COVID-19, social isolation and eating disorders on the rise
The repercussions of COVID-19 (eg, social isolation) have contributed to several additional crises, including a worldwide increase in symptoms of eating disorders (ED).
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For example, at least half of adults surveyed in the UK found it more difficult to monitor and / or regulate their diet during the 2020 COVID-19 lockdown than before.2 These adults also felt more concerned about food, exercise and their appearance than before the pandemic. People with a previous or current diagnosis of ED were the most likely to experience these increases.
A slightly different, but no less worrying scenario has been found in Australia. Here, adults with and without ED reported increased dietary restrictions and binge eating during COVD-19 lockdown, while those with a history of ED reported further increases in purging and exercise.3
Reasons for an increase in ED symptoms during the COVID-19 pandemic include, but are not limited to, routine disturbances (i.e., inability to access certain foods or exercise ), unavailability of services (e.g. loss of control, stress and mood swings.
Each of these factors deserves a full explanation and, therefore, I will only focus on social isolation for this post. Specifically, how this might impact the brain in a way that contributes to the current increase in ED symptoms during the pandemic.
COVID-19, social isolation and eating disorders
The current pandemic has changed how, how often and with whom we socialize. While this creates new challenges for many, these changes can be especially difficult for people with ED.
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This is because people with erectile dysfunction often struggle with social skills.seven Socialization, however, is an important erectile dysfunction prevention measure, with research showing that good social skills can reduce an individual’s risk of developing erectile dysfunction.1
Socialization also provides people with ED a support system and minimizes the opportunities for them to devote time to their ED behaviors (eg, exercise).
Recognizing the importance of the relationship between socialization and the development of ED, Fernández-Aranda et al. (2020) recently constructed the COVID Isolation Eating Scale (CIES) for research. The objectives of CIES are to4:
- Measure the impact of lockdown during COVID-19 lockdown on emergencies (and obesity).
- Measure changes in ED behaviors (eg, diet-related symptoms) and relevant mental health factors (eg, dysfunctional emotions) during confinement.
- Explore the difficulties of telemedicine while in lockdown.
In its trial, CIES showed that after containment of COVID-19, people with subclinical emergency disorders experienced a greater increase in dysfunctional eating, anxiety and depression compared to to people diagnosed with an emergency disorder. This suggests that people with undiagnosed erectile dysfunction might be particularly vulnerable during lockdown, possibly due to fewer treatment options available.
Social isolation and health
It is not known why chronic social isolation increases the risk of developing the disease.
One hypothesis (i.e. social control) is that having wider social networks and participating in social activities encourages people to take better care of themselves (e.g., l ‘exercise and check-ups). Isolated individuals, on the other hand, have less incentive to manage their health, as they may have fewer people to “live” (according to this assumption).
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While this may be somewhat true, neuroscience offers a more nuanced perspective.5 The nuance is important here because social experiences and our perceptions of them vary. For example, having a spouse can be comforting for one person, but stressful for another, especially if the relationship is abusive.
Therefore, how do individuals see their isolation during COVID-19 containment is important to consider.
Unfortunately, those with ED are often oriented towards a negative perception of themselves and the world; this makes these people vulnerable to loneliness during COVID-19 lockdowns.8
Perceived loneliness and the brain
Perceived loneliness prompts us to notice and pay attention to negative social visuals, which can lead to chronic stress. Chronic stress can lead to poor health by altering the way the hypothalamic-pituitary-adrenal cortex (HPA) axis regulates our bodies.6
The HPA axis of the body is like a thermostat. It is made up of a group of different regions of the brain and glands that are tasked with working together for the body to function optimally. When something needs tweaking or a threat emerges, the HPA handles it.
Source: Annie Spratt / Unsplash
Threats to our well-being do not have to be life threatening (eg disease). They can also be psychological (eg, public speaking). HPA regulates the body regardless, preventing us from becoming overly stressed.
Because we are individuals with different fears and concerns, the HPA axis is designed to detect what we each perceive as threatening (eg, social isolation), sending “danger” signals throughout the body. (eg, cortisol; cytokines) when a threat is detected. These signals change the way the body works to protect it from the threat.
The problem with a chronic threat (eg, social isolation), however, is that it makes the HPA Axis work relentlessly to protect us from our perceived threat. It causes chronic stress.
An overworked HPA axis desynchronizes our body by chronically modifying the functioning of our immune, metabolic, reproductive, cellular and cardiovascular systems, among others. This is dangerous since the body needs to function normally to keep us healthy.
In this way, social isolation can increase susceptibility to ED.
From perceived loneliness to eating disorder
One of the consequences of social isolation is that it can change the way our brain cells communicate. For example, a recent study of female prairie voles showed that social isolation can prevent the adult brain from making new cells, while altering or even killing our current cells.9 Our brain cells are what regulate our thoughts, feelings, and behaviors. Therefore, these changes can lead to increased stress, anxiety, and depression.
Source: Annie Spratt / unsplash
Likewise, a separate study on the prairie vole found that social isolation contributes to inflammation of the brain and changes in gut bacteria.ten Both of these consequences alter the way our brain cells regulate our behavior, which, again, can lead to increased anxiety, as well as decreased sociability.
The two anxiety11 and depression12, two implications of social isolation, have been shown to contribute to the symptoms of ED. This is because certain ED behaviors, including food restriction13, exercise14, and binge eating15 have been shown to reduce anxiety and relieve stress for some people. Simply put, ED behaviors can serve as unhealthy coping mechanisms for psychological disorders (eg, anxiety).
Overall, the perceived loneliness during COVID-19 lockdown can cause chronic stress. This can lead to bodily changes that impact our brains in a way that could increase anxiety and depression in some people.
Dealing with anxiety and depression while in confinement is not easy, especially for those without established healthy coping strategies. Social isolation gives people the time and discretion to engage in unhealthy coping strategies (eg, excessive exercise, binge eating, and food restriction).
In light of this, more research is needed on the impact of social isolation on the body and brain and the coping strategies people use to manage these changes. Understanding these relationships can help us better understand how to prevent and treat symptoms of ED during and after COVID-19 containment.