Written by Dr Joanna Silver

In the blink of an eye the world has changed beyond measure.  As Lead Therapist for Eating Disorders at Nightingale Hospital I am privileged to see inpatients and outpatients for group and individual therapy.  When the lock-down was announced, I felt a sense of panic. “How could I continue to support my patients in their time of need whilst still following government guidelines?”

At Nightingale Hospital,we have rolled out a remote therapy programme for patients. It has been wonderful to be involved in this and I have been delighted to see how we can still connect with and help patients. Below I outline some of the struggles that people with eating disorders and disordered eating may be facing during these unusual times, and possible strategies for managing these.

Managing food

For people with eating disorders, food can be a real challenge and many people will restrict and/or overeat as a way of managing feelings. In my experience it is very helpful for people to plan their food and the timing of meals and snacks well in advance as it can be very hard and stressful for people to be spontaneous.

At the moment, obtaining food is difficult and the timings of meals may feel hard to stick to. I would encourage people to do the best that they can do in these circumstances. For example, when writing a meal plan it may be helpful to have a first, second and third choice in case the foods that you originally wanted to have are not available. In terms of the timing I would encourage people to plan their days around these timings as eating at regular intervals can be vital for regulating blood sugar levels and reducing the urge to binge and purge. Notwithstanding this, I think it is important to remember that there are days that this may not be possible, try and be kind to yourself when this happens. If you have a day when the timing and amount of food is not optimal, the best thing that you can do is acknowledge it, learn from it and start again the next day.

Managing a routine

A routine can be very helpful for people recovering for eating disorders. It can therefore be very difficult and scary for people to find themselves at home with their daily routines so drastically changed.

I would really encourage people to gently find a routine that works for them at present. It is important however to approach this with compassion as it may take time to evolve. It may be helpful to chunk it down into different sections such as ‘planning food,’ ‘hobbies’ and ‘time with children.’ I would encourage people to make sure some of these sections are not food or weight related. However, be flexible with this routine- what worked last week may not work this week. Putting too much pressure on yourself to find the ‘perfect’ schedule may be unhelpful- some days you may be able to stick to your plan and other days you may not- this is totally normal.

For many people exercise is part of a daily routine and gyms being closed presents a real challenge. I think it is important to acknowledge this loss and find a safe place to express fears. However, I would encourage people, if they are able to, to try and use these restrictions as an opportunity to change their relationship with exercise. If you can go for walks you may find it helpful to set yourself little tasks such as describing what you can see, smell and hear. This may help you view exercise in a more holistic way and challenge some of your beliefs and assumptions about exercise.

Managing feelings

Whilst eating disorders manifest in physical ways, they are a way of managing, controlling or numbing difficult feelings.

It is likely that we are all experiencing several different feelings at present, loss, fear, anxiety, disbelief, hope and joy to name a few.  These feelings can be difficult to process and manage and can feel out of control. It is understandable that people may therefore turn to food to create an illusion of control.

I would really encourage people to find some way to acknowledge these feelings, as opposed to suppressing them. It is totally normal to go through waves of different, and sometimes conflicting emotions. It is impossible to not be impacted by the enormous suffering that we are all witnessing.  However, this does not mean that your struggles with food do not matter, all struggles and feelings are valid.

I think it is important for people to find a way to express their feelings as eating disorders thrive in isolation. Whilst we cannot be physically near people, there are still ways to connect with others. Of course, some people are apprehensive about connecting remotely with others and it is helpful to acknowledge these concerns. As with everything, there may be times that you feel like connecting with others and other times that this is not possible. Some people may find it useful to talk to a therapist whereas others may prefer to speak to friends and family or to connect with others via pro recovery websites. Expressing feelings does not always need to involve words- some people find it helpful to express themselves via music or art.

Good luck to everyone who is struggling at the moment with eating disorders or disordered eating.

Recovery is never a straight path and ‘blips’ are normal and can be a real opportunity for growth and learning.

Hope is always possible. 


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