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The impact of COVID‐19 epidemic on eating disorders: A longitudinal observation of pre versus post psychopathological features in a sample of patients with eating disorders and a group of healthy controls
Open accessAbstract
OBJECTIVE: the aim of this longitudinal study was to evaluate the impact of COVID-19 epidemic on Eating Disorders (EDs) patients, considering the role of pre-existing vulnerabilities. METHOD: 74 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). Questionnaires were collected to assess psychopathology, childhood trauma, attachment style, and COVID-19-related post-traumatic symptoms. RESULTS: A different trend between patients and HCs was observed only for pathological eating behaviors. Patients experienced increased compensatory exercise during lockdown; BN patients also exacerbated binge eating. Lockdown interfered with treatment outcomes: the descending trend of ED-specific psychopathology was interrupted during the epidemic in BN patients. Previously remitted patients showed re-exacerbation of binge eating after lockdown. Household arguments and fear for the safety of loved ones predicted increased symptoms during the lockdown. 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. DISCUSSION: COVID-19 epidemic significantly impacted on EDs, both in terms of post-traumatic symptomatology and interference with the recovery process. Individuals with early trauma or insecure attachment were particularly vulnerable.
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In the citing paper
“The current trends in the number and proportion of MHC-related ED visits, along with previous research ( 1 , 2 , 4 -8 ), indicate that the mental health effects of the pandemic might be particularly high among adolescent girls.”
In the citing paper
“Eating disorders can be triggered by pandemic-related risk factors (e.g., lack of structure in daily routine, emotional distress, and changes in food availability) or exacerbated by reduced access to mental health care during the pandemic ( 4 , 5 ).”
In the citing paper
“While comparing baseline to T1, patients with EDs reported an improvement of general psychopathology and ED-specific symptoms, objective binge eating and compensatory physical exercise.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al. (2020)
In the citing paper
“Despite 10 full remissions and 19 partial remissions at T1, 10 subjects reported a relapse into BN at T2.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al. (2020)
In the citing paper
“Moreover, the ED group reported higher COVID-19-related post-traumatic stress (PTS) symptoms in comparison with the HC group.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al. (2020)
In the citing paper
“Moreover, BMI increased significantly in patients with AN while remaining stable in patients with BN.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al. (2020)
In the citing paper
“Comparisons between pre- and post-lockdown (T1–T2) revealed that patients with EDs increased physical exercise during lockdown despite the initial improvement.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al. (2020)
In the citing paper
“No significant change was found in the HC group.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al. (2020)
In the citing paper
“Some specific differences between diagnostic subgroups emerged: patients with AN reported an improvement in BMI and specific ED psychopathology, whereas patients with BN exhibited an increase of objective binge eating.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al. (2020)
In the citing paper
“Childhood trauma and insecure attachment style resulted in the factors for COVID-19-related PTS symptoms in patients with AN.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al. (2020)
In the citing paper
“Interestingly, the main factor of increase in pathological physical exercise was household arguments, while the fear of safety for the loved ones predicted a higher increase in binge eating episodes.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al. (2020)
In the citing paper
“Patients with EDs experienced during pandemic the worsening of their preoccupation with weight and body shape, due to the difficulties in continuing their compensatory behaviors, including compulsive physical exercise (Castellini et al., 2020; Clark Bryan et al., 2020; Phillipou et al., 2020; Richardson et al., 2020; Schlegl et al., 2020a,b).”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al., 2020
In the citing paper
“Patients with EDs experienced the worsening of their symptoms as a direct consequence of deprivation in relationships with the significant ones, especially when an insecure attachment style was present (Castellini et al., 2020).”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al., 2020
In the citing paper
“There are only two longitudinal cohort studies (Castellini et al., 2020; Puhl et al., 2020) that compared pre- vs. post-pandemic behaviors or tried to find predictors of negative outcomes during pandemic.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Castellini et al., 2020
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Metadata
- Authors
- Castellini, G., Cassioli, E., Rossi, E., Innocenti, M., Gironi, V., Sanfilippo, G., Felciai, F., Monteleone, A. M., & Ricca, V.
- Affiliations
- University of Florence (IT)
- University of Campania "Luigi Vanvitelli" (IT)
- Corresponding author
- Castellini, Giovanni
- ORCID
- Venue
- International Journal of Eating Disorders
- Publisher
- Wiley
- Published
- 2020-08-28
- Volume
- 53
- Issue
- 11
- Pages
- 1855-1862
- ISSN
- 0276-3478 (ISSN-L)
- 1098-108X
- PMC
- PMC7461528
- OpenAlex
- W3080599908
- Cited by
- 223
- References
- 30
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 25 · 2023: 45 · 2022: 66 · 2021: 66 · 2020: 3
- FWCI
- 17.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Eating Disorders (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Florence Research (University of Florence) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- COVID-19 pandemic, eating disorders, anorexia nervosa, bulimia nervosa, lockdown, compensatory exercises, binge eating, posttraumatic stress symptoms, childhood trauma, insecure attachment, treatment outcomes, family conflict
- MeSH terms
- Psychological Trauma, COVID-19, Adolescent, Adult, Feeding and Eating Disorders, Feeding Behavior, Female, Humans, Italy, Longitudinal Studies, Middle Aged, Object Attachment, Pneumonia, Viral, Quarantine, Surveys and Questionnaires, Stress Disorders, Post-Traumatic, Exercise, Case-Control Studies, Coronavirus Infections, Young Adult, Pandemics
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