Eating Disorder Triggers and COVID-19: A Guide for Psychotherapists By Dana Harron, PsyD on 12/28/20 - 1:09 PM

“I don’t know why, I just feel more like using symptoms lately. There’s no particular reason,” Margaret said*. “Um…,” I ask, endeavoring and likely failing to keep my tone neutral, “…can you brainstorm anything that might be contributing?”

“Well, I haven’t seen my friends in several months. I’m not working right now. I don’t have anything to do all day. Except check Insta, where everybody’s on some kind of weight loss or exercise plan. I can’t go anywhere or do anything, and I have no idea how long this is going to last. It’s not too far-fetched to wonder if we’re all going to live in some horrible Mad Max dystopia. And, oh yeah, I might contract a lethal virus and die.”

Chris had a similar dissociative response to our collective trauma: “Ever since March or April, I’ve been really dissatisfied with my body. Maybe because of springtime, with the beach season on the way? Except of course this year I won’t be going to any beaches…so there’s that whole thing.”

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Acknowledging Eating Disorder Triggers

As therapists, our job is often to connect dots that aren’t readily apparent to our clients. It might seem obvious that they will be affected by the events in the world but, as one of my clients put it, “It’s hard to remember that you’re actually human sometimes, and that you’re vulnerable to the same stuff everyone else is.” And so, when working with people who have eating disorders it is important to know that almost every aspect of this pandemic is rife with potential triggers. By understanding the multiple ways in which COVID-19 can affect our clients with eating disorders, we can help them to plan for healthier ways to make sure that their needs get met in this difficult time.

Dealing with Unstructured Time

Many of my clients with eating disorders have the sense that they just don’t know what to do with themselves. Without normal routines to rely on, the days have begun to feel like an endless void. For these clients, eating disorder symptoms offer a way to be engaged in something. For some, this might mean over-exercise and calorie counting. For others, overeating. Still others will cycle between back and forth between overeating and attempting to “compensate” for the intake. One college student I am working with has been using food to break up the time to give it more structure by eating on a very rigid schedule. Unfortunately, for her this means getting out of sync with her natural body rhythms and being able to listen to her hunger and fullness cues.

Helping clients to schedule their day can give them a sense of groundedness and prevent filling up the time with unhealthy behaviors. With Sara, we sat down with her day calendar and plotted out a week’s worth of activities. Sometimes the structure was as loose as “Thursday morning—TV in the living room”; “Thursday afternoon—reading in the bedroom.” Other times when she was really struggling, we went hour by hour—including meals. If you do this, be sure to include changes in location as a part of the schedule, and outside time if at all possible.

Addressing Role Overwhelm

For many other clients, unstructured time is not a problem at all. In fact, there may be a sense that there is no time at all. This is particularly true for parents who will no longer have the support of the school environment and are being asked to take a role in their child’s education that is outside of their expertise. Many are also attempting to care for their children while working from home, guaranteeing that they will be able to do neither effectively—a client of mine recently described a morning in which her three-year-old emptied all her kitchen cabinets while she was on a Zoom meeting. When she was done with the meeting, she had 8 or 9 follow-up tasks—plus an entire kitchen to sort out, all while entertaining her child. While moving quickly from meeting to caretaking to schooling and back, clients with eating disorders may leave their own needs on the back burner, forgetting to eat, cook nutritious foods, or take time for themselves.

Fighting Toxic Cultural Expectations

In our compulsively productive culture, having some time on your hands mandates you to do something with it to “improve yourself.” More benign manifestations of this drive include educational tasks such as reading the classics or learning to knit. For our clients with eating disorders, though, this train typically runs down the “perfect your body” track. They are reinforced by a spate of “COVID workout plans” and a social media frenzy of fears about the COVID-19 (as in, the nineteen pounds one can supposedly expect to gain during quarantine). “If I’m not getting thinner, I’m not getting better,” one client said to me. As therapists we can provide a counterpoint to toxic cultural messaging—by what we say, and through what we do.

Addressing Perceived Lack of Activity

Perceived lack of physical activity is very triggering for lots of people with eating disorders. They worry that if their routines change, they might gain weight. This in turn is correlated with immense shame and fear of being unlovable, lazy, or worthless. Some with eating disorders will restrict their food intake to supposedly “make up” for lack of activity, often wildly overestimating how much caloric cutting back would be equal to the actual amount of energy unspent. Others, because of black and white thinking, will begin to have difficulty caring for themselves in any way if they are not able to follow their previous routines. Helping clients to reality-check how inactive or active they really are can be tremendously helpful, as can helping them to sit with and manage the anxiety it brings up.

Avoiding Isolation

It’s difficult for anyone not to have access to their support systems. For people with eating disorders, this includes access to a treatment team and peer network that help to fight the eating disorder “voice” by providing context, reassurance, and normalization. Without this support it can be easy for someone with an eating disorder to be overwhelmed by their own thoughts. As therapists, we can provide an important counterbalance, but it’s also more important than ever that we encourage our clients to participate in healthy groups and online forums.

Ameliorating Anxiety

Whether or not somebody qualifies as having an anxiety disorder, this is a time of heightened anxiety for everyone. None of us knows whether we or our loved ones are going to get sick. None of us knows how this will affect our society or how long it’s going to last. Many people with eating disorders deal with anxiety by converting it—rather than feel uncertainty and dread about things that are outside of their control, they channel their uncertainty into worrying about food and body issues. Helping clients with concrete tools such as diaphragmatic breathing and progressive muscle relaxation can help them to better cope with these uncomfortable feelings and distressing concerns.


COVID-19 is very triggering for everyone, but our clients with eating disorders will be triggered in specific ways. By keeping this in mind we can help them to maintain their gains, avoid or minimize relapse, and continue to learn to nourish their bodies and spirits.

*All names are changed, all quotes are compilations 

File under: The Art of Psychotherapy, COVID-19 Blogs