Vermonters seeking treatment for mental health are already likely to encounter long waiting lists. At the moment, the waitlist for The Adams Center for Mind & Body in South Burlington isn’t even live.
Sue Adams, founder and clinical director of The Adams Center, said the center has experienced a surge in demand for the treatment of eating disorders that have developed since the onset of the Covid-19 pandemic. Adams had to close the waiting list, which had grown to 70 people, in order to hire more providers with experience in treating eating disorders.
Hard data isn’t available yet about new instances, but the surge in eating disorders under the stressors of the pandemic is well-documented. Health professionals are reporting twice or three times as many people as in the past looking for treatment for eating disorders, and clinics are struggling to cope.
“There’s just been a high demand for services, and we can’t fulfill them,” Adams said.
The waitlist will reopen soon, Adams said, now that the center has brought on more providers to handle the uptick that experts say has been driven by the pandemic and related lockdowns.
Cynthia Bulik, a professor of eating disorders at the University of North Carolina and founding director of the UNC Center of Excellence for Eating Disorders, co-authored a study published last summer that found the early days of the pandemic had “strong and wide-ranging effects on eating disorder concerns and illness behaviors.”
“In the studies we conducted, participants reported that the lack of social support, living in a triggering environment, and the lack of structure to their days were the most common factors that contributed to the worsening of their symptoms,” Bulik wrote in an email to VTDigger.
The usual stressors haven’t gone away, either, according to a report on stress in America published by the American Psychological Association in October. “We are facing a national mental health crisis that could yield serious health and social consequences for years to come,” the report said.
New cases among adolescents began to appear around August and September, according to Aileen Whyte, a clinical psychologist and director of the outpatient Eating Disorders Clinic at Stanford University.
Whyte said the patients she saw would “almost always” indicate that their restrictive eating, a symptom associated with anorexia nervosa, started at the onset of the pandemic.
They expressed interest in “eating healthy and getting fit” around the time myriad so-called health trends were circulating social media. Teenagers who used the internet for health information searched for content related to fitness and exercise at a rate that was second only to content about Covid-19, according to a study referenced by Whyte.
“Teenagers are prone to comparing their own bodies to images they see online,” Whyte said. “That comparison is dangerous, and can create a downward spiral in terms of body image and self-esteem.”
Beyond social media, lockdown for some meant returning to unhealthy situations at home. “Sometimes with eating disorders, the family system is part of the problem,” Adams said.
Eating disorders can also seem to be a way to wrest control from uncertain times, “a way of managing anxiety by having a perceived sense of control,” Whyte said.
Longitudinal studies documenting eating disorder cases over time aren’t available, Bulik said, which makes it impossible to accurately estimate how many people developed disorders over the last year.
Bulik’s study did not collect data about which demographic groups were most affected, but it is understood that anyone could be affected. As in other realms in health care, race and class often influence access to care and treatment.
It’s often misunderstood, but eating disorders can develop in people of “all cultures, all shapes and sizes,” Adams said. She pointed to atypical anorexia nervosa, when someone exhibits the restrictive eating behaviors associated with anorexia without the extremely low body weight.
Telehealth challenges
Even for the 200 or so people who receive treatment at The Adams Center each week, the pivot to telehealth services has posed a challenge.
The eating disorder recovery program at the center is intensive, Adams said. Patients are paired with a dietitian, and with a psychotherapist for group and family therapy. Those sessions happened in-house before the pandemic.
“The intensity of the program is necessary for people to get better,” Adams said. “But because we can’t accommodate the amount of need today, that’s been a stressor for us.”
And not all internet connections are created equally. Some of Adams’ patients can’t video-call into a session from their homes because of privacy or safety concerns, opting instead to call from their car and withstand a fuzzy connection.
Adams said several of her clients have dissociative traits, which makes remote treatment more difficult.
In Bulik’s July study, 47% of the United States-based respondents rated their recent telehealth treatment as “somewhat or much worse” than usual, and Adams said 20% of her overall clientele dropped off when the center was forced to go online last spring.
Bulik thinks that was in part due to the novelty of the system, and sentiment has since changed for the better. In an informal poll of her outpatients, 90% said they would like to continue with telehealth for the convenience and negligible difference in quality.
“The eating disorders community has been incredibly united with sharing strategies for delivering effective virtual care, and I think that has allowed many services to ramp up and improve their delivery of telehealth services,” Bulik said in an email to VTDigger.
For more information and resources regarding eating disorders, visit the National Eating Disorders Association online.
