Eating disorders during COVID-19 pandemic: the experience of Italian healthcare providers

Abstract

Purpose Due to COVID-19 pandemic, the Italian population lived in quarantine from March to May 2020 (lockdown phase I). Restrictions impacted individuals' psychological health, especially in those with eating disorders (ED). Healthcare providers (HCPs) treating ED provided assistance by telemedicine and/or in walk-in clinics. We hypothesize that social restrictions represented a great stressor for ED patients and HCPs, negatively impacted their therapeutic alliance, and affected the frequency of dysfunctional behaviors. Methods This cross-sectional study consisted of an online survey investigating the experience of HCPs involved in ED treatment, with a specific focus on difficulties concerning the therapeutic efficacy. Questionnaire (n. 18 questions) was formulated ad hoc by our research team and sent by e-mail to Italian HCPs registered on online platforms. HCPs included ED experts specialized in psychology, nutrition or medicine. Data were collected during lockdown phase I and referred to patients with Anorexia Nervosa-(AN), Bulimia Nervosa (BN)-and Binge-Eating Disorder-(BED). Results One-hundred questionnaires were collected; 84 and 76 were included in our qualitative and quantitative analyses, respectively. Thirty-six% of HCPs felt their therapeutic intervention was unsuccessful, 37% complained compromised therapeutic alliance. Changes in frequency of compensatory behaviors (increased in 41% AN and 49,5% BN; reduced in 14,6% AN and 21,8% BN) and binge-eating episodes (increased in 53,3% BN and 30,5% BED; reduced in 30,7% BN and 24,7% BED) were experienced and ascribed to augmented patient's anxiety. Disorders switches and variation in dysfunctional conducts frequency were both significantly related to ED category (p < 0.05 for all). Concentration techniques were recognized as useful to offset such negative outcomes. Conclusion According to HCPs, social restrictions affected the frequency of dysfunctional behaviors in ED patients and the efficacy of their therapeutic intervention. Further long-term studies are needed to confirm our data in a larger sample size. Level IV Novel results from a cross-sectional study.

Clinicians’ perspectives on supporting individuals with severe anorexia nervosa in specialist eating disorder intensive treatment settings during the COVID-19 pandemic

“…Due to earlier discharges and/or virtual support, clinicians in both settings recognised the pandemic had shifted responsibility for recovery more towards patients and already burdened carers [ 7 ]. This shift appeared most notable in DP settings and corroborates research into Italian clinicians’ perspectives—virtual support may afford greater opportunity to foster patients’ autonomous motivation and more collaborative treatment [ 8 ], which have been associated with a greater reduction in ED behaviours [ 31 ]. DP, compared to IP, treatment appears to better facilitate responsibility in recovery [ 11 , 32 ], thus, virtual support may further increase this opportunity.…”

“…Limited research has considered clinicians’ experiences of the pandemic, with most focusing on the patient and/or carer perspective [ 5 – 7 ]. To date, clinicians’ experiences of delivering ED treatment during the pandemic have been explored in a service evaluation of a young person’s ED service [ 3 ] and in an online survey of clinicians working in ED services in the initial stages (March–May 2020) of the pandemic [ 8 ]. These studies suggest COVID-19 has significantly impacted ED service delivery.…”

A systematic scoping review of research on COVID‐19 impacts on eating disorders: A critical appraisal of the evidence and recommendations for the field

“…The percentage of participants who reported that the pandemic had worsened specific symptoms was as follows: binge eating (14–47%), dietary restriction (44–65%), driven exercise (42–50%), compensatory behaviors (7–36%), and body image concerns (29–80%). One study surveyed healthcare providers, asking them to retrospectively recall the perceived impact of the pandemic on their patients' symptoms (Colleluori et al, 2021 ). Healthcare providers reported that >30% of their patients had experienced an increase in binge eating and compensatory behaviors during this period.…”

Childhood onset exercise addiction or atypical anorexia nervosa during Covid-19: case report

“…A systematic literature review conducted by Mehta [ 20 ] including cross sectional and longitudinal studies, concluded the majority of individuals with pre-existing eating disorders reported an increase in anorexic symptomatology. This was also the perception for 41% of health care providers) for adults with AN, [ 21 ].…”