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

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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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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.·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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Additional file 2 of Adapting and adopting highly specialized pediatric eating disorder treatment to virtual care: a protocol for an implementation study in the COVID-19 context
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Additional file 3 of The impact of the COVID-19 pandemic and associated public health response on people with eating disorder symptomatology: an Australian study
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Additional file 1 of Adapting and adopting highly specialized pediatric eating disorder treatment to virtual care: a protocol for an implementation study in the COVID-19 context
Couturier, J. L., Pellegrini, D., Miller, C., Agar, P., Webb, C., Anderson, K., Barwick, M. A., Dimitropoulos, G., Findlay, S. M., Kimber, M., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14391189
Additional file 2 of Engaging primary care providers in managing pediatric eating disorders: a mixed methods study
Lebow, J. R., Narr, C., Mattke, A. C., O’Brien, J. R. G., Billings, M. L., Hathaway, J. C., Vickers, K. S., Jacobson, R. M., & Sim, L. A. (2021) · Figshare · doi:10.6084/m9.figshare.13579045
Additional file 1 of Exploring the impact of the COVID-19 pandemic and UK lockdown on individuals with experience of eating disorders
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Additional file 1 of Changes of symptoms of eating disorders (ED) and their related psychological health issues during the COVID-19 pandemic: a systematic review and meta-analysis
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Additional file 1 of Locked down with my eating disorder: a retrospective study on the impact of COVID-19 lockdown on adolescents with eating disorders
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Additional file 4 of 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) · Figshare · doi:10.6084/m9.figshare.18585642
Additional file 1 of Implementing service transformation for children and adolescents with eating disorders across England: the theory, politics, and pragmatics of large-scale service reform
Eisler, I., Simic, M., Fonagy, P., & Bryant‐Waugh, R. (2022) · Figshare · doi:10.6084/m9.figshare.21311055
Additional file 1 of Engaging primary care providers in managing pediatric eating disorders: a mixed methods study
Lebow, J. R., Narr, C., Mattke, A. C., O’Brien, J. R. G., Billings, M. L., Hathaway, J. C., Vickers, K. S., Jacobson, R. M., & Sim, L. A. (2021) · Figshare · doi:10.6084/m9.figshare.13579042
Additional file 1 of Clinicians’ perspectives on supporting individuals with severe anorexia nervosa in specialist eating disorder intensive treatment settings during the COVID-19 pandemic
Webb, H., Dalton, B., Irish, M., Mercado, D., McCombie, C., Peachey, G., Arcelus, J., Au, K., Himmerich, H., Johnston, A. L., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19234282
Additional file 1 of 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) · Figshare · doi:10.6084/m9.figshare.18585633
Additional file 2 of The impact of COVID-19 on eating disorder referrals and admissions in Waikato, New Zealand
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Additional file 1 of COVID-19-Related distress, body image, and eating behaviors: a cross-sectional explanatory model
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Additional file 1 of Anxiety is associated with appetitive traits in university students during the COVID-19 pandemic
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Additional file 1 of The Bergen Facebook Addiction Scale: its psychometric properties and invariance among women with eating disorders
Ali, A. M., Hendawy, A. O., Abd Elhay, E. S., Ali, E. M., Alkhamees, A. A., Kunugi, H., & Hassan, N. I. (2022) · Figshare · doi:10.6084/m9.figshare.19497976
Additional file 1 of The impact of COVID-19 on eating disorder referrals and admissions in Waikato, New Zealand
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Additional file 1 of The impact of the COVID-19 pandemic on eating disorders risk and symptoms: a retrospective study
Straface, E., Jacobis, I. T. D., Capriati, T., Pretelli, I., Grandin, A., Mascolo, C., Vona, R., Gambardella, L., Cittadini, C., Villani, A., et al. (2023) · Figshare · doi:10.6084/m9.figshare.22705853
Additional file 1 of Canadian pediatric eating disorder programs and virtual care during the COVID-19 pandemic: a mixed-methods approach to understanding clinicians’ perspectives
Novack, K., Dufour, R., Picard, L., Taddeo, D., Nadeau, P.-O., Katzman, D. K., Booij, L., & Chadi, N. (2024) · Figshare · doi:10.6084/m9.figshare.26585295
Additional file 3 of Canadian pediatric eating disorder programs and virtual care during the COVID-19 pandemic: a mixed-methods approach to understanding clinicians’ perspectives
Novack, K., Dufour, R., Picard, L., Taddeo, D., Nadeau, P.-O., Katzman, D. K., Booij, L., & Chadi, N. (2024) · Figshare · doi:10.6084/m9.figshare.26585301
Additional file 2 of Is this the ‘new normal’? A mixed method investigation of young person, parent and clinician experience of online eating disorder treatment during the COVID-19 pandemic
Stewart, C. S., Konstantellou, A., Kassamali, F., McLaughlin, N., Cutinha, D. J., Bryant‐Waugh, R., Simic, M., Eisler, I., & Baudinet, J. (2021) · Figshare · doi:10.6084/m9.figshare.14889457
Experiences of weight stigma before and during the COVID-19 pandemic: A cross-sectional analysis
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The impact of the COVID-19 pandemic on eating disorder symptoms and COVID-19-related stress
van Heumen, V., Maas, J., Burger, P., & Simeunovic-Ostojic, M. (2026) · Journal of Eating Disorders · doi:10.1186/s40337-026-01578-x · Cited by 1
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Ceccato, E., Zanin, S., Merlino, L., Bonetto, C., & Sala, A. (2026) · IJEDO · doi:10.32044/ijedo.2026.05
COVID ‐19‐Related Stress and Adolescent Anorexia Nervosa: Early Detection, Similar Illness Course
Vaccaro, D. H., Zhang, Z., Wang, Y., Han, X., Walsh, B. T., Posner, J., & STEINGLASS, J. E. (2026) · International Journal of Eating Disorders · doi:10.1002/eat.70134
Social and Behavioral Correlates of Self-Perceived Psychological Distress in Celiac Disease During the COVID-19 Pandemic: An Exploratory Cross-Sectional Study (COVIMPACT)
Marenna, A., Monaco, F., Vignapiano, A., Valitutti, F., Ciambelli, P., Panella, R., Vecchi, C., Steardo, L., Corrivetti, G., & Fasano, A. (2026) · Nutrients · doi:10.3390/nu18111731
Eating disorders in women
Bulik, C. M., Mazzeo, S. E., & Weinstock, M. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-45863-7.00094-9
Self-citation

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
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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