Posted inCultures

The Pandemic, Eating Disorders and the Internet.

Illustration by Lizzy Nightingale.

TW: Disordered eating, pandemic trauma. No behaviours are discussed but please read at your own discretion.

First there came the pandemic. Then there came the collateral. Rates of mental illness increase was foretold. Even Conservative opponents to lockdown cited faltering mental health as a reason to reduce protective measures. As weeks stretched into months during the first lockdown, anxieties about the wellbeing of the population heightened. Despite the well-meaning Zoom calls and the hopeful “I hope you’re doing okay?” messages, people’s mental health waned. It was a distinctly bleak period, but ultimately, for a lot of people, things were salvageable once normality began to ebb back in and colour returned to our daily lives. Some of us were able to move on and all was well enough.

But, even as things began to soften back into a more familiar semblance of normal life, enveloped in the screen of the pandemic, vulnerable, ruminative and insecure teenagers and young adults had been left to their own devices. Eating disorders a truly insidious category of mental illness had germinated in silence. 

What was it about the pandemic that pushed so many people to their limits, and precipitated such a rise in eating disorder incidence? Researchers have been trying to synthesise some possible explanations, without being too reductive, and without over-intellectualising the trauma of the past two years. For example, one suggestion was that the “perceptions of scarcity of certain food products” could “increase the likelihood of binge-eating in some individuals. Binging is, in some instances, a biological response to perceived famine, and a means of the body doing what it can to mitigate any chances of incurring an energy deficit which can have detrimental effects such as muscle wastage, hormone disruption and secondary amenorrhoea (loss of periods) in menstruators

Especially at the beginning of the pandemic, when so many of us were gripped by uncertainty and a lack of anything else to compare the virus to, the media capitalised on sensationalist stories of supermarket shortages (likely worsening them through a cycle of perpetuating fear and effecting a very reactive reader response). Admittedly, by 2021, this became something of a reality as COVID collateral intermingled with Brexit border difficulties. For others, the pandemic and fears of contracting the virus may have been the backbone of an incipient eating disorder. “Fear of contagion from COVID-19 may lead individuals to experience increased concerns regarding the quality of food or its capacity to be a vehicle of contagion and a way of creating a feeling of control (authentic or otherwise) can be recreated through the regulation of our food intake. Sufferers of the eating disorder Orthorexia Nervosa become preoccupied with the nutritional value (ie. how quantifiably ‘healthy’ a food is), though the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not yet posit a definition or specific diagnostic criteria for the disorder. Sufferers may have convinced themselves that nutritional benefits “may protect them from contracting the coronavirus or minimise its effects.” This could well be a side effect of the pandemic’s early days when anyone, irrespective of their medical qualification (or lack thereof) vied for a platform to give out medical advice, touting magical vitamins, detoxes, or diets as surefire immunity from a virus that we knew precious little about. 

Another reason is that a lot of us spent more time fixed to our screens and devices. And why would we not have? Remote and virtual learning aside, our phones and laptops offered some semblance of communication, some replication of our lives and relationships pre-lockdown. They have always served as a seemingly endless reserve of content or validation, able to provide us with mental stimulation on demand. A few years before the pandemic, as Debra M. Katzman, the Professor of Pediatrics at the University of Toronto, comments, “Virtual reality grows in importance over real life. As a consequence, physical appearance becomes the first thing to consider when relating to others.” Now, in conjunction with this, consider that in the throes of the pandemic, real life was, ostensibly, substituted for virtual life as work, school, socialisation and family relations shifted almost exclusively online. For some of us this invoked a huge preoccupation with and anxiety about our appearances with one study finding that eating disorder incidence increased by “an overall excess of 15.3% […] compared with the previous year [2019].” This constructed an arena in which anxious teenagers and young adults began to interiorise the idea that unless they looked a certain way, and adhered to certain normative structures of beauty, that they would be unworthy of love and respect, or somewhat lesser than other people, including their peers. 

Lurched into the cavernous depths of a world that was too unsafe to be interacted with normally, susceptibilities to an eating disorder would have been allowed to run riot. Something as innocuous as a Google search for a baking recipe, as so many of us took up in lockdown, may have generated results saturated with diet culture and an ideal of thinness or contrived health. It feels, granted, quite strange to think of baking or cooking as a potentially harmful pastime, but when the intentions behind it are to manipulate one’s size out of fear, anxiety or insecurity, the hobby becomes a vehicle for self-damage. This impetus to alter one’s food intake, and be more fastidious about which recipes are deemed acceptable, was then compounded by the explosion of profiles and content creators on social media taking to baking etc. in lockdown. As our access to the ‘outside’ world shrank, an internal (perhaps from the family unit) drive to spend more time in the kitchen, or try out some kind of ‘health kick’, created a humid, sticky petri dish for the cultures of an eating disorder to thrive upon. A seemingly harmless search for a brownie recipe to bond over with one’s younger sister, could have so easily transmuted into an internet search evoking feelings of guilt, or sown a seed on how to limit or alter one’s food consumption, causing the innocent brownie to metamorphose into an ultra-low-fat, skinny, vegan, refined sugar free, gluten free, keto, paleo, four ingredient, guilt free, hidden vegetable, protein-packed, spiralised, blended, no-bake, calorie burning, fat cell absorbing, laxative, morally sanctimonious, self-worth destroying, joy eviscerating abomination. 

Food aside, “experimental studies have shown that even five minutes of exposure to “thin and beautiful images” can negatively affect body image.” Given the visually-oriented nature of social media at present, the quantity of content that depicts (and glorifies) certain body types over others would likely have been higher and more readily accessible for all of us than ever before. R. M. Perloff hypothesises that “individuals predisposed towards eating disorders may be even more negatively impacted by social media than traditional media because they have more opportunities in this media ecosystem to find and consume a wealth of content that can trigger eating disordered behavior.” Never before has there been such access not only to these idealised images but to content resembling ‘instruction manuals’ on how to reach this ideal, in the shape of YouTube channels, Instagram and TikTok accounts, blogs, forums, etc., before even considering film and televisual media. Content creators inducted some of us into a dimension of escapism and assumed a sort of ‘big sister’ or ‘best friend’ role; they gave (often well-meaning) advice on diet, exercise and lifestyle. The visual nature, of so many popular social media platforms, especially TikTok and Instagram, meant that certain content creators’ diets looked especially appealing, for they had the visible results to ‘back it up’, attesting the efficacy of eating x food or doing y in the bid to chisel out a perfect body. 

But would it be totally disingenuous to malign the internet for its interrelations with eating disorders and eating disorder sufferers? Perhaps it would. For some sufferers, social media platforms serve as an unconventional form of support. Other patients in another study indicated that having a space to discuss their eating disorders was indispensable to them as, in a world with healthcare inequality and rampant inaccessibility to adequate mental health services, “some users [of online eating disorder spaces] simply offered support in the form of empathy, compassion, and understanding,” crucial for sufferers at the time. Naturally, it was easier for problems to develop and fetter unspotted, and harder for the right kind of support, either informally, like that dispensed from friends, or professional and clinical, to reach the sufferer. There is a great potential for online spaces to nourish sufferers’ recoveries. The online world grows ever more labyrinthine and trickier to navigate and spaces specifically designed to cater to those who suffered from eating disorders become a hard thing to designate as good or bad. For example, the Reddit eating disorder page stipulates these rules for its users:

 “1. No pro-ED comments: No posts or comments encouraging eating disordered behavior. Eating disorders are a serious mental illness, not a lifestyle choice.

   2. No Numbers: No Numbers about weight, bmi, clothing size, extreme details, or caloric intake. Saying you are a healthy weight, overweight, or underweight is enough.”

But there is only so much moderation a moderator can do. An innocuous comment from one person may prove triggering to someone else. People may read other ED sufferer’s anecdotal stories to try and trigger themselves, or forge comparisons between perceived ED ‘severity’ that are impossible to quantify. There is no way we can police this. We have to remember that many sufferers’ have ‘ego-dystonic’ thoughts defining ‘ego-dystonic’ to mean: “denoting aspects of a person’s thoughts, impulses, attitudes, and behavior that are felt to be repugnant, distressing, unacceptable, or inconsistent with the rest of the personality.” So, for example, the sufferer’s desire to restrict their own food does not mean that they believe their friends are undeserving of food a truly tragic clash of kindness to others and harshness directed inwards. Additionally, we have to remember that eating disorders are often manifestly competitive. Sufferers can and do perpetuate their own illness by seeking out content that will only ensnare and tangle them more inescapably into their own mental illness. Thus, creating subsections of the internet purely for the discussion of eating disorders and the usage of sufferers can never be a wholly undangerous act. It is a precarious balance.

Yet, with treatment being so woefully inadequate for mental illnesses, these ‘informal’ methods of managing a mental illness become a last resort. Or perhaps a previous, bad experience with a healthcare professional dissuaded an ED sufferer from pursuing treatment earlier. Hope Virgo, an advocate for early intervention with eating disorders and an anorexia survivor, wrote for The Telegraph: Imagine if you broke your leg. You would make your way to A&E, you would get seen, X-rayed, they would examine the break, and then plaster it up. Pretty standard. But what if you turned up at the hospital, had an X-ray, only to be told to come back when the break was worse? This is the reality for someone with an eating disorder, who will often be told their BMI isn’t low enough to qualify for treatment.” Thus, as treatment becomes withheld due to both inadequate funding from the government, and a short-sighted opinion from some medical professionals of what an eating disorder ‘looks like’, who warrants help and who doesn’t, these online spaces become one of the only places sufferers have left to turn to, for better or for worse.

It is messy and it is in places obfuscated, but one hopes that as ‘taboos’ surrounding mental illness are reduced, the gradually changing narrative around eating disorders (and diet culture as a whole), will begin to make treatment and support easier to access. Perhaps these often-unregulated internet spaces that have historically encouraged eating disorders will begin to be left behind, or can be used in a more productive, safer way.