always possible to feel positively about your body, but it is always possible to accept it and treat it with kindness. The end goal of both of these is to increase the acceptance of all body sizes and to help people feel more comfortable in their own bodies.

In contrast, body positivity is the idea that everyone deserves to feel positively about their body image. If you’ve ever seen a post on social media telling you to “love your body”, then you’ve probably experienced body positivity.

At first glance, body positivity sounds great. After all, things would be so much simpler if we could all just love our bodies! However, that’s often easier said than done for a number of people.

The idea of body positivity has its roots in fighting diet culture, but the term doesn’t resonate with everyone. After all, feeling positive about your body is a tall order for a lot of people.

First of all, there is a multi-billion dollar diet industry that uses its considerable resources and influence to convince us all that there is something wrong with our bodies. Feeling insecure about how our bodies look is a surefire way to get us to buy products that will “fix” us. However, consider the idea that there was nothing wrong with your body in the first place.

People who are chronically ill or have varying abilities might not feel like they can be positive about a body that is constantly in pain or not able to move through the world easily. People who are recovering from eating disorders might not trust their body’s cues or might feel distress when thinking about their bodies.

Body acceptance might feel like a more attainable goal than body positivity.

You might also go back and forth between positivity and acceptance for your body depending on the day. Nothing lasts forever, and the feelings you currently have about your body probably won’t last. What will last are the consequences of the way you treat yourself, so do what you can to show yourself compassion.

It’s important to remember that one isn’t better than the other. Body positivity and body acceptance are options, and if one feels more attainable than the other, don’t push yourself to feel things about your body that you’re not ready for.

Here are some questions that I get asked frequently about body positivity and acceptance:

Question: I hear all of this stuff about body positivity and feel hopeless. I feel like I am nowhere near loving my body. Is it necessary for me to feel body positivity to recover from my eating disorder?

Answer: While body image, or what we feel and think about our body, is closely tied to eating disorders, body positivity is not necessary for recovery. Body positivity is an ideal outcome of recovery, but it’s not the only outcome available.

In a nutshell, body dissatisfaction or a negative body image often contributes to the extreme eating and exercise behaviors we see in folks with eating disorders. In fact, if negative body image is not in check, the eating disorder will keep going. However, feeling positive about your body is not required to start recovery.

Body acceptance is often a more accessible place to start. As mentioned above, body acceptance is the practice of acceptance, even if you aren’t completely satisfied with it. Body positivity is the practice of feeling positively about your body, which can be a lot harder to do.

It is okay to like some parts of ourselves, but not all. Like so much in life (jobs, school), we may like some parts but not all. Either way, we accept that the parts we don’t like are there.

Question: I really don’t like my body. How can I at least work on increasing body acceptance?

Answer: The knee jerk reaction in our culture is if we don’t like something we need to “fix it”. Certainly, diet culture gives a false notion that if we “work hard enough” then we can have the body we want.

I am here to say I have never met a person with an eating disorder that is NOT a hard worker.

Body acceptance is about changing our thoughts about our body, not about changing our body to match our thoughts.

A typical thought someone may have with body dissatisfaction is “If I get my body to look a certain way I will be more confident.”

While there may be some truth to that, changing your looks is not the only way to feel confident. Confidence can come from so many places, but unless you address the root of that insecurity, a new one will pop up in its place.

If you broaden your thoughts, you will see that there are lots of other ways to build or have confidence without staying in your eating disorder.

Another typical thought someone may have about body dissatisfaction is “I am afraid of what people are thinking of me.”

That is to say you fear people will react negatively to you. Lots of times, you don’t even have proof of this happening, but the fear is there all the same.

Unfortunately, many folks who struggle with eating disorders have been teased, ridiculed, or bullied about their body. Many people who struggle with eating disorders come from families that place high value on looks. (If that’s the case for you, this is something to address and unpack with a therapist.)

More often than not, when we assume people are thinking something bad about our bodies, we don’t have any evidence to back this up.

These thoughts and worries are the real distress, not our bodies. Freeing yourself from the worry that other people are judging your body can give you more time to think about what it would feel like to accept your body as it is.

If accepting your body still sounds scary, there are things you can do to help. One way to increase body acceptance is to identify parts of your body that you do like. It is OK to like some parts of your body but not all parts. You can keep a journal where you write down what you like about your body. You can write down something that you’re grateful for that your body does – like how your stomach holds in all your organs and protects them, or how your thighs help you get from place to place. You don’t have to love each little bit of your body to want to take care of it and keep it safe. Acceptance is enough.

Increasing body acceptance is key in eating disorder recovery. If you’re looking for more support in developing body acceptance, please click here to schedule a free 15-minute phone consultation with me.

Coping With COVID-19 and Eating Disorder Recovery: Tips for College Students

Posted on September 23, 2020September 22, 2020 by Alison Pelz, LD, RD, CDE, LCSW

Let’s face it – starting a new year in college during the COVID-19 pandemic is rough. College life looks much different than it used to, with virtual classes and less socializing, to name a few things. If you add an eating disorder into the mix, it can make starting the semester feel downright daunting.

If your eating disorder symptoms have increased since the pandemic started you are not alone. Eating disorder behaviors are a way to manage and cope with stress, so more stress can equal the exacerbation of eating disorder symptoms.

Furthermore, the nature of physical distancing can lead to feelings of worry, sadness, hopelessness, and loneliness which also can trigger eating disorder behaviors, including dietary restriction, purging, binge eating, and overexercising.

Starting a new semester (or starting college for the first time) is associated with many “positive feelings” and excitement. However, along with these positive feelings, students may experience feelings of isolation, worry, and sadness, again exacerbating eating disorder symptoms.

Remember it is normal to be experiencing more stress, worry, and sadness during the pandemic. However, there are tools that you can use to manage your feelings.

Below are some tips to help you cope with stress, the pandemic, and your eating disorder:

Keep connected with your treatment team.
- Whether you are doing treatment in person or virtually, keeping regularly scheduled appointments is key to keeping your eating disorder recovery on top of the priority list. If you feel like you need more support during this time, ask your team about more frequent visits and/or attending virtual groups. To learn more about eating disorder treatment teams or how to get treatment, click here.

Stay social.
- College with a side of COVID can be very isolating especially if you participating in virtual learning. It is not uncommon to experience an increase in loneliness. Social connection with family and friends can help reduce feelings of loneliness, sadness, and worry. Keep socializing in whatever way feels safe to you a top priority.

Make time for hobbies and other coping skills.
- Coping skills and hobbies can help manage stress and uncomfortable feelings such as worry, sadness, and anger. Healthy coping skills are activities that you can help you positively manage stress. These can include talking with a friend, spending time outside, playing with a pet, reading, cleaning, doing a puzzle, praying or meditating, or volunteering, to name a few. Hobbies such as crafting, art, photography, and the like can also help reduce feelings of stress.

Keep a routine.
- Having a routine can help reduce stress levels by adding structure and organization to your day, even during the pandemic. Having a general—but not rigid—routine around eating, sleeping, socializing, and studying can be helpful in your recovery from your eating disorders and generally improve mental health.

Remember that it is normal for eating disorder symptoms to increase during times of stress, and the COVID-19 pandemic is a very stressful time. By practicing the tools above, you can learn ways to reduce your stress and continue with recovery.

If you would like to learn how I help clients manage stress or you need help in your eating disorder recovery, please click here to schedule a free 15-minute phone consultation.