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Q. One of my patients, a young adult with AN, reported that her symptoms, and her concerns about body shape and her increased anxiety and depression, worsened during the COVID 19 “lockdown.” Is it just a passing reaction to the increased isolation she experienced? (J.B., New Orleans, LA).
A. The effects of the COVID lockdown, which began in spring 2020, have been reported widely among adults with eating disorders, especially those with feeding and eating disorders (FED). Several studies have shown a positive effect on patients’ motivation to recover from their eating disorders.
One study that examined the conflicting results—motivation to recover, and negative effects from the isolation–stimulated Dr. Bianca Borsini and colleagues to design a study of FED symptoms. The study examined avoidant/restrictive food intake disorders (ARFID) symptoms during the lockdown among 45 young patients (11-13 years of age) and older patients (14-18 years of age). The researchers used open questions, multiple choice questions, yes/no questions, and a symptom checklist. The study was completed online (J Eat Disord. 2023. 11:71). Among the participants, 37 were females, and 8 were males.
About half of the participants (47%) reported that the lockdown had a positive effect on their symptoms, while 59% of those with AN reported having worsening symptoms during the lockdown. Better symptom improvement was observed among younger patients than among older ones. The lockdown was identified as the precipitating factor for FED among 61% of newly evaluated patients. The results paint a complex picture of effects from the pandemic on those with FED.
Among adults with FED, symptoms deteriorated during the lockdown, especially for those with AN, like your patient. There was also a favorable beneficial effect on intrafamilial relationships and motivation to recover or to comply with treatment.
The authors found that although the pandemic and the related lockdown precipitated FED for many patients, and worsened symptoms for others, it had a positive effect on some younger patients who were in treatment, but greater impairment among adults. Nearly all patients felt their treatment and care were satisfactory during the lockdown.
In another study, reduced access to eating disorder services, loss of routine, and heightened anxieties and eating disorder symptoms resulting from COVID 19 and lockdown measures presented challenges for adult AN patient (16 years of age and older) and their caregivers. AN patients were slower to adopt some of the measures. Increased remote support by ED services enabled treatment to continue, and self-management resources and strategies promoted self-efficacy in both patients and caregivers (Eur Eat Disord Rev. 2020.28:826).
To your question: Will these effects pass? The worsening of pre-existing symptoms may be more transient. For those who had a new onset of FED during the COVID pandemic, it seems very unlikely that the end of COVID-related public health emergency orders, or the transition from pandemic to endemic COVID-19, will signal the end of their FED. The increased need for eating disorders services is likely to persist into at least the near future.
—SC