Major increase in anorexia nervosa attributed to pandemic


Everyone from Truman Capote to Joan Rivers to the Duchess of Windsor has been credited with coining the phrase, “You can never be too rich or too thin,” but, in fact, you can be too thin – and an ever-increasing number of Americans are being caught up in a surge in anorexia nervosa cases exacerbated by – you guessed it – COVID-19.

“The pandemic created the perfect storm for developing an eating disorder,” said Anna Vass Schad, LMHC, a Certified Eating Disorder Specialist who counsels clients virtually in Vero Beach and throughout Florida. “Many who exhibited minor symptoms have wound up with full-blown cases because of the isolation and stress we all experienced during that time.”

During the first 12 months of COVID-19, the number of hospital admissions for adolescents with eating disorders at the University of Michigan Medical School more than doubled. Over the past three years, there has been a 25 percent increase in the number of adolescent eating disorder patients nationwide, according to an analysis of medical record data from 80 hospitals. The National Eating Disorder Association helpline has reported a massive 40 percent increase in call volume.

Even more concerning, monthly hospitalizations for the disease have nearly tripled compared with pre-pandemic rates. Hospital regions with the highest numbers of COVID-19 cases and strictest stay-at-home measures during the pandemic experienced the highest numbers of newly diagnosed cases.

Though the disease tends to be associated with young women, just about anybody can develop it, according to Schad, “It’s a coping mechanism that doesn’t discriminate across gender, race, socio-economic status, ethnicity, or body shapes and sizes,” she said.

“Approximately 75 percent are female and 25 percent are male.”

Personality traits such as neuroticism, obsessiveness and perfectionism play a large role in facilitating some eating disorders, including anorexia and bulimia.

Healthline reports that the causes of anorexia nervosa are complex. The disease can be driven by a range of personal, genetic and environmental factors. The disorder appears to have a strong relationship to other psychiatric disorders, such as anxiety and depression.

People with a family history of anorexia are more likely to have it, too.

There are three telling characteristics:

  • A persistent restriction of energy intake (food) leading to someone becoming significantly underweight compared to the norm for their age, sex, developmental stage and physical health.
  • A diagnosis of an intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain.
  • Disturbance in the way one’s body weight or shape is perceived, undue influence of body shape and weight on self-image or persistent lack of recognition of the seriousness of the current low body weight.

Schad said many warning signs can alert family and friends if someone is spiraling out of control. “Since some people with anorexia binge and purge like bulimics, they become expert at hiding food. They have dry skin, are cold to the touch, suffer from fatigue and, of course, have extreme weight loss.” For a complete list of symptoms, check the website of the National Eating Disorders Association at

According to Eating Disorder Hope, an online community that shares information from professors, psychiatrists and other relevant experts and organizations, there are many short- and long-term health effects of anorexia nervosa.

Short-term health effects begin almost immediately. Starved for nutrients and energy, the body will begin to look for these essential ingredients in other sources – breaking down muscle mass, siphoning nutrients out of bones, or redirecting energy or nutrients from other processes in order to fuel the essential centers of the brain, heart and lungs.

In response to the energy deprivation, the brain releases hormones, which could have further negative effects on the body and its internal functions.

For women, one of the most important functions of the endocrine system – which is affected by nutrition – is the regulation of the menstrual cycle. When this system is not functioning properly, it’s common for someone to lose their menstrual cycle completely.

The body may also pick up on other signals, such as a low level of body fat, which tells it that it’s not a good time to conceive.

A lack of critical vitamins and minerals, including iron, can cause anemia, which leads to fatigue, weakness and irregular heartbeat. People with anemia may also bruise easily, experience internal bruising or take longer to heal.

Studies have found that up to 58 percent of people with eating disorders have gastrointestinal problems, compared to just 5 percent of healthy people. Common problems include:

  • Bloating
  • Gassiness
  • Nausea
  • Constipation
  • Cramping
  • Diarrhea

Short-term effects of anorexia are unpleasant and uncomfortable, but long-term effects are dangerous and potentially deadly.

The longer the struggle with anorexia, the more damage is inflicted on the body and the more difficult it will be to fully heal.

Common long-term effects include damage to the heart, the muscle most impacted by anorexia. The heart’s electrical system may get out of whack, causing arrhythmia and creating a vulnerability to heart disease or heart failure.

Heart damage can be significant and lead to sudden cardiac death. Since it may be struggling to beat as hard as it needs to, it’s common for someone with anorexia to experience low blood pressure.

Even with a healthy diet and lifestyle, the body breaks down and rebuilds bones throughout its lifespan. During adolescence, the body makes more bone mass than it loses. But as people age, they naturally begin to lose bone mass, which frequently leads to osteopenia and osteoporosis. The malnutrition brought on by anorexia can greatly speed up this process.

Starvation can cause muscle weakness, nerve-related pain, headaches, seizures, fainting, movement problems and, eventually, death.

It is a grim picture, but victims of the disease are not helpless. Schad said the underlying causes can be affected by a person’s attitudes and actions, including seeking medical and therapeutic assistance. “Health at every size,” she said. “We must accept that. A large body can be your perfect body.

“The stigma that is deeply ingrained in our culture that thinness means healthiness and beauty needs to change. Body acceptance should be the dream for society. We should all be working towards a life without eating disorders.”

Anna Schad, LMHC, CEDS, received an MS in Counseling Psychology from Palm Beach Atlantic University in 2011. She practiced in Vero Beach until her recent move to Tampa. She will continue to treat her Vero clients and accept new clients here who are willing to meet virtually via Zoom. Her number is 772-789-0153.

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