Prioritizing recovery from an eating disorder is just as important as ever, although perhaps more complex in light of the coronavirus (COVID-19) outbreak. UCSF remains committed to supporting individuals with eating disorders and has developed a toolkit to help support recovery during this time of change and uncertainty. The below toolkit provides a list of overall tips for eating disorder recovery, tips for families in family-based treatment (FBT) and tips for general coping, as well as a list of resources for young people and their family members. We hope this guide will support your well-being and help you more effectively navigate treatment during this time.
UCSF eating disorders program COVID-19 toolkit
- Tip 1: Don't forgo regular meals and snacks
This is a critical time to take good care of your body. We know that eating disorders impact all physical systems of the body and that being malnourished makes the body more vulnerable to illness. Create a structure and schedule to help you stay on track with regular meals and snacks. Stick to your meal plan, if you have one. If you are having trouble accessing foods that support your recovery, work with providers and loved ones to identify alternatives. Some may feel overwhelmed by having constant access to food. Should you struggle with binge eating, for example, you may recruit help from loved ones to stick as much as possible to a regular schedule of eating and integrate varied nutrition throughout the day. Fully nourishing yourself with a variety of foods, getting enough sleep and finding ways to relax are all proven to support overall health and immunity.
- Tip 2: Stay actively engaged in care
While the global scale of this crisis changes the context of your medical and mental health care, it is critical to stay engaged in your treatment. Your providers are committed to your recovery and want to make sure you are accessing the care you need. For those who have transitioned to telehealth visits, appearing on video and seeing oneself on video may be distracting or even triggering. It may be helpful to brainstorm with your provider about the best way to navigate the transition to video visits, including modifying settings for video accessibility during treatment sessions (i.e., to hide "self view" as needed or to creatively use it as a form of exposure). Your team will guide you regarding their recommendations for treatment and how these may change in the current context.
- Tip 3: Find safe ways to move your body
There are many different ways to move our bodies. Physical movement can decrease stress in the body, facilitate feelings of joyfulness and help us stay grounded. Simple stretches and a short walk in nature are examples of movement that may bring positive benefits without activating disordered behaviors. However, finding activity that supports recovery can be challenging, and should be done with the guidance of your treatment team and family. Please consult your treatment team about what type of activity is safe and advisable for you at this time.
- Tip 1: Remember, you are doing the best you can
We aren't supposed to know exactly how to respond to the current situation. Every family's circumstances may be slightly different. Try to be kind to yourself as you navigate new terrain and create new structures and rituals as a family. Now is not the time to expect perfection (and we'd argue there's never a good time for this!). For those of you in partnerships, recognize that you will each have your own unique challenges in coping and communicating during this time, and give each other the benefit of the doubt.
- Tip 2: Create a meal/snack schedule that works for your family
You may find it helpful to post a schedule in the home. Divvying up meals between caregivers when possible may be important to give one another a break. Share the schedule in advance with your child, so they know what to expect and whether there will be any changes. For caregivers split across households, communicate clearly with one another about how to support your child during this time.
- Tip 3: For families in Phase II, find new ways to support your child's independence
It may be difficult to find as many opportunities for your child to practice independence, especially if they were practicing eating independently at school or with friends. They may be able to schedule virtual meals and "outings" with their friends that involve eating. Get creative and brainstorm strategies to facilitate next steps in recovery with your treatment team.
- Tip 4: Monitor physical activity closely
For young people in recovery who have struggled with using exercise to compensate for eating or to attain a specific weight or ideal shape, this may be a very challenging time. It is also a time of great opportunity to help your child practice forms of movement that both support their recovery and are feasible during this unique situation (i.e., no more access to gyms, team sports, and dance classes). Physical activities in isolation may be especially problematic, and we encourage families to find ways to be active together (e.g., walks, kicking a soccer ball, or stretching/yoga classes, many of which can be streamed online).
- Tip 5: Connect with other families
Some families find it helpful to connect with others who are going through similar struggles, and now especially may be a time when it is helpful to learn from one another about how to continue to support your child's recovery. FEAST is a great resource for seeking additional support and connecting with other families.
- Tip 1: Create space for all emotions
Some people may not notice much change in their emotional state, while others may experience a wide range of emotions. Each family member's response may be different and may change throughout the day. Take time to check in with one another daily. Understanding each other's emotional response and how to support one another can greatly improve communication and a sense of connection and safety. Below are some helpful resources to guide conversations about COVID-19 and our reactions to it.
- Tip 2: Set boundaries around COVID-19 media consumption
It may be difficult to disconnect from the inundation of news and alerts about COVID-19, and this can contribute to feelings of panic and fear. We recommend limiting media consumption around the virus and choosing one or two trusted sources for updated information (e.g., CDC and WHO).
- Tip 3: Create a new routine
It is normal to feel disoriented with changes in routine and structure, and it may take time to find a new routine that works for you. We recommend creating a general schedule that allows for work or school time, unwinding activities and some time outdoors. It may be helpful to reframe this time as an opportunity to slow down, connect with values and other interests, and care for one another.
- Tip 4: Stay connected
While we are all doing our best to follow guidelines on social distancing to decrease the spread of COVID-19, it is equally important to find ways to stay connected to our community and loved ones. There are many ways to keep connected via social media, video calls and online courses. We have shared some resources below. In addition, it is helpful to remember that we are all in this together. Each and every human being is struggling to weather this crisis; some struggles are individual and some struggles are universal. Connecting around our shared humanity and reminding ourselves that we are not alone can be a very helpful buffer against loneliness.
Mental health resources
- Resources to support your mental health during the COVID-19 outbreak
The UCSF Department of Psychiatry has compiled an excellent list of resources that may be helpful as a starting point for additional ideas and supports.
This online mindfulness app has guided meditations, relaxation exercises, sleep stories and soothing sounds. It also offers a suite of free tools, like journals and calendars, to support your mindfulness practice.
- Free mental health apps
This website provides a list of evidence-informed apps that support mental health, including tips and tools for managing stress and anxiety, sleep difficulties, substance use and post-traumatic stress disorder (PTSD).
- Recovery Record
This is an eating disorder recovery app that has many different features. Talk with your clinician about whether you might integrate this into your treatment plan.
- FACE COVID
"How to respond effectively to the Corona Crisis," by Dr. Russ Harris, author of The Happiness Trap.
Other local resources
COVID-19 Bay Area Community Resources + Up-to-Date Health Information
This is a living document from the Freedom Community Clinic on mass resources in the Bay Area during the COVID-19 pandemic, also available in Spanish.
How to talk to your kids about COVID-19