COVID-19, Social Isolation, and Eating Disorder Increases

COVID-19 repercussions (e.g., social isolation) have contributed to several additional crises, including a global rise in eating disorder (ED) symptoms.

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For example, at least half of surveyed adults in the U.K. found it more difficult to control and/or regulate their eating during the 2020 COVID-19 lockdown than they did previously.² These adults also felt more preoccupied with food, exercise, and their appearance than prior to the pandemic. Those with a previous or current ED diagnosis were most likely to experience these increases.

A slightly different, but no less concerning, scenario was found in Australia. Here, adults with and without an ED reported increases in food restriction and binging during the COVD-19 lockdown, while those with a history of an ED reported additional increases in purging and exercising.³

Reasons for an increase in ED symptoms during the COVID-19 pandemic include, but aren’t limited to, routine disruptions (i.e., unable to access certain foods or exercise), service unavailability (e.g., support networks and health care), isolation, losses of control, stress, and changes in mood.

Each of these factors deserves a full explanation and, therefore, I will solely focus on social isolation for this post. Specifically, how it might impact the brain in ways that contribute to current increases in ED symptoms during the pandemic.

COVID-19, Social Isolation, and Eating Disorders

The current pandemic has upended how, how often, and with whom we socialize. While this creates new challenges for many, these changes might be especially difficult for those with an ED.

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This is because people with an ED often struggle with social skills.⁷ Socializing, however, is an important ED prevention measure, with research showing that good social skills can reduce an individual’s risk of developing an ED.¹

Socializing also gives individuals with an ED a support system and minimizes opportunities for them to devote time to their ED behaviors (e.g., exercise).

Recognizing the importance of relationships between socializing and ED development, Fernández-Aranda et al. (2020) recently constructed the COVID Isolation Eating Scale (CIES) for research. The aims of the CIES are to⁴:

• Measure how confinement during COVID-19 lockdown impacts EDs (and obesity).
• Measure changes to ED behaviors (e.g., eating symptoms) and relevant mental health factors (e.g., dysfunctional emotions) during confinement.
• Explore telemedicine difficulties during confinement.

In its trial run, the CIES showed that, following COVID-19 confinement, people with subclinical EDs experienced greater increases in dysfunctional eating, anxiety, and depression compared to people diagnosed with an ED. This suggests that people with an undiagnosed ED might be particularly vulnerable during lockdown, possibly because of fewer available treatment opportunities.

Social Isolation and Health

It's unclear why chronic social isolation increases the risk for illness development.

One hypothesis (i.e., social control) is that having larger social networks and participating in social activities encourages people to take better care of themselves (e.g., exercise and health checkups). Isolated individuals, in contrast, have less of an incentive to manage their health, as they may have fewer people to “live for” (according to this hypothesis).

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While this might be somewhat true, neuroscience offers a more nuanced perspective.⁵ Nuance is important here because social experiences and our perceptions of them vary. For example, having a spouse might be comforting for one person, but stressful for another, especially if the relationship is abusive.

Therefore, how individuals perceive their isolation during COVID-19 confinement is important to consider.

Unfortunately, those with an ED are often oriented to perceive themselves and the world negatively; this makes these individuals susceptible to loneliness during COVID-19 lockdowns.⁸

Perceived Loneliness & the Brain

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Perceived loneliness orients us to notice and attend to negative social visuals, which can lead to chronic stress. Chronic stress can cause poor health by altering how the hypothalamic-pituitary-adrenocortical (HPA) axis regulates our bodies.⁶

The body's HPA axis is like a thermostat. It's made up of a group of different brain regions and glands that have the job of working together to keep the body functioning optimally. When something needs tweaking or a threat emerges, the HPA manages it.

Source: Annie Spratt/Unsplash

Threats to our well-being don't have to be deadly (e.g., illness). They can also be psychological (e.g., public speaking). The HPA regulates the body regardless, keeping us from becoming overstressed.

Because we're individuals with different fears and worries, the HPA axis is designed to pick up on what we each perceive as threatening (e.g., social isolation), sending “danger” signals throughout the body (e.g., cortisol; cytokines) when a threat is detected. These signals change how the body functions to protect it from the threat.

The problem with a chronic threat (e.g., social isolation), however, is that it makes the HPA axis work tirelessly to protect us from our perceived threat. This causes chronic stress.

An overworked HPA axis throws our bodies out of synch by chronically altering how our immune, metabolic, reproductive, cellular, and cardiovascular systems, among others, function. This is dangerous given that the body needs to function normally to keep us healthy.

In this way, social isolation can increase ED susceptibility.

From Perceived Loneliness to Eating Disorder

One consequence of social isolation is that it can alter how the cells in our brains communicate. For example, a recent study with female prairie voles showed that social isolation can prevent the adult brain from making new cells, while changing or even killing our current cells.⁹ Our brain cells are what regulate our thoughts, feelings, and behaviors. Consequently, these changes can result in increased stress, anxiety, and depression.

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Similarly, a separate prairie vole study showed that social isolation contributes to brain inflammation and changes in gut bacteria.¹⁰ Both of these consequences alter how our brain cells regulate our behaviors, which, again, can lead to increased anxiety, as well as decreased sociability.

Both anxiety¹¹ and depression¹², two implications of social isolation, have been shown to contribute to ED symptoms. This is because certain ED behaviors, including food restriction¹³, exercise¹⁴, and binge eating¹⁵ have been shown to reduce anxiety and alleviate stress for some individuals. Simply put, ED behaviors can serve as unhealthy coping mechanisms for psychological ailments (e.g., anxiety).

Summary

Putting this together, perceived loneliness during COVID-19 confinement can cause chronic stress. This can lead to bodily changes that impact our brain in ways that could increase anxiety and depression for some individuals.

Managing anxiety and depression during confinement isn't easy, especially for those without established healthy coping strategies. Social isolation provides the time and discreetness for people to engage in unhealthy coping strategies (e.g., excessive exercise, binge eating, and food restriction).

Considering this, more research is needed on how social isolation impacts the body and brain and the coping strategies people use to manage these changes. Understanding these relationships can help us better understand how to prevent and treat ED symptoms during and after COVID-19 confinement.