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Cynthia Bulik, PhD, founding director of the UNC Center of Excellence for Eating Disorders (CEED) is leading a study with Christine Peat, PhD, director of the National Center of Excellence for Eating Disorders (NCEED), to characterize the impact of the COVID-19 pandemic on people with eating disorders. Preliminary data from the U.S. and the Netherlands are being published to share with clinicians and caregivers to provide a roadmap forward as the pandemic evolves.

Contact: Carleigh Gabryel, 919-864-0580,

CHAPEL HILL, NC – When the COVID-19 pandemic led to mandatory stay at home orders and physical distancing efforts, UNC School of Medicine’s Cynthia Bulik, PhD, Distinguished Professor of Eating Disorders, and Christine Peat, PhD, assistant professor of psychiatry, took quick action to understand how this was impacting people with eating disorders.

Bulik, founding director of the UNC Center of Excellence for Eating Disorders (CEED), along with Peat, director of the National Center of Excellence for Eating Disorders (NCEED), received rapid ethical approval to survey people with eating disorders in the U.S. and the Netherlands to assess how they were being impacted. They have published the information they gained from a baseline survey taken from approximately 1,000 participants who joined the study in April and May.

“People with eating disorders are really struggling,” Bulik said. “Those who are alone are really feeling the lack of support and are saying that they find themselves swirling around in negative thoughts. Many are also finding it hard to stay motivated to recover. On the other hand, some who are working on recovery, but are living in close quarters with others are having trouble finding the privacy to, for example, have telehealth sessions with their treatment team.”

Bulik and her fellow researchers found that study participants in the U.S. with anorexia nervosa are reporting increased dietary restriction and fears about being able to find foods consistent with their meal plan. People with bulimia or binge-eating disorder reported increases in binge-eating episodes and urges to binge. Respondents also noted an increase in anxiety levels since 2019 and fears that their eating disorder will worsen due to a lack of structure and social support, and living in a triggering environment.

Bulik said, “Eating disorders truly thrive in isolation. Much of the secrecy associated with eating disorders is driven by anxiety and can include secret exercise for weight loss, secret binge eating, secret purging or other behaviors. Having others around can be a deterrent to engaging in unhealthy behaviors. When you are alone, there are no social deterrents, so the eating disorder can escalate unchecked.”

Just over 80 percent of U.S. study participants already in eating disorders treatment pre-COVID reported having transitioned to telehealth services, but satisfaction was mixed, with almost half saying their treatment wasn’t as effective as usual. Troublingly, 47 percent of the U.S. participants reported not being in any treatment for their eating disorder. Bulik hopes the preliminary data they are sharing now, and additional data collected in this year-long study, will inform best practices for clinicians and caregivers and provide a roadmap for eating disorders care as the pandemic evolves.