The first time Lexie Pelchen, 26, purged a meal, she was a junior in college spending Thanksgiving at home in Pennsylvania. She ate a traditional holiday dinner with her family and was going with her boyfriend for round-two at his family’s house. Before leaving, she made a stop in the bathroom and stuck her fingers down her throat to make space in her stomach.

“I remember thinking: ‘Wow, I feel so much better,’” she recalls. “I just did it once and didn’t think much about it.”

But during the next three months, as she felt her boyfriend slip away and she faced the role of president-elect for the Panhellenic Council at school, Pelchen started suffering from extreme anxiety and panic attacks.

Like many who develop an eating disorder, Pelchen discovered a maladaptive coping mechanism: binging and purging. She used it to gain some semblance of control in her life, but the irony is that such self-harming behaviors have the opposite effect. Instead of facing the root cause of her anxiety, Pelchen threw up every meal she ate. She began weighing herself every day and tracking her pounds on a monthly calendar. She started losing her hair. 

While Pelchen is now in control of her eating disorder, when the novel coronavirus outbreak began in March, she, “noticed a switch in my mindset during quarantine. It’s been harder not to want to act during this time.”

Maladaptive coping mechanisms develop or can be retriggered, when a person is facing a stressful situation: social isolation, lack of structure, and heightened anxiety during a global pandemic, for example. While Pelchen is now in control of her eating disorder, when the novel coronavirus outbreak began in March, she, “noticed a switch in my mindset during quarantine. It’s been harder not to want to act during this time.”

Julija Joy, a medical nurse practitioner who’s worked with eating disorder patients at Behavioral Health of the Palm Beaches for more than 10 years, says there has been a “steady influx” in enrollment. Many of the patients Joy is treating were in remission from their eating disorders, and she anticipates more will be checking themselves in as quarantine orders lift.

“The situation of a pandemic is going to increase anxiety and probably worsen any behaviors that might’ve been in recovery,” Joy says.

To combat the vulnerability of slipping back into her eating disorder, Pelchen says she fights each urge by working out — sometimes in excess.

“If I do a 30-minute workout and I’m really sweaty, I still feel like that wasn’t enough; like I need to do more,” she says. “I didn’t burn enough calories. I know that I ate a salad today and my salad had tofu and that added so many calories and I need to burn that off. While exercise is a healthy thing, I think my mentality around it, especially when I have those urges, is very unhealthy.”

Excessive exercise, emotional eating, binging and purging, restricting food intake, social withdrawal, and even substance abuse are all examples of what maladaptive coping mechanisms look like for people who’ve suffered from an eating disorder

“The patients we typically see have a dual diagnosis,” Joy says. “They come in here with substance abuse — and particularly with females, if they feel like their eating disorder is at bay, we see that they have been dependent on alcohol, and they use that as an unhealthy coping mechanism.”

Collette Stohler, a 33-year-old TV host, and travel journalist who lives in Hermosa Beach, California, has been in remission from her eating disorder for more than a decade.

“I think back, and it’s really sad to think about my smaller self, and I wish I could’ve protected her a bit more and tell her not to take her life so seriously,” she says.

While Stohler has adopted healthier ways to cope — like immersing herself in the local CrossFit community and traveling for work — when those outlets were removed under quarantine orders, she felt a “real uncertainty of the future” that caused familiar out-of-control emotions to arise.

“The bulimia is the behavior, but the thoughts and the emotions will always be with me,” she says. “Food is something we face every single day, and so even if I might not engage in the behavior of bulimia, that thought process, that self-talk has definitely stayed with me, and I’ve had to make a choice to either rise above or seek out help from a psychologist or a friend when I am getting triggered and being in quarantine has brought up so many things. 

As Stohler ate bowl after bowl of protein cereal early on during the lockdown, she says she felt the cycle coming back: the fear and anxiety, then the binge, then the remorse.

“I just thought, ‘Oh no, I can’t dip back into this. I’ve come too far,’” she says.

Lee Cotton, a Florida-based “non-diet dietitian” who works with eating disorder patients, suggests keeping the temptation to react in a way that might jeopardize the recovery process at bay by ditching social media accounts that are detrimental to recovery, honoring the body’s hunger and fullness cues, and avoiding labeling foods as “good” or “bad.” She and Joy also say maintaining a daily routine is key.

If an eating disorder flairs back up, Joy suggests reaching out to a therapist or a virtual support group in order to discover the root of the issue and work through it with help.

“Anybody who struggles with anxiety needs structure to anticipate what your day is going to look like, and when that is removed, that heightens the anxiety, meaning that the patient population will use coping mechanisms,” Joy says.

If an eating disorder flairs back up, Joy suggests reaching out to a therapist or a virtual support group in order to discover the root of the issue and work through it with help. If needed, a patient can check themselves into a rehab facility like Behavioral Health of the Palm Beaches. The treatment program includes sessions with a dietitian and therapist for up to 30 days before patients are transitioned to partial hospitalization at home with intensive therapy several times a week

After that first binge, Stohler reached back out to the therapist who helped her during her early 20s when she was at the height of her eating disorder. Since then, she’s been able to adopt alternative ways to cope under quarantine, like reading, meditating, taking long walks to calm her sympathetic nervous system, FaceTiming with family and friends, and journaling. 

“I really hope during this time, as challenging as it may be, we can support each other, whether you’re a man or a woman struggling with these issues,” Stohler says. “If we band together, it stops that cycle of shame, and we can hopefully change the narrative around eating disorders so people can actually speak out, get help, and get better.”