With the outbreak of COVID-19 and approximately a third of the world’s population currently living under lockdown conditions, we truly are living through one of the most extraordinary events of our lifetimes.
While we are all finding our way as we adjust to this ‘new normal’ (on top of managing a myriad of emotions that this pandemic is bringing up for us collectively and individually), we know that the experience of being ‘in lockdown’ is presenting a unique set of challenges for people with eating disorders, and therefore our AED community.
Over the coming weeks, I will be sharing conversations I’ve had with members of the AED on how this global crisis has impacted their lives and their work. My hope is that these conversations will provide points of solidarity, insight, hope, and courage as we move onward!
On this week’s AED Lockdown Blog series, I speak with Professor Cristina Segura García MD, PhD. Cristina is Chair of Psychiatry at the Department of Medical and Surgical Sciences at the University Magna Graecia of Catanzaro (Italy) and is responsible for the Outpatient Unit for Clinical Research and Treatment of Eating Disorders at the University Hospital “Mater Domini” of Catanzaro, Italy. I caught up with Cristina at the start of May and really enjoyed this conversation, I hope you do too!
Nadia: How are you today?
Cristina: I’m quite well, thank you. Things feel better now than at the beginning of this crisis. At the beginning, I was perhaps a little overwhelmed at the amount of work, by the new situation. But now, I feel more comfortable, things are getting a little better, a little easier.
Nadia: How has your day to day has changed during lockdown?
Cristina: The difference starts when I leave the house. I have to wear gloves, a mask, practice social distancing. Then, the biggest difference for me is when I come into my clinic in the university hospital. There are no patients, no residents, no students, no trainees, no researchers - I work alone. Everything is now online. I spend my day on lots of telephone calls, Zoom calls, Google Meet calls. I spend a lot of time in front of a screen. Then when I go back home, again, it’s gloves, mask, social distancing. I barely see anyone.
Nadia: Are you working from home at all?
Cristina: As a doctor at the hospital, I have to go in every day. I’m a psychiatrist so I have to be at the hospital. Sometimes I do consultations at the general hospital and visit patients who are inpatients on different wards and who also have eating disorders or other psychiatric disorders – e.g., depression, schizophrenia. I see them as a psychiatrist alongside their other doctors.
Nadia: Is there an inpatient eating disorder clinic at your hospital?
Cristina: We don’t have an inpatient clinic for eating disorders at the hospital – we just have an outpatient clinic. This means at the moment I am only seeing patients online. In the case of very acute cases, I can visit them face to face, but since the beginning of March, I’ve been seeing 99% of my eating disorder patients online. We are doing some groups; we are having meals together and some arts and crafts. We are also one-on-one sessions.
Nadia: How are your patients with eating disorders doing?
Cristina: It depends. Some of them are doing quite well, as well as they can be. Others are struggling quite a lot.
Nadia: Can you talk about why some people with eating disorders are struggling more with lockdown?
Cristina: There are a couple of problems. The first problem is that eating disorder behaviours are unhealthy coping strategies for stress. So, in a stressful situation, their eating disorder can feel like a solution for managing stress – a way of alleviating anxiety. This is a problem as people can spiral into worse eating disorder behaviour patterns. The second problem is that people with eating disorders feel stuck at home with their worst enemy – food. Based on my patients, people with binge eating disorder, bulimia nervosa, or anorexia nervosa binge-purge subtype, anyone that struggles with binging as part of their eating disorder, they are struggling the most. They feel trapped where there’s lots of food and little distraction, so it’s very difficult. The third big problem is that people are trying to cope without their support system, they are not with their friends, their teachers or professors, or with us – their treatment teams. From my point of view, these are the worst problems.
Nadia: You also said some patients are doing well. Can you say more on that?
Cristina: Yes, of course. I’ve noticed is that some of my patients are recognising their mortality for the first time. They see that people are dying and they are actually taking better care of themselves and their health. Maybe before they knew they could die from their eating disorder but didn’t believe it. Perhaps they believe it more now.
Nadia: That’s really encouraging, it sounds like the pandemic has ignited their survival instinct to look after themselves. Out of interest, was there a problem with food scarcity and panic buying in Italy?
Cristina: No, not really at all. The supermarkets are open and full of everything. The only thing you couldn’t find at the supermarket was yeast, because everyone was cooking and baking. It was even on the news – no yeast.
Nadia: That’s funny. I think there’s been a shortage here too. I guess it’s a good thing for most people to be cooking more. I know you teach as well as seeing patients, how is that going?
Cristina: Yes, so I’m a professor of psychiatry at the School of Medicine and at the School of Psychology. We are doing all our lessons online. At the beginning, I was making videos and simply uploading them, but I didn’t like it because I prefer to talk to the students, to discuss, and to give them the possibility to ask questions. So, I switched and now I am giving lessons directly to them in real time. It’s nice because I didn’t know it was possible to give a lesson with 300 people together at the same time. It’s new for us (professors), we are not millennials, but it’s good for us to realise that technology is not that difficult, we can learn. We are doing exams at home and we’ve had PhD defences at home - it’s incredible. A couple my students sent me pictures of themselves in their suits but wearing slippers! The main challenge that students can’t do their training with patients.
Nadia: That makes sense. Before we finish, do you have any advice for people caring for people with an eating disorder at the moment?
Cristina: I think it’s important for caregivers to really look after themselves well and find their own healthy coping strategies. This situation is new and difficult for everyone. It’s easier to support others when you feel strong and resilient yourself.
Nadia: Right, like on planes when you are told to put your own oxygen mask on first before helping others.
Cristina: Yes. It’s also important to communicate - to talk about ‘normal’ things unrelated to the eating disorder. And then, I always remind parents to try not to be too critical of the patient. I remind them that eating disorders are an illness – it’s not something the patient has chosen.
Nadia: Yes, so important. It’s easy to get frustrated as a caregiver because you just want the person to be well – it’s a good point to remember. And what about you? We’ve spoken about your patients and your students, but what are you doing that’s making you feel good?
Cristina: Research. I like doing it very much. It’s nice, I’m working with other researchers and we can meet at any time of the day - I have more flexibility that way.
Nadia: Do you find that you are working more now?
Cristina: Yes, of course. I had to modify my lessons; I’ve had to modify how I see my patients. Everything changed. I’m working much more, but it’s nice. At the beginning it was difficult, but it’s got easier. Now it flows. The problem will be in the coming weeks here because now in Italy, we are starting again with seeing patients face to face. So, it will be a big challenge, because we will have to clean the room after each visit. After the patient leaves, we will have to open the windows, clean, etc. This means I will not be able to see as many patients so then the issue will be about which patients to prioritise to see face to face. It will be a new challenge.
Nadia: Is there anything making you feel hopeful right now?
Cristina: I am quite optimistic. We have learned a lot so far and have adapted. We will get through this.
Nadia: Thank you for all that you are doing! I really enjoyed this conversation.