How COVID-19 is affecting women recovering from eating disorders

The need for a gender-informed approach to COVID-19

COVID-19 is having particular impacts on women and girls. These impacts are being documented across several domains, including family violence, unpaid work, employment and superannuation. In common with many of these analyses is the conclusion that public health efforts, fiscal policy and social policy responses are simply not taking into account the exacerbation of pre-existing power relations and gender norms, nor the effects of the pandemic on diverse cohorts of women. As the Federal Minister for Women notes, COVID-19 has thrown gender-based differences into sharp relief, as it has with previous pandemics and natural disasters. It is likely that these effects will continue long after the COVID-19 crisis has passed, as they have in other disasters. For example, a year after Hurricane Harvey landed in the US, researchers found that found that social factors associated with the disaster led to ongoing higher rates of family violence and child abuse.

COVID-19 and mental health

There is growing acknowledgement that mental health is one of the areas requiring a dedicated response to support women. An Australian Bureau of Statistics COVID-19 survey has found that loneliness is affecting more women (28%) than men (16%) during the pandemic – this is concerning given that social isolation is a risk factor for poor mental health. Another survey of people who have lost work during the pandemic has found that severe psychological distress is more prevalent among women (and young people).

The ABS has also found that over the March-April 2020 period, women were more likely than men to have felt the following feelings that affected their emotional and mental wellbeing at least some of the time:

• Restless or fidgety (47% compared with 36%);
• Nervous (40% compared with 30%);
• That everything was an effort (30% compared with 22%); and
• So depressed that nothing could cheer them up (10% compared with 5%).

Only one in ten people (women and men) who reported these feelings accessed a health professional, which shows that service access is not necessarily the best indicator of community need. Outside of the pandemic – and based on administrative data following the introduction of the Better Access initiative – it is estimated that only 46 per cent of people with a mental health condition access mental health services in any given year. This suggests that the increase in contacts to helplines such as Beyond Blue’s Support Service, Lifeline and Butterfly Foundation’s National Helpline represents just the tip of the iceberg.

The impact of COVID-19 on women with eating disorders

Eating disorders are a set of complex mental health conditions associated with high levels of psychological distress and significant physical health complications. The aetiology of eating disorders involves a combination of biological, psychological and sociocultural factors. While eating disorders can affect men and women, it is women and girls who are most at risk of developing an eating disorder, particularly in adolescence and early adulthood. When ’disordered eating behaviours’ are included (that is, behaviours that do not meet the clinical threshold for a diagnosis), almost 20 per cent of all women and girls are affected.

A new survey of people affected by eating disorders across Australia – which was conducted during the COVID-19 crisis – provides insights into how women with eating disorders are faring at this time. This is because of the 563 people surveyed by Butterfly Foundation across urban, regional and remote areas, 95 per cent were female (and the majority of them were aged 18-30).

While we can all relate to feelings of frustration and distress at this time, for those living in regional and remote areas, the experience of isolation from services and treatment they desperately need is a reality that will continue long after the pandemic has passed. Nearly two thirds of respondents reported that COVID-19 had affected their ability to seek treatment or support.

Survey respondents were also asked whether the pandemic heightened thoughts or feelings related to eating disorders. The overwhelming majority of the sample – 92 per cent of people with eating disorders – reported heightened eating disorder thoughts or feelings, while 80 per cent of people said they needed extra support during this time.

This finding is not surprising given that eating disorders thrive on social isolation. While telehealth has enabled individual treatment to continue, face to face group programs have stopped. This means programs involving meal support have stopped, while food shortages in supermarkets have affected the ability to buy ‘safe’ brands or follow dietary advice. As one respondent put it, ‘The virus makes getting food impossible, so it’s a time bomb isn’t it?’.

These barriers have compounded existing issues such as geographic limitations on accessing services for people outside of metropolitan areas, and financial barriers to care. Cost is a barrier for many people; even with subsidisation via Medicare Benefits, gap fees can amount to several thousand dollars each year. As one survey respondent noted, ‘Gap payments mean the cost of treatment is still out of my reach. One hour with a psychiatrist is a fortnight’s income for me’.

As in other areas of mental health care, discrimination was a feature, with nearly a third of respondents saying they had experienced discrimination in accessing services. When elaborating, one respondent said: ‘I was told that my ethnic background doesn’t get EDs and that I would grow out of it’. Another respondent referred to: ‘Being called the wrong name and pronouns consistently. Accessing some of the health care systems made me worse instead of better’.

With widespread government and non-government recognition of the mental health impacts of COVID-19, and with women and young people disproportionately affected by the economic fallout, there could never be a better time to invest in improving support and service access for women and girls with eating disorders.

 

Butterfly Foundation’s MAYDAYS campaign runs until 30 June – check out the #PushingPastPostcodes campaign page. For free, confidential counselling, advice and referral, please contact their National Helpline (1800 ED HOPE), which is available seven days a week from 8am-Midnight (AEST).