COVID and Eating Disorders: A Parent’s Perspective

I took a deep breath and held onto it as long as I could.

The thought of planning my son’s transition home with COVID-19 circling the globe just about logged a new record of anxiety for me. I do not suffer from anxiety, but the years of my son’s eating disorder treatment, return-to-home transitions, relapse and now supporting his recovery during a stay-at-home order made me more than nervous. For me, this order translates into isolation. And isolation is not an option for my son’s continued recovery from anorexia nervosa.

When I finally exhaled and grabbed another deep breath, the thought of isolation continued to rattle my nerves more than the pandemic that was about to unleash its fury across America.  This time, though, we were not returning home from treatment. We were returning home for our son to finish his freshman year of university in our household.

While sitting in the airport waiting for our flight home, televisions were focused on COVID-19 updates. As news of stay-at-home mandates were being unveiled, I observed a greater focus of my son’s attention on the isolation orders.  Further news focused on maintaining physical and mental health with diet and exercise. This fueled my anxious thoughts of eating disorders thriving in secrecy and isolation.

I couldn’t tell if these news reports resonated with him as they did with me. But I desperately needed some fresh air to clear my mind. I didn’t want to gulp a breath of airport air with COVID-19 hiding somewhere around us. Thankfully, it was time to board our flight.

When my son was in eating disorder treatment, COVID-19 was not on the global stage. During treatment, parents were educated on eating disorders, family-based treatment, emotional coaching, meal planning, relapse prevention and transitioning home.  With this parent toolbox of knowledge and skills in place, we were ready to harness the power of our wisdom to care, coach and support our son’s recovery.

Prior to COVID-19, I perceived mental health treatment providers’ resistance to virtual options for various levels of care. Beginning conversations on virtual IOP were taking place with some trials being conducted by providers. Now with face-to-face sessions mandated to be virtual, options for virtual services are being embraced by mental health professionals. While ensuring continual care for the treatment of eating disorders, treatment providers are also looking at extending virtual pathways to provide treatment and support for comorbidity diagnoses, as in anxiety and OCD with my son.

In transitioning home, we updated our parent toolbox with virtual options for outpatient care. Both the therapist and dietician remain on bi-weekly schedules. We ensure solid Internet connectivity and privacy for our son’s sessions.

A challenge surfaced when the responsibility for blind weigh-ins transferred from dietician to parents. Not only did we have to procure a scale, we needed to ensure it could not be freely accessed. Together with the dietician, we talked through the process with our son, and followed the same steps as if it was in person. We made it a seamless non-event, and ensured the number was securely provided to the dietician prior to the session.

We coordinated our son’s return from treatment to school, in person, with school counselors and teachers. Today, that is done virtually, and in consideration of teachers, possibly providing an abbreviated version of e-learning instruction. Even at the university level, modified and reduced class instruction causes excess stress for our son. Anxiety is fueled when extra help is required and the teacher’s bandwidth is exhausted. Backfilling this void for parents becomes a juggling act with work at home responsibilities and other family member needs. Even when this is burdensome for me, I stay calm to minimize my son’s observation of any anxious thoughts.

For my son, the joy he had in returning to school and friends were key ingredients to energizing his life after treatment.

Being quarantined delays a child or adolescent from enjoyment derived from being surround by peers. The loss of school dances, proms, and graduation celebrations can bring a new level of loneliness for which both child and parent struggle to find answers and solutions. While this was not our scenario, our son did struggle with the loss of friend groups. By adding a family therapist to our care team, we were able to work through his anguish and discover new social outlets for him. In today’s COVID-19 environment, and in addition to the therapist and dietician, virtual family therapists and process groups are options provided by treatment providers to work through the loss of a physical return to school.

Maintaining mealtime schedules has been a practiced dynamic in our household since our son returned from treatment. As a family, we created a new normal in our lives and our approach to meal planning, preparation, and family meals. We have continued to practice and fine-tune this new paradigm to support our son’s recovery during the COVID-19 pandemic.

Our local COVID-19 guidance for grocery shopping recommends one household member, one time per week, to shop. We are also experiencing certain food products either being in high demand or low in supply. This has spurred comments from our son that we have not experienced for a while: “Why are you serving this again, when we just had it last week?” “Do I really have to have dessert after dinner?” “While at school, there were more lunch choices than sandwiches?” “I am so full from this breakfast.” and “ It hasn’t been over two hours since breakfast, so I don’t need my snack.” When these questions and comments surface, it’s our son’s eating disorder looking for a crack in our structure. Staying true to our boundaries and addressing this with our son’s dietician reinforces our at home meal programming.

Our parent toolbox with COVID-19 has not gone unchallenged during our household isolation. As lunch was being served, one of my son’s teachers threw a curve ball to his class. This caused my son to panic over a grade. Before we could fully understand the issue, he instantly retreated to his eating disorder, spouting, “I don’t have time for lunch. I have to figure this out with the teacher now!” I took another, very deep breath, reached into the toolbox, and responded, “I can see that you are upset over the teacher’s comments. However, the teacher is in another class now and you will not be able to reach him until later this afternoon. Since our lunch has been served, let’s enjoy it together, and I have a funny work story to share with you from earlier today.” A quick redirection resulted in an enjoyable lunch for the both of us.

Living in a pandemic creates unknown dimensions for all parents.

It certainly has for my wife and I. Supporting our son in his eating disorder recovery amongst COVID-19 requires a lot of deep breaths with safe and creative decisions. Staying true to household structures, limits, boundaries, schedules, and not relaxing our commitment to virtual therapist and dietician appointments continues to move our son along his recovery journey.