How Can Adolescents Maintain Self-Care During The COVID-19 Crisis?

Teens recovering from an eating disorder are at risk of relapse during the COVID-19 pandemic, which has introduced unpredictable and sometimes seemingly unmanageable stress into their lives. Understanding the components of self-care that are most helpful for teens, recognizing the signs and symptoms of difficulty coping with stress, and getting help early can help teens stay in recovery, nourishing their bodies and continuing their healing despite their circumstances.

Components of Self-care for Teens

The phrase self-care is used broadly but generally describes intentional activities that promote one’s own physical, mental, social, emotional, and spiritual well-being. Practicing self-care can improve confidence and self-esteem and serve as an important reminder that your own needs are just as important as your responsibilities and the needs of those around you.

According to Eugene Beresin, M.D., M.A., today’s adolescents are under more stress than ever before, making self-care a critical component in their daily routines. He recommends the following tools for ongoing self-care: 

• prioritizing self-care enough to carve out time, even on a busy day
• practicing mindful meditation with the help of a YouTube video or mindfulness app if necessary
• practicing yoga at home or in a studio, with or without instruction based on the level of experience
• incorporating exercise into your routine, even if it’s as simple as taking a 30-minute walk each day or parking in the furthest spot in the lot for a few extra steps
• setting a regular sleep schedule that includes enough sleep to wake up rested and recharged
• expressing oneself creatively through writing, drawing, playing music, or simply creating something 
• spending time with a pet, providing care, showing love, and enjoying their affection
• connecting with peers in person, through video chat, on the phone, or even through social media or gaming platforms (be wary of bullying on these platforms)
• spending time outside, taking time to take in the sights, breath fresh air, and appreciate the sounds and smells of nature
• disconnecting from technology if even for a little while to eliminate the constant interruptions of notifications
• giving by doing something kind for someone else, like volunteering, donating, lending a listening ear, or sending a card or gift

Growing in their spirituality, being intentional about gratitude, and keeping their space organized are other ways teens can practice self-care. 

Incorporating mindful habits into the new routine can be challenging for teens who are lacking structure and constructive outlets right now, but it’s still possible. Planning each day in advance can be especially helpful in remaining productive and intentional about how time is spent.

The Impact of COVID-19 on Routines and Mental Health

Initially, COVID-19 was seen as a threat to health and safety, but as the situation has evolved, it’s become evident the consequences will extend well beyond the possibility of viral infection. While people of all ages are impacted by the pandemic, teens are experiencing unique challenges as a direct result of the pandemic and actions taken to prevent the spread of infection. 

Adolescents are not only isolated from friends, but working to complete their schoolwork without the guidance and accountability to which they’re accustomed. In many cases, their parents are either essential workers and working long hours or laid off and worried about making ends meet at home, both of which can put a strain on the children at home. Some teens are worried about missing once-in-a-lifetime milestones like their senior prom or graduation.

Additionally, many students are out of activities that may have been a part of their eating disorder recovery plan, like youth group, group therapy, sports, church, or other extracurricular activities. 

The Centers for Disease Control and Prevention (CDC) outlines some of the factors that contribute to an increase in stress during this pandemic:  

• fears and worries related to health 
• changes in sleeping and eating patterns
• difficulty falling asleep
• trouble with concentration
• worsening of mental health or chronic health conditions

Teens and adolescents who are exhibiting signs of an eating disorder might be at increased risk of worsening symptoms during this stressful experience. 

Signs that teens might be struggling to cope with the changes and stress that accompany the COVID-19 pandemic include but aren’t limited to excessive crying or irritability, changes in eating and sleeping habits, acting out, irritability, poor performance at school or failure to complete school assignments, short attention span, unexplained physical symptoms like headaches and stomach aches, avoidance of hobbies, acting out, and use of tobacco, drugs, or alcohol. Any of these signs might be an indication that more support is needed.

It is also important to be familiar with the signs of an eating disorder like anorexia nervosa, bulimia nervosa, or binge eating disorder: excessive exercising and dieting, excessive weight loss, oversized clothing, visiting the bathroom after eating, refusing to eat with others, the disappearance of food m(for use in binge eating episodes), comments about being fat, or amenorrhea (absence of menstruation).

Self-care Needs for Teens in Recovery During COVID-19

Teens recovering from an eating disorder like anorexia nervosa, bulimia nervosa, or binge eating disorder can practice the self-care measures listed above, but it’s important to ensure self-care focused on recovery is incorporated into their daily routines. These activities can help them move forward despite the stressors introduced by the COVID-19 pandemic. 

• Communicate openly about thoughts, worries, fears, and struggles as they relate to eating, exercise, and recovery. If you’re having harmful thoughts or considering harmful behaviors, tell somebody you trust. 
• Surround yourself virtually with people who are dedicated to your health and happiness. Don’t allow social distancing guidelines or stay-at-home orders to prevent you from connecting with people who support your recovery. 
• Stay in close contact with your care team. If you start to experience thoughts or behaviors that aren’t conducive to recovery, speak with your doctor or another member of your recovery team.
• Join a support group. Online forums and support groups can provide just the camaraderie and encouragement you need to cope with stress in positive and productive ways and stay strong.
• Follow your treatment plan. Ensuring regular routines continue can provide a sense of comfort and control over daily life during a time that can feel very much out of your control. 
• Be aware of the signs and symptoms of anxiety and depression, and speak with a professional if you notice them arising as these issues can make it more challenging to stick to your eating disorder treatment plan if left untreated. 
• Avoid watching the news and limit your time on social media as the pandemic coverage leads to stress and fear for many teens and may trigger symptoms for you. 
• Spend time doing things you love to do. Whether you enjoy reading, writing, running, listening to music, or something else, having and enjoying solo hobbies is something you can continue to do despite stay-at-home orders in your state.

Teens who are recovering from an eating disorder may need to be more aware of how they’re thinking, feeling, and behaving in order to prevent a relapse.

What to Do if You Need Treatment

It is important to remember that not everyone who has an eating disorder is in recovery; many teenagers hide their eating disorder well and have entered into this pandemic without ever receiving the treatment they need to heal. These teens are especially vulnerable right now as they spend more time alone, work to cope with a number of changes and stressors, and lose access to resources and hobbies that might have been helpful prior to the pandemic.

Teenagers who were previously exhibiting the signs and symptoms of an eating disorder may be at higher risk of mental health issues and subsequently, exacerbation of their eating disorder symptoms, during stressful times like a pandemic. Parents and loved ones should keep an eye out for the signs and symptoms of an eating disorder as well as the signs of a mental health crisis and seek help immediately if they suspect a problem.

Despite closures across many industries, including some healthcare clinics and health-related services, treatment for eating disorders remains available. It is still safe to seek treatment in an residential treatment facility despite the COVID-19 pandemic. In fact, because untreated eating disorders can lead to serious consequences like heart failure, esophageal rupture, and even death, it is much safer to seek treatment during the COVID-19 pandemic than it is to allow an eating disorder to go untreated for the vast majority of clients. When you reach out for help for yourself or someone you love, the care team will determine the safest treatment plan, ensuring the least amount of risk of transmission that is feasible. 

Residential treatment programs have implemented a number of measures under the CDC’s guidance to keep their clients safe during the pandemic:

• asking screening questions over the phone prior to admission, including whether you have traveled to a high-risk country and whether you have been in contact with somebody who has been tested for COVID-19
• perform a symptom and temperature screening at the time of admission to ensure new clients don’t pose a risk to current clients in the home
• continue to screen daily and isolate any client who presents with a fever or symptoms indicative of COVID-19

Staff should also receive training regarding appropriate hand washing and more frequent disinfection of shared spaces for the safety of those receiving treatment within the home.

Because eating disorders are dangerous and help is available despite the pandemic, observing for signs and symptoms and reaching out remains crucial during the COVID-19 pandemic and after it’s over. There is help available for those who need it (and many barriers to treatment are resolve during the pandemic such as the need to attend school or work). 

To summarize, self-care is important for all teens as they cope with the new normal presented by the COVID-19 pandemic, but self-care might both look a little different and become critically important for those who are either exhibiting signs of an undiagnosed or untreated eating disorder and those who are in recovery after treatment for an eating disorder. Residential treatment services remain available and safe despite the widespread transmission of COVID-19, and in most cases, seeking treatment without delay is safer than riding out the pandemic and delaying much-needed treatment for an eating disorder and any associated medical or mental health conditions.