Objective: The COVID-19 pandemic and the resulting public restrictions pose a psychological burden for humans worldwide and may be particularly detrimental for individuals with mental disorders. Therefore, the current study explored effects of the COVID-19 pandemic on eating disorder (ED) symptoms and other psychological aspects in former inpatients with anorexia nervosa (AN). Method: One-hundred and fifty-nine patients with AN-discharged from inpatient treatment in 2019-completed an online survey on contact history with COVID-19, changes in ED symptoms and other psychological aspects, health care utilization, and strategies patients employed to cope during the pandemic. Results: Approximately 70% of patients reported that eating, shape and weight concerns, drive for physical activity, loneliness, sadness, and inner restlessness increased during the pandemic. Access to in-person psychotherapies and visits at the general practitioner (including weight checks) decreased by 37% and 46%, respectively. Videoconference therapy was used by 26% and telephone contacts by 35% of patients. Patients experienced daily routines, day planning and enjoyable activities as the most helpful among the most used coping strategies. Discussion: The COVID-19 pandemic poses great challenges to patients with AN. ED-related thoughts and behaviors may be used as dysfunctional coping mechanisms to regain control over the current circumstances. E-mental health interventions appear to be promising for supporting AN patients during these hard times. Furthermore, interventions addressing symptoms of depression and anxiety, as well as intolerance of uncertainty might help them manage their ED symptoms.

Objective To evaluate the feasibility, acceptability, and preliminary efficacy of an innovative therapist‐guided smartphone‐based aftercare intervention following inpatient treatment of patients with severe anorexia nervosa (AN). Method Forty female patients with AN (ICD‐10: F50.0/F50.1) (aged: 15–36 years) were randomized either to an 8‐week smartphone‐based aftercare intervention (German version of “Recovery Record”) with therapist feedback as an adjunct to treatment as usual (intervention group [IG]) or to treatment as usual alone (control group [CG]). Body mass index (BMI) and eating disorder (ED) symptoms were assessed at discharge (baseline), postintervention (after 8 weeks), and at 6‐month follow‐up. Additionally, patients' satisfaction, adherence to the smartphone‐based intervention, and postdischarge health care utilization were evaluated. Results Patients showed a high level of adherence and reported a very high acceptance of the app and the aftercare intervention. We found at postintervention nonsignificant small to moderate between‐group effect sizes favoring the IG regarding BMI (d = −0.24; 95% confidence interval [CI] [−0.90, 0.41]) and ED symptoms (Eating Disorder Examination‐Questionnaire global: d = 0.56; 95% CI [−0.10, 1.22]). At 6‐month follow‐up, effects wore off and no significant differences between the IG and CG were evident. Discussion This was the first study to evaluate a therapist‐guided smartphone‐based aftercare intervention for discharged inpatients with AN. Results suggest that such an intervention is highly accepted by patients and that it could support symptom stabilization or continued improvement as an add‐on therapy to treatment as usual. A larger scale randomized controlled trial is now planned to further evaluate the efficacy of this aftercare intervention for patients with AN.

Objective: The COVID-19 pandemic might pose special challenges to patients with eating disorders (EDs) by interfering with daily routines. The aim of this study was to investigate the impact of the current pandemic on patients with bulimia nervosa (BN). Methods: Fifty-five former inpatients with BN completed an online survey on psychological consequences of the COVID-19 pandemic as well as on changes in health care utilisation and on the use and helpfulness of different coping strategies. Results: Almost half of patients (49%) reported a deterioration of their ED symptomatology and 62% reported a reduced quality of life. The frequency of binge eating increased in 47% of patients and self-induced vomiting in 36%. Forty-six percent of patients stated a noticeable impairment of psychotherapy. Face-to-face psychotherapy decreased by 56% but videoconferencing therapy was only used by 22% of patients. Enjoyable activities, virtual social contacts with friends and mild physical activities were rated as the most helpful coping strategies among those most used. Discussion: Approximately one half to two-thirds of former inpatients with BN experienced a negative impact of the crisis on their ED symptomatology and quality of life. In challenging times when face-to-face therapy options are restricted, e-health treatments such as videoconferencing therapy should be considered to ensure continuity of care.

BackgroundPrevious studies have predominantly evaluated the effectiveness of inpatient treatment for anorexia nervosa at the group level. The aim of this study was to evaluate treatment outcomes at an individual level based on the clinical significance of improvement. Patients’ treatment outcomes were classified into four groups: deteriorated, unchanged, reliably improved and clinically significantly improved. Furthermore, the study set out to explore predictors of clinically significant changes in eating disorder psychopathology.MethodsA total of 435 inpatients were assessed at admission and at discharge on the following measures: body-mass-index, eating disorder symptoms, general psychopathology, depression and motivation for change.Results20.0-32.0% of patients showed reliable changes and 34.1-55.3% showed clinically significant changes in the various outcome measures. Between 23.0% and 34.5% remained unchanged and between 1.7% and 3.0% deteriorated. Motivation for change and depressive symptoms were identified as positive predictors of clinically significant changes in eating disorder psychopathology, whereas body dissatisfaction, impulse regulation, social insecurity and education were negative predictors.ConclusionsDespite high rates of reliable and clinically significant changes following intensive inpatient treatment, about one third of anorexia nervosa patients showed no significant response to treatment. Future studies should focus on the identification of non-responders as well as on the development of treatment strategies for these patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-014-0258-z) contains supplementary material, which is available to authorized users.

BackgroundPrevious studies have shown an unmet need in the treatment of eating disorders. In the last decade, interest in technology-based interventions (TBIs) (including computer- and Internet-based interventions [CBIs] or mobile interventions) for providing evidence-based therapies to individuals with different mental disorders has increased.ObjectiveThe aim of this review was to systematically evaluate the potential of TBIs in the field of eating disorders, namely for anorexia nervosa (AN) and bulimia nervosa (BN), for both prevention and treatment, and also for carers of eating disorder patients.MethodsA systematic literature search was conducted using Medline and PsycINFO. Bibliographies of retrieved articles were also reviewed without date or study type restrictions.ResultsForty studies resulting in 45 publications reporting outcomes fulfilled the inclusion criteria: 22 randomized controlled trials, 2 controlled studies, and 16 uncontrolled studies. In total, 3646 patients were included. Overall, the studies provided evidence for the efficacy of guided CBIs, especially for BN patients and for compliant patients. Furthermore, videoconferencing also appeared to be a promising approach. Evaluation results of Internet-based prevention of eating disorders and Internet-based programs for carers of eating disorder patients were also encouraging. Finally, there was preliminary evidence for the efficacy of mobile interventions.ConclusionsTBIs may be an additional way of delivering evidence-based treatments to eating disorder patients and their use is likely to increase in the near future. TBIs may also be considered for the prevention of eating disorders and to support carers of eating disorder patients. Areas of future research and important issues such as guidance, therapeutic alliance, and dissemination are discussed.