Harm Reduction, COVID-19, and Eating Disorders

Woman struggling with eating disorder during COVID-19

As the COVID-19 pandemic continues to impact our society and disrupt our everyday lives, individuals struggling with disordered eating beliefs and behaviors report feeling more challenged than ever. The circumstances of COVID-19 have created a perfect storm of triggers for those already fighting for their lives and working toward harm reduction.

Grocery shopping, which is already a tough experience in eating disorder recovery, is even harder due to the food shortages, behavioral guidelines, and emotional impact of COVID. The already triggering experience of loneliness and isolation is worsened by mandatory quarantining, cancellation of social gatherings, and closing down of businesses.

Negative emotional states, one of the most common triggers for eating disorders, are at an all-time high. With the sheer amount of possible triggers increasing or worsening, it is not surprising that many individuals struggling with an eating disorder feel more alone and helpless than ever.

It is with this consideration that Margaret Janse van Rensburg wrote an article for the Journal of Eating Disorders suggesting that “recovery” may not be a possibility for some at this time (1). Instead, Janse van Rensburg posited that a focus on harm reduction might be more beneficial in this challenging season.

Harm Reduction

When Janse van Rensburg mentions harm reduction, she is referring to the concept of “interventions aiming to reduce the problematic effects of behaviors (2).” One study points out that harm reduction interventions initially began with substance use treatment to allow clinicians flexibility in working with “clients who, for whatever reason, may not be ready, willing, or able to pursue full abstinence as a goal (2).”

Janse van Rensburg points out that, for many with eating disorders, their disordered behaviors may be the only coping skills they have at their disposal at this time. Not only that, but individuals may also have been in the Contemplation stage of recovery as opposed to the Action stage and still processing their desire to achieve recovery.

Finally, COVID-19 has increased the barriers to recovery and triggers to engage in disordered behaviors and decreased access to support. All of these, and many other aspects, could contribute to an individual being unready, unwilling, or unable to pursue full recovery as a goal at this time.

There is no shame in being in this place in one’s recovery and, in encouraging harm reduction strategy, Janse van Rensburg is emphasizing that sending the message that it is okay for reduction of behaviors to be the only goal one can commit to at this time.

Hispanic Woman Sitting on Bench thinking about Harm ReductionJanse van Rensburg gives an example of her own harm reduction process during this time, sharing that she ceased her most harmful and physically dangerous disordered behaviors while still engaging in other disordered behaviors.

Janse van Rensburg stated, “maintaining my ED, in as healthful a way as possible, is a coping strategy which gives me control during a time when I have lost complete control (1).”

Intervention Strategies

For those considering this approach, it is important to consult with treatment professionals first. The voice of an eating disorder is cunning and manipulative.

Therefore, it is important to check that any harm reduction strategy is made not because your ED can find a “way in” but so that you can find a way to maintain your recovery in this reality. For treatment professionals, an important factor in harm reduction is meeting the individual where they are currently in their recovery journey.

If a client feels that complete ceasing of disordered behaviors is not possible for them at the moment, meet them in that space and help them to process that. What barriers are they experiencing that make recovery feel like an impossibility?

The goal is to reduce or eliminate these barriers over time, but we cannot pretend they don’t exist in the current moment. Meeting the client where they are will help reduce any feelings of guilt or shame they may feel and, ultimately, allow them to be more open in their process because they will feel less judged.

Harm reduction strategies must be carefully evaluated and monitored. They don’t mean clients are given a “free pass” to engage in disordered eating behaviors or ineffective coping skills just because times are difficult. Janse van Rensburg emphasizes that these strategies are intended to be temporary (1).

They act more as an understanding that even baby steps are steps forward in recovery and that we, as humans, will have moments where baby steps are all we can offer at the moment. This approach can be controversial, and harm reduction focused treatment should not be engaged in without the help of an eating disorder specialist.

Even so, as Janse van Rensburg summarizes, “rather than giving up completely, or forcing ED recovery, a harm-reductionist approach embraces the uncertainty of our times and promotes a strengths-based dialectic perspective of EDs (1).”


Resources

1. Margaret Janse van Rensburg, M. COVID19, the pandemic which may exemplify a need for harm-reduction approaches to eating disorders: a reflection from a person living with an eating disorder. J Eat Disord 8, 26 (2020). https://doi.org/10.1186/s40337-020-00306-3

2. Logan, D. E., Marlatt, G. A. (2010). Harm reduction therapy: a practice-friendly review of research. Journal of Clinical Psychology, 66:2.


About the Author:

Image of Margot Rittenhouse.Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.


The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published August 28, 2020, on EatingDisorderHope.com
Reviewed & Approved on August 28, 2020, by Jacquelyn Ekern MS, LPC