Research Review: The impact of COVID-19 epidemic on eating disorders

By: Melissa Giovanni, MS, RDN, LDN, CEDRD

 A longitudinal study was conducted to study the impact of the COVID-19 epidemic on Eating Disorder (EDs) patients taking into consideration the role of pre-existing vulnerabilities. This study was published in the International Journal of Eating Disorders.

Seventy-four patients with Anorexia Nervosa (AN) or Bulimia Nervosa (BN) and 97 healthy controls (HCs) were evaluated before lockdown (T1) and during lockdown (T2). Patients were also evaluated at the beginning of treatment (T0). Surveys were collected to assess psychopathology, childhood trauma, attachment style, and COVID-19-related post-traumatic symptoms. Patients attending the Outpatient Clinic for EDs of the University of Florence were enrolled, providing they met the following inclusion criteria: female sex, aged 18-60 years, current DSM 5 diagnosis of AN or BN. Exclusion criteria included: comorbid psychotic disorder, illiteracy, intellectual disability, severe medical conditions precluding outpatient treatment, current use of psychoactive medications except for antidepressant and benzodiazepines, which were kept stable during the study.

It was found that a difference was observed only for pathological eating behaviors between HCs and patients with EDs. Patients experienced increased compensatory exercise during lockdown. BN patients also experienced exacerbated binge eating. Lockdown interfered with treatment outcomes including the descending trend of ED-specific psychopathology being interrupted during the epidemic in BN patient. Previously remitted patients showed re-exacerbation of binge eating after lockdown. They found household arguments and fear for the safety of loved ones predicted increased symptoms during this time. BN patients reported more severe COVID-19-related post-traumatic symptomatology than AN and HCs, and these symptoms were predicted by childhood trauma and insecure attachment style.

Bottom Line: While the present study had some limitations based on small sample size and the patients included were all under treatment already the study did highlight that quarantine during COVID-19 epidemic did interfere with the recovery process of patients with ED, in terms of relapses and pathological eating behaviors. It was found that BN patients and those without remission seemed to be more vulnerable, while participants with a history of childhood abuse were more likely to report PTSD symptoms related to the pandemic.