Early impact of covid-19 on individuals with eating disorders: a survey of ~1000 individuals in the United States and the Netherlands

Termorshuizen, Jet D.; Watson, Hunna J.; Thornton, Laura M.; Borg, Stina; Flatt, Rachael E.; MacDermod, Casey M.; Harper, Lauren E.; van Furth, Eric F.; Peat, Christine M.; Bulik, Cynthia M.

doi:10.1101/2020.05.28.20116301

PreprintCited by 304Eating Disorders and BehaviorsCOVID-19 and Mental HealthNutrition, Health and Food Behavior

Early impact of covid-19 on individuals with eating disorders: a survey of ~1000 individuals in the United States and the Netherlands

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Termorshuizen, Jet D., Watson, Hunna J., Thornton, Laura M., Borg, Stina, Flatt, Rachael E., MacDermod, Casey M., Harper, Lauren E., van Furth, Eric F. +2 more·2020·International Journal of Eating Disorders

DOI 10.1101/2020.05.28.20116301PMC PMC7274236

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Abstract

We received rapid ethical permission to evaluate the early impact of COVID-19 on people with eating disorders. Participants in the United States (US, N=511) and the Netherlands (NL, N=510), recruited through ongoing studies and social media, completed an online baseline survey that included both quantitative measures and free-text responses assessing the impact of COVID-19 on situational circumstances, eating disorder symptoms, eating disorder treatment, and general well-being. Results revealed strong and wide-ranging effects on eating disorder concerns and illness behaviors that were consistent with diagnoses. Participants with anorexia nervosa (US 62% of sample; NL 69%) reported increased restriction and fears about being able to find foods consistent with their meal plan. Individuals with bulimia nervosa and binge-eating disorder (US 30% of sample; NL 15%) reported increases in their binge-eating episodes and urges to binge. Respondents noted marked increases in anxiety since 2019 and reported greater concerns about the impact of COVID-19 on their mental health than physical health. Although many participants acknowledged and appreciated the transition to telehealth, limitations of this treatment modality for this population were raised. Individuals with past histories of eating disorders noted concerns about relapse related to COVID-19 circumstances. Encouragingly, respondents also noted positive effects including greater connection with family, more time for self-care, and motivation to recover.

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In Termorshuizen et al. (2020), positive effects of the pandemic were described on both the interpersonal side (greater connection with relatives) and the motivational side.
“Positive effects of the pandemic were described also in this survey on both the interpersonal (greater connection with relatives) and the motivational side.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Termorshuizen et al. (2020)
In Termorshuizen et al. (2020), all groups described difficulties in accessing their treatments.
“All groups described difficulties in accessing their treatments.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Termorshuizen et al. (2020)
In Termorshuizen et al. (2020) two-site online study, patients with AN described mainly fears about the availability of foods chosen for their special meals and reported an exacerbation of food restriction.
“Patients with AN described mainly fears about the availability of foods chosen for their “special” meals. Moreover, they reported an exacerbation of food restriction.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Termorshuizen et al. (2020)
In Termorshuizen et al. (2020), patients with BN and BED increased binge and purge episodes.
“Patients with BN and BED increased binge and purge episodes.”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Termorshuizen et al. (2020)
Restrictions or difficulties in healthcare access was relevant in the three studies reviewed.
“This factor was relevant in the three studies (Brown et al., 2020; Clark Bryan et al., 2020; Termorshuizen et al., 2020).”
From Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review (2021) · cites this paper as Termorshuizen et al., 2020

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Longer‐term impact of COVID ‐19 among individuals with self‐reported eating disorders in the United States, the Netherlands, and Sweden
Termorshuizen, J. D., Sun, Q., Borg, S., Mantilla, E. F., Goode, R. W., Peat, C. M., Thornton, L. M., Watson, H. J., van Furth, E. F., Birgegård, A., et al. (2022) · International Journal of Eating Disorders · doi:10.1002/eat.23824 · Cited by 10 · see citing works
Self-citation
Eating disorders in times of the <scp>COVID</scp>‐19 pandemic—Results from an online survey of patients with anorexia nervosa
Schlegl, S., Maier, J., Meule, A., & Voderholzer, U. (2020) · International Journal of Eating Disorders · doi:10.1002/eat.23374 · Cited by 258 · see citing works
Course and predictors of eating disorder symptoms, anxiety symptoms, and pandemic‐related eating disorder concerns among adults with eating disorders during the first year of the COVID‐19 pandemic
Thompson, K. A., Hedlund, E. L., Sun, Q., Peat, C. M., Goode, R. W., Termorshuizen, J. D., Thornton, L. M., Borg, S., van Furth, E. F., Birgegård, A., et al. (2022) · International Journal of Eating Disorders · doi:10.1002/eat.23870 · Cited by 12 · see citing works
Self-citation
Longitudinal experiences and impact of the COVID-19 pandemic among people with past or current eating disorders in Sweden
Birgegård, A., Abbaspour, A., Borg, S., Clinton, D. N., Mantilla, E. F., Savva, A., Termorshuizen, J. D., & Bulik, C. M. (2021) · Eating Disorders · doi:10.1080/10640266.2021.1985286 · Cited by 15 · see citing works
Self-citation
The impact of the COVID-19 pandemic and associated public health response on people with eating disorder symptomatology: an Australian study
Miskovic‐Wheatley, J., Koreshe, E., Kim, M., Simeone, R., & Maguire, S. (2022) · Journal of Eating Disorders · doi:10.1186/s40337-021-00527-0 · Cited by 41 · see citing works

Authors: Termorshuizen, J. D., Watson, H. J., Thornton, L. M., Borg, S., Flatt, R. E., MacDermod, C. M., Harper, L. E., van Furth, E. F., Peat, C. M., & Bulik, C. M.
Affiliations: Karolinska Institutet (SE)
University of North Carolina at Chapel Hill (US)
Corresponding author: Bulik, Cynthia M.
ORCID: Termorshuizen, Jet D.
Watson, Hunna J.
Thornton, Laura M.
Flatt, Rachael E.
MacDermod, Casey M.
Peat, Christine M.
Bulik, Cynthia M.
Venue: International Journal of Eating Disorders
Publisher: openRxiv
Published: 2020-05-29
Volume: 53
Issue: 11
Pages: 1780-1790
ISSN: 0276-3478 (ISSN-L)
DOI: 10.1101/2020.05.28.20116301
PMC: PMC7274236
OpenAlex: W3045754778
Cited by: 304
References: 29
Citations by year: 2026: 11 · 2025: 8 · 2024: 31 · 2023: 44 · 2022: 86 · 2021: 100 · 2020: 22 · 2019: 1
FWCI: 25.22
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: International Journal of Eating Disorders (publishedVersion)
medRxiv (acceptedVersion)
PubMed (publishedVersion)
Leiden Repository (Leiden University) (submittedVersion, cc-by)
PubMed Central (submittedVersion)
UWA Profiles and Research Repository (UWA) (submittedVersion, other-oa)
Data Archiving and Networked Services (DANS) (submittedVersion, cc-by)
Funders: Sunovion
Vetenskapsrådet (R01MH119084, R01 MH120170, 538‐2013‐8864, award: 538-2013-8864, Vetenskapsrådet, award: 538-2013-8864)
Idorsia Pharmaceuticals
National Institutes of Health
National Institute of Mental Health (R01MH120170, R01MH119084, 538-2013-8864)
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, binge eating disorder, eating disorder symptoms, anxiety, telemedicine, relapse, dietary restriction, binge eating, well-being, family ties, self-care

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Early impact of covid-19 on individuals with eating disorders: a survey of ~1000 individuals in the United States and the Netherlands

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