Months into the COVID-19 pandemic, the mental health fallout has become clear. Researchers have documented increases in anxiety and depression stemming from the stress, grief, isolation, and economic damage wrought by the novel coronavirus. New research from scientists at the University of Florence points toward another area of concern: The lockdowns designed to slow the spread of the virus may lead to relapse among patients in treatment for anorexia and bulimia.
Italy was an early epicenter of the pandemic, with a general lockdown put in place at the beginning of March. The newly published research followed a group of 74 women ranging in age from 18 to 60. All had been undergoing treatment for anorexia or bulimia and were part of a larger longitudinal study on treatment outcomes. These women were matched with a control group of 97 women (similarly aged) with no lifetime history of an eating disorder. Those in the control group did not receive any psychological treatment during the lockdown. (Though study participants were all women, eating disorders can occur in any gender.)
The women completed a thorough assessment (including self-report questionnaires and an interview with a psychiatrist) a few months before the outbreak of COVID-19 in Italy. They completed further assessments via telemedicine around six weeks after Italy’s lockdown began. None of the women tested positive for COVID-19. The women had all been receiving in-person outpatient cognitive behavioral therapy for their eating disorders prior to the pandemic, but were transitioned to online, telemedicine appointments during lockdown.
Overall, the results of the study revealed that the pandemic significantly interfered with the recovery trajectories of the patients with eating disorders—especially those who had not achieved remission prior to the beginning of the lockdown. During the lockdown, the eating disorder patients showed increases in binge eating. The women in the control group did not show these increases. This is especially notable given that treatment continued during the lockdown (though it was provided via telemedicine). Normally, symptom profiles would continue to improve during treatment.
Patients with bulimia showed especially worrisome trends. Many of the patients with bulimia who had been in full remission before the pandemic relapsed during lockdown. Though patients with anorexia generally fared better than those with bulimia, several patients with anorexia evidenced what’s referred to as “diagnostic crossover”—they developed symptoms during the lockdown that led to diagnoses of bulimia. Women with anorexia reported an increase in compensatory exercise behaviors during the pandemic, an increase not seen in the control group.
Binge-eating (whether in the context of bulimia or in the context of binge-eating disorder) is thought to be triggered by periods of intense emotional distress. Consistent with this idea, the researchers found that patients who reported high levels of fear about the safety of their loved ones due to the pandemic were especially likely to show increases in binge eating. Though it may seem counterintuitive, binge eating is also linked with food insecurity. It’s possible that reports of food shortages heightened these concerns and contributed to a worsening of symptoms.
For many of us, social media use became more common (and more intense) during lockdowns. A large body of research links social media use to body image disturbance—likely because feeds frequently contain a stream of images featuring thin, airbrushed bodies. Concerns about health and fitness were also a common theme on social media posts during lockdowns, with many expressing concern about gaining weight during the pandemic. Stress over pandemic-related economic conditions could also have played a role in worsening symptoms.
Overall, the results of this study and others suggest that the COVID-19 pandemic has been a significant threat to mental health—but especially for people who are already vulnerable. Those who have eating disorders or related symptoms should take steps to stay connected with treatment providers, even if they are not able to attend in-person sessions. If you are concerned that you may be experiencing the symptoms of an eating disorder, seek help sooner rather than later. Even if in-person options are limited in your area, telemedicine is now available from a wide variety of providers and some eating disorder treatment centers are offering intensive online versions of their outpatient treatment programs.
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