Ali Caudle has always known determination and persistence. She’s a star swimmer, co-editor of her high school newspaper and was accepted into Northeastern University to pursue a journalism career.
Like so many other teens, she’s tackling mental health issues exacerbated by the pandemic.
"So many of my friends are also struggling with mental illness right now," Caudle said. "Honestly, it's harder to find a friend who isn't struggling with anything at all. Almost everyone is."
Caudle's eating disorder started a few years before the pandemic, in ninth grade. She was 14 years old.
"My therapist talks a lot about it being kind of like an addiction, like you're addicted to not eating," Caudle said. "But unlike other addicts, you can't just avoid food like you can avoid alcohol or avoid smoking. You have to eat, so you have to face that multiple times a day, every day."
At 5 feet 2 inches tall, she dropped below 100 pounds. Her period stopped. That’s when her doctor talked to her about putting on healthy weight.
"That's all the conversation ever was; there was no talk about like the mental side of things," Caudle said. " Like, what is the trauma that this is coming from? It's just, 'Let's get you to a healthy weight, and everything will be solved.'"
And, it was — until March 2020, the start of the COVID-19 pandemic.
"It kept dragging on and on, and I remember I started to be like, 'I need to make sure I look good when we come out of lockdown," Caudle said.
She returned to school full-time at the start of her junior year. Between swimming, pursuing an international baccalaureate diploma and other extracurriculars, it became overwhelming.
"I fell into a full-blown relapse," Caudle said.
A CDC report released earlier this year found the number of teen girls going to the emergency room for eating disorders almost doubled during the pandemic.
The National Eating Disorders Association says its helpline reported a 58% increase in calls, texts and chats between March 2020 and October of 2021, but experts think the real numbers could be even higher.
"[It] was like nothing I've seen in my entire career: the explosion of need out of the pandemic," said Dr. Jillian Lampert.
Dr. Lampert is chief strategy officer for the Emily Program. It has 20 locations across the country, from inpatient to virtual care.
"Overnight, we had twice as many people knocking on the door or calling on the phone, sending in emails," Dr. Lampert said.
Waitlists across the country became unmanageable.
"I think that the pandemic really yielded the perfect recipe to get an eating disorder," Dr. Lampert said. "If you were ever going to create an eating disorder, you would take a huge dose of anxiety, a huge dose of isolation, and stir it up in a big container of social media pressure."
Social media, designed to be addictive, is a constant presence in most teens’ lives. Experts say it was to blame for eating disorders long before the pandemic, but for teens like Caudle, more time online during lockdown piled on the pressure.
"You click on one thing that may be promoting something ... you shouldn't be engaging with, and then all of a sudden, that's all you see," Caudle said. "Suddenly it's everywhere, and you feel like you can't escape it."
Dr. Caitlin Martin-Wagar is the sole doctor at the University of Montana researching eating disorder treatments, and also trying to fill the gap in services through her own practice.
"I hadn't even launched my website, and I was able to fill up to what I wanted with patients right off the bat," said Dr. Martin-Wagar. "We know that the longer people suffer with an eating disorder, the less likely they are to have quick and full recovery. There's a lot of hope, though. We need to be keeping an eye on things and really making sure that we get people in treatment as soon as possible."
Advocates say no matter where you are, reaching out is critical.
"We hear from our program and others where people who are waiting for care end up dying," Dr. Lampert said. "These are treatable illnesses. People shouldn't have to die from eating disorders. That's horrifying. Every time we hear that, it's heart-wrenching. We know that somebody dies every 52 minutes from an eating disorder."
"You convince yourself that you have it under control, even when you clearly don't," Caudle said.
A turnaround came for Caudle when one of her teachers noticed something wrong.
"She stepped in and was like 'Something is not right, and I know it's not right,'" Caudle said. "You feel so disconnected from everything, and you feel like if you look around, there's no way out."
It was the support she needed to crawl out. Caudle started counseling and met with a dietitian. She changed her Instagram habits.
"One of the first steps I took is to cleanse my social media feed," Caudle said.
Now as Caudle and so many others like her prepare for another big change — college — she’s arming herself with tools to stay on track.
"I think I'm at a point where I can move into the future and not have to worry about it as much," Caudle said. "I can sit down and enjoy a meal with my family, or I can let go, grab food late at night with my friends, and it doesn't feel like some big insurmountable challenge."
But she knows the challenge is still very real for so many others and hopes her story inspires others to take the first step.