The COVID-19 pandemic has had a profound effect on the mental health of young Australians. As a clinical psychologist practicing for almost 20 years, I have never experienced such demand for my services. The social isolation, disruptions to routines and inability to engage in valued activities has led to enormous psychological distress.
Adolescents and young adults are at a time in their lives when they should be individuating and increasingly looking outward, beyond their immediate families. The pandemic and lockdowns confined them to their bedrooms and a virtual world for months on end. For these people, the medicine has been worse than the disease.
As reported frequently in the media, eating disorders have surged during the pandemic. It is a myth that eating disorders are a fad or a diet gone wrong; they are serious mental illnesses that together with substance abuse disorders, and have the highest mortality rate of all psychiatric disorders.
An Australian study of 1723 people during the first lockdown in 2020 revealed that compared to before the pandemic, people with eating disorders experienced an increase in body image concerns, food restriction, binge eating, excessive exercise, and self-induced vomiting. These statistics certainly fit with my clinical experience in both private practice and in one of Melbourne’s leading public eating disorder services.
A Loaded Gun
Throughout the pandemic, I’ve spent thousands of hours talking to patients, loved ones and colleagues about this distressing situation. I’ve tried to understand the relationship between the pandemic and eating disorders. Was it the isolation? Cancelled sporting competitions? Distance learning? Was it that young people today aren’t as resilient as previous generations? While we hope that lockdowns are a thing of the past, if we are required to contemplate social restrictions again, having a better understanding of how eating disorders develop and what pandemic related factors serve as triggers could help save many of our young people from this devastating illness.
I have been supporting people with eating disorders since first becoming a psychologist in 2005 when these conditions didn’t attract much media attention. I knew that we had a problem because I was always in demand. Year after year, Mission Australia surveys show that young people consistently rate body image as one of their top four concerns. 77% of Australian Young Adults (16-25 years) report Body Image Distress. A review in 2012 estimated that approximately 4% of Australians were living with an eating disorder. This figure is likely an underestimation. Rates of binge eating and extreme dieting have increased significantly over time.
The introduction of the Medicare Eating Disorder Plans in 2019, acknowledged the seriousness of the issue. Under these plans, people can access 40 subsidised sessions with a psychologist and 20 with a dietitian per year, compared to the 10 sessions allocated to all other mental illnesses.
The point here is not to discount the effect of the pandemic and lockdowns (they certainly exacerbated the situation), but we had a major problem building before COVID arrived that cannot not be dismissed. We had a loaded gun in our hands and the pandemic was a trigger. There are always individual triggers in eating disorders – dieting, puberty, trauma, bullying – but this trigger, the pandemic, affected an entire generation. The other factors that put people at risk of an eating disorder are their biology or genetics, psychological factors, and their social environment of peers, family, and the media around them.
What does ‘cause’ an Eating Disorder
We know from a growing body of research that there is a strong genetic element to eating disorders. We also know that our society promotes very narrow standards of beauty. These narrow standards are internalised by children even before they reach primary school. This can lead people to believe that their self-worth is almost completely determined by their bodies and their ability to control their shape, weight, eating. This vulnerability factor must be addressed through school education programs such as the Butterfly Body Bright program from the Butterfly Foundation and The Embrace Kids film.
It is not only about appearance and beauty standards. Our increasing concern with health and the ‘obesity epidemic’ is relevant too. The dark side of these campaigns is that there has been increased fat phobia and weight stigma. I have observed an increasing number of well-meaning parents deeply concerned with their child’s perfectly normal weight fluctuations. Their worries are related to fear of obesity and its associated health effects. Sometimes this causes relationship friction if their child is not concerned about their weight. Most of the time, the young person ends up developing poor body image and experimenting with dieting, which is a common trigger for an eating disorder. We need to spread the message that bodies come in different shapes and sizes and that health can be achieved in a much wider range of body sizes than the healthy body mass index range.
Eating disorders are serious, complex mental illnesses that require an in-depth understanding of the relevant vulnerability factors and triggers. No single trigger can be held accountable- we can’t blame it all on Covid! It is crucial that we take a biopsychosocial perspective when trying to understand eating disorders and develop interventions to both prevent and treat them successfully.
If you are worried about your own or someone might have concerns in relation to body image or eating disorders, please contact The Butterfly Foundation Helpline on 1800 33 4673.