Impact of COVID-19 Confinement on Adolescent Patients with Anorexia Nervosa: A Qualitative Interview Study Involving Adolescents and Parents

Abstract

COVID-19-related restrictions may have a serious impact on patients with eating disorders. We conducted semistructured interviews with female adolescent patients with anorexia nervosa (AN) (n = 13, 13–18 years) currently receiving inpatient or outpatient treatment and their parents (n = 10). We asked for their experiences during COVID-19 confinement regarding everyday life, AN symptoms, and treatment. We used thematic analysis to interpret the data. The main themes identified from the patients’ interviews involved restrictions of personal freedom (i.e., leading to tension between patients and family members, reduced motivation to work on recovery), interruption of the treatment routine (emerging risks through self-monitored weight, challenges/opportunities of teletherapy), changes in AN symptoms (more exposure to triggering situations), COVID-19-related fears, and compulsions but also potential opportunities (less stress, better family relationships). The parents discussed changes in daily routines as negative (challenges in maintaining day structures) and positive (more family time, “slowing down”). They expressed reservations about reduced outpatient monitoring and increased teletherapy and discussed challenges in keeping contact with the child and clinicians during inpatient treatment. Moreover, the parents discussed deteriorations and improvements in the patients’ psychopathology. Clinical implications from these in-depth insights include the importance of strengthening communication between changing staff cohorts, patients, and parents; motivational work; and joint weight monitoring with the therapist.

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

“…In IP settings, patients were isolated from friends/family and (socially/physically) distanced from clinicians, factors that may intensify social isolation, reduce patient engagement and autonomy in recovery, and thereby exacerbate IP institutionalisation [ 11 , 28 ]. This finding echoes research into adolescents’ and their carers experiences of IP treatment during the pandemic; COVID-19 restrictions meant contact between patients and families, and families and clinicians, was perceived as limited and more emotionally burdensome [ 29 ]. Due to the virtual DP offer, the pandemic limited opportunities for patient-patient and clinician-patient connections, in addition to wider restrictions in the community.…”

“…Whilst elements of virtual ED support may be possible and promising, given the tendency to deny illness severity, treatment ambivalence, and frequency of relapse and physical health concerns in AN [ 36 ], clinicians concerns are unsurprising. Indeed, previous studies have raised concerns over remote risk management and reliance on patients’ self-reporting their weight during the COVID-19 pandemic [ 29 , 37 ]. Due to frequent medical complications and difficulties surrounding patients’ self-reporting weight, medical monitoring remains integral, and precedence should be given to in-person physical health monitoring where possible.…”

Review of Ireland’s First Year of the COVID-19 Pandemic Impact on People Affected by Eating Disorders: ‘Behind Every Screen There Was a Family Supporting a Person with an Eating Disorder’

“…The experience of family members and carers also changed during the pandemic. Research thus far indicates that this was evident across three key areas—the experience of service provision, an impact on the family situation and carers’ observations of the health of people with eating disorders [ 27 , 47 , 48 , 49 , 50 ]. Specific concerns included a fear of premature discharge from services and changes in delivery of supports, increased signs of anxiety, new food triggers, signs of relapse, extra time at home and increased cooking frequency by people with eating disorders as compulsive and consuming.…”

Anorexia nervosa: Steigt die Inzidenz in der Coronapandemie?

“…In der Literatur gibt es bereits erste Annahmen, dass Langeweile und weniger Ablenkungsmöglichkeiten durch Homeschooling und Ausgangsbeschränkungen im Alltag AN-typische Kognitionen und Verhaltensweisen auslösen und unterhalten [ 13 ].…”

“…So wurden eine bessere Selbstfürsorge und verbesserte familiäre Beziehungen im Rahmen der Lockdownmaßnahmen beschrieben, was wiederum einen positiven Effekt auf anorexiespezifische Symptome hatte. Auch werden Auswirkungen des Homeschooling kontrovers diskutiert: Neben den bereits beschriebenen negativen Auswirkungen werden positive Effekte auf die Autonomieentwicklung und Selbstfürsorge bei Patienten/Patientinnen mit AN beschrieben, die als protektive Faktoren für die betroffenen Patienten/Patientinnen gewertet werden können [ 13 ].…”