Eating disorders in times of the COVID‐19 pandemic—Results from an online survey of patients with anorexia nervosa

Abstract

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.

Impact of the COVID-19 Pandemic on Disordered Eating Behavior: Qualitative Analysis of Social Media Posts

“…The objective of this analysis was to characterize the impact of the COVID-19 pandemic on disordered eating behavior using inductive, thematic analysis of ED-related Reddit forums. Consistent with previous investigations [ 7 - 12 , 24 , 25 , 30 ], our findings indicate that the COVID-19 pandemic and associated public health prevention measures negatively impacted the psychiatric health of most users. Users frequently sought comfort in a time of heighted emotional distress by engaging in ED behavior, which was exacerbated by abrupt and involuntary changes in daily routine, exposure to food shortages and panic buying, closure of exercise facilities, and reduced access to care and social support networks.…”

“…Although some ED patients, particularly those in recovery, may modify social media accounts to turn attention to positive or recovery-focused content [ 7 ], those with untreated ED and those at risk for ED may be especially harmed by these media trends. Across existing studies, ED individuals consistently reported anxiety related to physical activity and the inability to exercise [ 9 - 11 , 24 ], especially after exposure to exercise-related media content [ 10 ].…”

The impact of the COVID-19 pandemic on individuals with eating disorders: the role of emotion regulation and exploration of online treatment experiences

“…Despite this, our qualitative analysis reflected that some participants were still able to identify and apply adaptive strategies in their lives: these included accessing social support, setting appropriate boundaries for self-care and protection, and adding adaptive strategies in the form of new structures and reinforcing activities, as implicitly aligned with behavioural activation approaches to depression [ 57 ]. Only two studies have examined the coping activities engaged in by people with EDs at this time: consistent with the importance of setting new structures and enjoyable activities highlighted by our participants, these previous studies found that among the most helpful activities for people with AN and BN were establishing routines, day planning and scheduling pleasant activities [ 12 , 13 ], in addition to time with family, yoga and gentle exercise.…”

Anxiety and depression symptoms, the recovery from symptoms, and loneliness before and after the COVID-19 outbreak among the general population: Findings from a Dutch population-based longitudinal study

“…The sudden societal changes and related stressors after the COVID-19 outbreak may also have worsened symptoms or have hindered the recovery of symptoms among individuals with existing mental health problems. In addition, the pandemic may have reduced access to or use of mental health care services, or forced mental health care workers to continue the treatment using online facilities instead of usual vis-à-vis contacts contributing to a deteriorating mental health [ 13 , 14 ].…”