This page was created to give those caring for someone with an eating disorder guidance on supporting the person during the coronavirus crisis. You may also find it helpful to read our information for those suffering with an eating disorder.
During this pandemic, acting as a carer to someone with an eating disorder may be even more demanding. When so much change is happening so quickly, many people who are carers might be struggling to know how to support those with eating disorders. People suffering with eating disorders might feel their preoccupation with food, weight and shape is worse at the moment, as they navigate new circumstances, deal with the additional worries caused by coronavirus, and perhaps fall back on something familiar in the face of so much uncertainty. They might need additional reassurance and support at this time.
Fundamentally, eating disorders are a mental health issue, and behaviours around food are symptoms. It’s likely that symptoms become worse during this period of increased anxiety and worry, so try not to view setbacks as giant steps backwards – long term, they may even be important learning points.
These are very unusual times, and it may take time to work out how best to navigate them when you’re supporting someone with an eating disorder. Try to be kind to yourself if you don’t get it right all the time – you are doing your best.
Staying on the path to recovery
A lot of the treatment for eating disorders has necessarily changed for the time being to keep both patients and healthcare professionals safe. Some appointments are being cancelled or postponed, and others are no longer face-to-face. The person you’re supporting may also have heard about the pressure on healthcare services at the moment, and be worried about adding to this. But they still deserve and should be getting care, even if the way this is delivered needs to change for a while. The NHS website stresses that it’s still important to get medical help if you need it. Try to empower the person you are supporting to take responsibility for their treatment, but also let them know you are there to support them.
Encourage them to call their treatment team to ask about current provision. If they feel unable to do this, try to explore how you could support them to communicate with their team.
If you are concerned about the state of the person’s physical health, call their treatment team. If you are seriously worried about them, call their GP and inform them that you are concerned. In some circumstances you might not have permission to be involved in the person’s treatment; however, anyone can call a treatment team or GP and give them information.
If you feel their life is in immediate danger, call 999.
The pandemic has created a number of practical issues around food, and anxieties about the effects of the crisis may increase the urge to use eating disorder behaviours. Your patience and kindness at this time is vital.
It could be helpful to talk to the person you’re supporting about meal planning, what foods they feel comfortable with, and what support you can put in place during mealtimes. You could also help them to think about substitutes for any foods they’re still struggling to get hold of.
You could try a traffic light system on meal plans, noting which foods they feel are safe (green), challenging but manageable (amber), or very challenging (red) – meals involving more red or amber foods could require more support, and you could plan how you could put support in place with them for the more challenging meals. You can do this even if you’re not with them in person – for example, by video calling them during meals so you can “eat” together.
People with eating disorders might be struggling with thoughts of compensation such as exercise or purging after meals. Try and have a conversation (away from mealtimes) around how you can support them with distraction techniques after meals – for example, sitting down to talk, going for a gentle walk together, playing a game, or watching a film.
Now might be the time to set up a support network of trusted people you know who might be able to get hold of safe foods. Once again, check in with the person you’re supporting that they feel comfortable about you doing this.
The current guidance to help avoid bingeing involves regular eating – three meals and three snacks per day is ideal. It might be helpful not to assume that the person you’re supporting accepts this idea. However, you could ask permission from them to make a suggestion. It’s important to help them feel as ‘in control’ of the situation as they can be at the moment.
If the person with the eating disorder is not physically hungry, they are less likely to binge. Restricting foods and not eating can cause bingeing because the person is hungry. If you’re already making a plan for the day, you could ask them whether it’s helpful to make a meal plan too.
If their binges are triggered by emotions, a way to support them could be thinking through BLAST – are they Bored, Lonely, Angry, Stressed, or Tired? Ask them whether it might be helpful to write a list of distraction techniques for each scenario.
Try to support them to make a plan of their own, rather than ‘fixing it’ or imposing your own ideas. They are more likely to follow through on the plan if they come up with the ideas themselves.
Binge foods – do I lock food away?
This is tricky to navigate. We would suggest that you approach a conversation about this very carefully.
We are getting some feedback from people who are suffering with binge eating that they might find it really helpful if carers supported them to lock food away at this time. However, this may not be useful for everyone. It's vital to discuss this possibility calmly and without making assumptions about what would best help the person you're supporting – everyone is different and what may be helpful for some may be unhelpful for others.
Perhaps agree that you’ll check in about this regularly. If you keep this guideline in place at this time, it will need to be reviewed when situations calm down and food is more accessible. Maybe agree a timeframe for how long you’d like to put this in place. For example, you might agree that you lock certain foods away for one week and then you will review it together after that and it might change.
You might also find that only certain foods need locking away, or that after a week they would like access to those foods again. At the moment things are changing regularly, so constant reviewing and reassessing will be needed in the weeks to come.
Managing day to day communication
While it might be tempting to want to step in and ‘fix things’ we would encourage you to stand by the advice we give to carers on how to communicate. It’s really important that you keep the conversation open and keep checking in with the person you’re supporting to ensure you have understood what they have communicated with you. Both you and they may wish to keep some record of how they’ve been feeling to refer back to when they next speak to healthcare professionals.
Listen to the person you’re supporting. They might be feeling very scared at this time. A lot of people with eating disorders say that they find it incredibly hard to open up and ask for help, so if they do open up, please do thank them for sharing how they are feeling with you. Listen to them and then try to acknowledge how they are feeling.
If they say, for example, “I’m scared about getting access to my safe foods right now,” you could respond with something like “Thank you for being honest with me about how you feel. I can totally appreciate that you might be feeling anxious at the moment – this is a scary time. How can I support you to make a plan moving forwards?”
Don’t try to jump in and fix things; try to ensure that they feel heard. It might be wise not to assume they would like support, but maybe ask them the following open questions. Try not to bombard them with questions, but let them know you are there.
How can I support you at this time?
How can I support you with your meal plan at the moment?
What would you like me to do/not do at the moment?
Is there anything I’m doing currently that is heightening your anxiety?
If you’re not sure about what they’ve said, reflect the sentence they’ve just said to you back to them and ask them if you’ve understood correctly.
If you’re not physically with the person at the moment, consider video calling them so that you can pay attention to their body language while you’re having conversations.
Communication after lockdown
Particularly if you and the person with the eating disorder are not in lockdown together, it may be difficult to know how things are going to be when things begin to go back to normal. We asked people currently experiencing an eating disorder what they would and wouldn’t find helpful, and were given the following suggestions:
- Avoid comments on their appearance or weight, or the difference between before and after lockdown. Be sure to also avoid talking about your own weight, diets or weight gain or loss during lockdown.
- Don’t expect them to able to do everything they did before lockdown. For example, they may have been able to go out to a restaurant, but need some time to build up to that level again.
- Be careful not to say anything that could appear to downplay the struggle of living with an eating disorder or compare it to the struggles caused by coronavirus. Many people feel guilty for accessing support if they’re worried that they’re not ‘deserving’ of it.
- Ask them things like how they are coping, how the lockdown felt for them, what they’re struggling with now, and how you can help.
- Give them time and space to open up again, as it may take time to adjust.
We encourage people who are suffering with eating disorders to create a structure to their day. One way you could really support them is by writing this structure with them and joining in with it where you can. If you’re supporting someone you don’t live with, you could ask them to send you their plan for the day and then agree times that you’re going to check in with them.
An example of a daily structure might be as follows:
|09:30 - 10:30
||Suduko, crossword, Journalling etc.
|11:00 - 12:00
||Drawing, play music etc.
|13:00 - 14:00
||Box set episode
|14:00 - 15:00
||Laundry, minimal cleaning
|15:00 - 15:30
||Garden if you have one, sit by open window
|16:00 - 17:00
|17:00 - 18:00
||Planned Exercise Time
|19:00 - 21:00
||Phone friend/ online book club
|21:30 - 22:00
||Wind Down Time
||Listen to music/ watch film
Eating disorder talk
Even in areas with fewer restrictions where seeing others is allowed again, it might still feel like you’re living in a bit of a ‘fishbowl’. People who are suffering with eating disorders might feel frightened that you’re going to challenge them on eating disorder behaviours and you might have noticed yourself that you’ve become more fixated on their behaviours. Anxiety is rife at the moment and all of us might feel we’re not communicating as well as we could.
One way to try and combat this might be to agree to have eating disorder talk ‘free time’ – you could agree when you will talk about it during the day, and that within reason you won’t discuss it outside that time. Try to stick to these boundaries so that you don’t feel like you’re all ‘walking on eggshells’.
What can and can’t be controlled?
It might be helpful to sit down together and make a list of what you can and can’t control. By recognising that some things are out of their hands, they may be able to focus on things that they can have a positive impact on.
For example, they can’t control:
- What kind of food is available in the shops.
- The fact that they may not be able to access treatment the way they would normally.
- How long things will be like this.
- What other people do with regard to coronavirus guidance.
But they can focus on:
- Getting support to make adjustments to meal plans.
- Staying in touch with their treatment team through other means.
- Putting plans in place to make things easier while this situation goes on.
- Following guidance themselves.
Caring for yourself
It’s likely that you’ve had to adapt to a different routine over the last few months. Lots of us are trying to work from home and possibly put new boundaries in place to separate work from home life. You may be finding the ongoing situation very tiring, or have started to settle into it, but either way, we would really encourage you to look after yourself more than ever through this time.
We advised you to look at putting in a structure with the person you’re supporting; however, this will be beneficial for you too. Try to structure in some self-care in your day.
It may also be helpful to ask a few close friends if you could check in with them and chat through how things are going. It might feel difficult to have these conversations in the house, so perhaps you could go somewhere else, for example, phone them from your car or garden or go for a walk, so that you have time and space to have honest conversations and offload about how you feel.
Remember, the Beat Helpline is here to support anyone affected by eating disorders, including those supporting someone. You can find out how to get in touch with us here.