Eating Disorders, Couples, and COVID-19 By Dana Harron, PsyD on 11/5/20 - 2:50 PM

COVID-19 is a perfect storm for worsening eating disorders. It leaves people with a great deal of anxiety and uncertainty, too much time on their hands, too little support and treatment disruptions. It’s also terrible for couples. Even for the healthiest among us, spending too much time with a loved one is a wonderful way to forget about the reasons you love them. Small issues become big problems, and big problems begin to seem completely overwhelming.

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So, as a therapist who specializes in helping couples impacted by eating disorders, I see that my clients are twice hit. Take, for example, Lyndon and Jamie (not real names, of course). Jamie has been in recovery from anorexia for the past year or so. But when COVID began, her work went virtual. As a fairly efficient employee, she completed her tasks in much less than the assigned time. And then she had a good amount of extra time to think…and worry.

Some of her worry centered on the same anxieties that plague us all. Will I get sick? Will my loved ones get sick? Will we be able to come together as a society to do the things we need to get over this calamity? Some of her worry was an echo of old ways of thinking about herself. Jamie started wondering if, with all this time on her hands, she was being productive “enough.” This led to gut-level doubt about being “good enough”—a question that, for her, often disguised itself as panic about being “thin enough.”

Simultaneously, her treatment team had all gone virtual. She was able to talk to her therapist, but she couldn’t sit in the room and physically feel support and care surrounding her. There was no chance for “limbic resonance.” She was upfront about what she was going through and talked through her fears, but she felt distant and disconnected from her therapist. Her dietician was also no longer able to weigh her in person regularly, and so she had to go for longer periods of time without the “reassurance” that she was not gaining a significant amount.

Without access to the gym classes she regularly attended, Jamie perceived herself as less active than before (although she wasn’t). And so, she started eating “just a little bit less.” And then less, and then less, as the feeling of safety she had been seeking continued to elude her.

At the same time, Lyndon was also dealing with an escalation in anxiety—at the very same moment that he was losing access to his typical ways of dealing with it. His routine was disrupted as he moved to part-time telework. Financial stress mounted as his service-based job was impacted by the virus. He was becoming depressed as he had less structure to his days, and isolated as he was unable to visit friends and family. Worst of all, Jaime—his most important support—was becoming increasingly preoccupied and unavailable.

Because they were cooped up together 24/7, Jamie’s food choices were on full display to Lyndon. He noticed her eating less and working out more. He felt her absence as she pulled away emotionally. Because of the strain he was also under, he dealt with these changes about as poorly as you would expect. When the couple entered therapy, Lyndon was asking Jamie to report all her meal choices to him. It felt impossible for him not to comment as she pushed food around on her plate. He had considered asking her to weigh herself daily to ensure she wasn’t losing too much weight, but luckily had stopped short of that point and gotten himself and Jamie into couples’ therapy.

The couple had entered a fairly typical pattern—Lyndon responded to the eating disorder in some ways that made it worse, and the worsening eating disorder made him double down on these responses. Jamie’s restriction had also come to be representative for Lyndon—a stand-in for all the things in his life he couldn’t control. He felt that if he could just get Jamie to eat better, everything would be okay. But he couldn’t, and it drove him crazy.

Even with all of this going on, the practicalities of COVID were the very first thing we dealt with in couples’ therapy. We identified areas of Jamie and Lyndon’s apartment that would become “private spaces,” where they each could retreat from the relationship. The space was small, so Lyndon ended up taking time for himself on the balcony, while Jamie took long baths. This helped each member of the couple to regulate themselves emotionally. With some breathing space, they were no longer perpetually reigniting conflict.

Then we opened space to talk about the deep anxieties that the couple was dealing with. Jamie was worried that her parents, in a hot zone for the virus, could contract it. When she started talking about these concerns with Lyndon, he was able to contextualize her eating behaviors and understand that they were about fear and uncertainty, not anger and defiance.

With this understanding, Lyndon softened. He was able to acknowledge that his identity was too wrapped up in his professional success, which the fallout from COVID-19 had pumped the brakes on. He was able to notice, and to share with Jamie, how out of control and alone he felt. With support, Lyndon became much better able to sit with his vulnerability. This made him able to sit with Jamie’s vulnerability, too, and ask her about her feelings and experiences when he noticed her having difficulty with food. Feeling more supported at home and much closer with Lyndon, as time went by Jamie felt strong enough to challenge herself to eat more normally.


I offer this snapshot of treatment to illustrate the ways in which successful eating disorders treatment often have little to actually do with food. In this instance, food and lack of food represented control and lack of control, safety and lack of safety. Against the backdrop of COVID-19, these fears make a great deal of sense. This treatment also capitalized on the existing attachment relationship between Jamie and Lyndon. Allowing space for the existential and practical vulnerabilities that we are all addressing right now gave them each room to connect with their own humanity, and with each other.

File under: Couples Therapy, COVID-19 Blogs