While the impact of Covid-19 lockdowns on family dynamics and eating behaviors has been widely studied, there is limited and conflicting evidence regarding families of children and adolescents with restrictive eating disorders (EDs). This study examines differences in eating psychopathology and perceptions of family functioning in pediatric patients with anorexia nervosa (AN; restrictive and atypical) and avoidant/restrictive food intake disorder (ARFID) before and after the pandemic.

A total of 640 children and adolescents with restrictive EDs and their parents, assessed from January 2018 to December 2022, were grouped into pre-Covid-19, Covid-19, and post-Covid-19 periods. Measures included the Family Assessment Device, the Eating Disorders Inventory-III, and the Eating Disorders Questionnaire in Childhood. Data were analyzed using ANOVA (p < .05).

Children and adolescents with AN showed greater difficulties compared to children and adolescents with ARFID both in family functioning and eating psychopathology. In particular, children with AN in the COVID-19 group exhibited higher scores in Affective and Mood Disorders, Obsessive-Compulsive Disorder, Pica, and Selective Eating compared to the pre-Covid-19 group. Adolescents with AN reported worse eating psychopathology in Post-COVID-19 group compared to others.

Patients with restrictive EDs show more dysfunctional family functioning and greater eating psychopathology after the pandemic compared to preceding periods but results varied by age and diagnosis. These findings highlight the need for diagnosis-specific, tailored interventions to address the evolving clinical and family dynamics in pediatric ED populations.

Level V Evidence obtained from a cross-sectional descriptive study.

The COVID-19 pandemic has been shown to increase psychological burden and requires efficient coping strategies to maintain mental health. In particular, it remains unclear which pandemic-related stress response pattern occurs in pre-existing posttraumatic stress disorder (PTSD) during the pandemic - at the same time these patients potentially exhibit dysfunctional coping of artificially generated psychosocial stressors. To analyze this so far widely unconsidered pandemic-related stress response in PTSD, this study longitudinally measured psychosocial burden and adjustment disorder (AD) symptom load in 14 patients with a primary or secondary diagnosis of PTSD vs. a cohort of 145 psychiatric patients without PTSD. The previously established Goettingen psychosocial Burden and Symptom Inventory (Goe-BSI) was used. Patients were interviewed at the end of the first (April/May 2020) and the second nationwide lockdown in Germany (November/December 2020). In our convenience sample, psychiatric disorders were diagnosed by patients' treating clinicians prior to study inclusion. Psychosocial burden and AD symptom load were significantly higher in patients with PTSD than in patients without PTSD over the course of the pandemic (both p = .005). Moreover, explorative analysis of Goe-BSI-assessed general psychiatric symptoms did not reveal changes during the pandemic in patients with PTSD. In sum, we provide preliminary evidence that, in relation to psychiatric patients without PTSD, those with PTSD might experience a higher pandemic-related burden and might thus cope less efficiently with this enduring real-world stressor. This study is limited inter alia by the small sample size and by the underrepresentation of some psychiatric diagnoses.

This study had two aims; first to explore changes in compulsive exercise among adult females across the first year of the COVID-19 pandemic, and second, to explore how changes to physical activity early in the pandemic impacted compulsive exercise. Participants were 174 adult females who completed online surveys four times (T1-T4) during the first 12 months of the pandemic. Participants reported changes in physical activity (T1) and completed the compulsive exercise test (CET) at each time point (T1-T4). Mixed ANOVAs with time (T1-T4) and group (did versus did not report changes in physical activity) as factors revealed that compulsive exercise significantly differed across timepoints for the whole sample. Furthermore, females who reported that their physical activity levels had changed early in the pandemic reported higher levels of CET Weight Control Exercise compared to those who reported no change. No significant interactions were found. Among this sample of adult females, attitudes towards exercise changed during the first year of the pandemic, which may reflect the impact of varying lockdown restrictions. Additionally, changes to physical activity early in the pandemic were linked with exercising to control body weight. This suggests that externally influenced changes in physical activity may be an influential factor in the development of compulsive exercise. This may have implications for understanding and managing risk in a range of transition situations that impact upon physical activity.

The COVID-19 pandemic has significantly impacted global mental health, exacerbating the prevalence and severity of Eating Disorders (EDs). This study evaluates changes in the presentation and severity of EDs before and after the pandemic at the Regional Residential Center "Mariconda" in Salerno.

This retrospective cohort study analyzed records from 162 patients admitted to the center between December 2018 and December 2023. The onset of pandemic restrictions in mid-2020 divided the subjects into pre-COVID and COVID groups. Data collected included age, gender, education level, previous hospital admissions, admission diagnoses, body mass index (BMI), and comorbidity with other psychiatric conditions.

Among the 162 subjects, 115 (71%) were admitted during the pandemic period. This group was significantly younger (mean age: 18.3 vs. 20.6 years, p = 0.009), had lower educational attainment (67% vs. 49% below secondary school diploma, p = 0.025), had a higher rate of prior hospitalizations (49% vs. 26%, p = 0.007), and demonstrated a higher prevalence of severe comorbidities with other mental illnesses (94% vs. 82%, p = 0.009) compared to the pre-COVID cohort. No significant differences were observed in gender distribution, initial diagnoses upon admission, or average length of hospital stay.

The findings indicate that the COVID-19 pandemic intensified the presentation and severity of EDs, particularly among younger individuals with lower educational backgrounds. This underscores the urgent need for targeted, integrated treatment approaches for EDs in the context of global crises, including the development of strategies to address the increased severity of comorbid conditions and higher frequency of hospital readmissions observed in this study. These results highlight the necessity of reinforcing multidisciplinary care models that integrate medical, psychological, and social support to address the heightened complexity of post-pandemic ED cases and ensure more effective, long-term treatment outcomes. Future research is essential to explore the long-term effects of the pandemic on EDs, as well as to refine treatment strategies that better support those affected.

The aim of this study was to analyze data of children and adolescents in Germany insured according to legal requirements (statutorily insured) regarding epidemiology, comorbidities, and care of bulimia nervosa (BN) pre- vs. intra-COVID-19 pandemic.

The study is based on anonymized claims data of 10-17.9 years old children and adolescents statutorily insured in Germany from the InGef Berlin GmbH research database. The database combines data of more than 50 statutory health insurances and is representative of the German population. Prevalence, (quarterly) incidence, comorbidities and in- and outpatient treatment of BN (ICD-10: F50.2/F50.3) pre-COVID (01/2018-03/2020; N = 282,711) vs. intra-COVID (04/2020-12/2021; N = 282,738) was compared using descriptives and χ2 tests, Welch-tests and interrupted time series analysis. The analysis was stratified by age groups (children: 10-13 years; adolescents: 14-17 years).

Prevalence of BN was 0.09% pre-COVID and 0.07% intra-COVID (OR = 0.78 [0.65, 0.93]). After pandemic onset, a positive trend in the quarterly incidence among adolescents was observed (p = .016). Outpatient visits to general practitioners decreased (OR = 0.59 [0.35, 0.98]).

The observed decline in diagnosed and treated BN cases and the positive trend in quarterly incidence could be attributed to an increase in unregistered cases due to the overburdened care situation that emerged with the onset of the COVID-19 pandemic. Researchers and healthcare providers need to be aware of the potential for a backlash and deterioration/chronification of BN symptoms in children and adolescents. Level of evidence No level of evidence.

Despite an increase in eating disorder (ED) cases during the COVID-19 pandemic, there are limited longitudinal studies exploring treatment outcomes. The aims of the present study were: (1) to compare the clinical features of patients with EDs whose onset was during the COVID-19 lockdown (pandemic cohort) against patients with EDs whose onset was prior to the pandemic (pre-pandemic cohort) and, (2) to compare therapy responses between the cohorts.

The sample consisted of 115 adult women with an ED. N = 37 new ED cases (pandemic cohort) were diagnosed and included in the study during the pandemic (May 2020-May 2021); these patients did not have any previous history of an ED. We also included N = 78 ED cases (pre-pandemic cohort) diagnosed prior to the COVID-19 pandemic breakout (prior to March 2020). All ED subtypes were considered in both groups and several clinical variables were assessed.

At baseline, pandemic cohort reported lower levels of impulsivity and higher emotional regulation capacities than the pre-pandemic cohort; however, no differences were found in aspects of general psychopathology and ED related severity. Following treatment, the pandemic cohort showed higher rates of good outcome and lower rates of dropouts than the pre-pandemic cohort.

Although both cohorts showed similar ED-related symptoms and general psychopathology scores, treatment outcomes were more favourable in the pandemic cohort.

The COVID-19 pandemic has sparked or amplified many mental health problems. The aim of this study was to compile evidence from existing systematic reviews to provide an overall assessment of the impact of social restrictions during the COVID-19 pandemic on people affected by eating disorders (EDs). PubMed and Scopus were searched up to August 16, 2023. Systematic reviews and meta-analyses were selected using the PRISMA 2020 statement. The quality assessment of the included studies was conducted using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Eleven studies were included in this umbrella review. Six main categories emerged from the studies described in the review: dietary changes and psychopathological effects showed an overall worsening of symptomatology; in studies concerning the impact of isolation and restrictive measures, it was found that social distancing was associated with feelings of loneliness, anxiety, and depression; limited access to direct care was found and therapeutic changes were made; the influence of mass media negatively impacted people with ED; several studies reported positive findings regarding symptomatology; finally, studies regarding 'impact on vulnerable populations showed that vulnerable people are more at risk of reporting body image distortion and eating disorders. The COVID-19 pandemic has negatively impacted most of the population with ED leading to a worsening of specific symptomatology. In addition, this worsening of the condition may be caused by limited access to care and treatment, changes in routine, or to the negative influence of the media.

COVID-19 necessitated a rapid move from face-to-face services to remote care for eating disorders/eating distress (EDs). This study explores the advantages and challenges of remote care, identifying future implications for service provision. Remote care has been considered in the broadest of terms, including therapeutic care (e.g., Cognitive Behavioural Therapy, peer support, forums, one-to-one and group care options).

Using a mixed methods approach, data were collected from 211 people with lived experience of EDs (PWLE), with and without formal diagnosis. 27 participants took part in semi-structured interviews/workshops and a further 184 participants took part via an online survey. Participants reported on their ED status, the impact of the pandemic on symptoms, the benefits, and challenges of remote care (and type of support accessed), and any reasons for not accessing support. Participants were invited to make future care recommendations.

ED symptoms were reported as worsening during the pandemic with contributing factors including isolation, lack of routine, negative emotions, and feeling like the external situation was outside of one's control. Remote care was positively attributed to increased flexibility and facilitation of social connection. Identified barriers to access included lack of awareness about support availability, digital access/literacy, and competing commitments. Further challenges included approaches being perceived as too clinical (e.g., ED information and support presented using clinical language and/or limited to support within medical care settings, without acknowledging the broader context of disordered eating), uncertainty around remote care quality, and concerns that remote platforms may facilitate masking of symptoms. Participants reported distress caused by online platforms where self-view is the default during video calls. They expressed a need for more holistic approaches to remote care, including: "real stories" of recovery, and hybrid (online and offline) options for greater flexibility and widening of access and choice. Participants also expressed a need for appropriate digital literacy training.

Future recommendations emphasise user-centred holistic and hybrid approaches to ED remote support, with training to address digital literacy barriers and facilitate user control of platform functionalities (e.g., self-view). This study underscores the need for continued remote care with a focus on inclusivity and user empowerment.

Studies comparing treatment outcomes in patients with eating disorders before and during the coronavirus (COVID-19) pandemic have yielded conflicting results. Furthermore, no study has yet evaluated treatment outcomes in adolescent patients with anorexia nervosa before, during and after the crisis. Hence, this study investigated the outcomes of an intensive Cognitive Behavioral Therapy-Enhanced (CBT-E) program on adolescents with anorexia nervosa consecutively treated before (n = 64), during (n = 37) and after (n = 31) the period of emergency spanning 8 March 2020 to 31 March 2022. Results show consistent and similar improvements in eating disorder psychopathology, general psychopathology and body mass index-for-age percentiles across all three periods, with approximately 60% of patients maintaining a full response at the 20-week follow-up, suggesting that treatment efficacy remained robust. Overall, the study underscores the effectiveness of intensive CBT-E as a viable treatment option for adolescents with anorexia nervosa, even during and after unprecedented challenges such as those posed by the COVID-19 pandemic.

This systematic review aimed to summarize the evidence on the existence of a distinct phenotypic expression of Eating Disorders (EDs) associated with childhood maltreatment (CM), the so-called maltreated eco-phenotype of EDs. PRISMA standards were followed. Articles providing data about the characteristics of individuals with an ED reporting CM were included. Relevant results were extracted and summarized. A quality assessment was performed. A total of 1207 records were identified and screened, and 97 articles published between 1994 and 2023 were included. Findings revealed distinct biological and clinical features in patients with EDs reporting CM, including neuroanatomical changes, altered stress responses, ghrelin levels, inflammation markers, and gut microbiota composition. Clinically, CM correlated with severer eating behaviors, higher psychiatric comorbidity, impulsivity, emotional dysregulation, and risky behaviors. Additionally, CM was associated with poorer treatment outcomes, especially in general psychopathology and psychiatric comorbidities. This review highlighted the need to move towards an etiologically informed nosography, recognizing CM not merely as a risk factor, but also as an etiologic agent shaping different eco-phenotypic variants of EDs.

Timely intervention is beneficial to the effectiveness of eating disorder (ED) treatment, but limited capacity within ED services means that these disorders are often not treated with sufficient speed. This service evaluation extends previous research into guided self-help (GSH) for adults with bulimic spectrum EDs by assessing the feasibility, acceptability, and preliminary effectiveness of virtually delivered GSH using videoconferencing.

Patients with bulimia nervosa (BN), binge eating disorder (BED) and other specified feeding and eating disorders (OSFED) waiting for treatment in a large specialist adult ED out-patient service were offered virtually delivered GSH. The programme used an evidence-based cognitive behavioural self-help book. Individuals were supported by non-expert coaches, who delivered the eight-session programme via videoconferencing.

One hundred and thirty patients were allocated to a GSH coach between 1 September 2020 and 30 September 2022; 106 (82%) started treatment and 78 (60%) completed treatment. Amongst completers, there were large reductions in ED behaviours and attitudinal symptoms, measured by the ED-15. The largest effect sizes for change between pre- and post-treatment were seen for binge eating episode frequency (d = -0.89) and concerns around eating (d = -1.72). Patients from minoritised ethnic groups were over-represented in the non-completer group.

Virtually delivered GSH is feasible, acceptable and effective in reducing ED symptoms amongst those with bulimic spectrum disorders. Implementing virtually delivered GSH reduced waiting times, offering a potential solution for long waiting times for ED treatment. Further research is needed to compare GSH to other brief therapies and investigate barriers for patients from culturally diverse groups.

Eating disorders (EDs) are a severe type of mental illness that nurses in many settings may encounter. The three primary eating disorders-anorexia nervosa, bulimia nervosa, and binge eating disorder-are described here. Signs, symptoms, and treatment of eating disorders are outlined, along with the importance of nurses in early identification of EDs and developing therapeutic relationships with patients. A case study and elements of spiritual care are presented.

To examine implications of the COVID-19 pandemic on eating disorder (ED) features and psychopathology in female adolescents with anorexia nervosa (AN).

In total 79 females with first-onset AN (aged 12-22 years) were included and were followed up across a period of 1 year. We assessed AN participants recruited pre-pandemic (n = 49) to those recruited peri-pandemic (n = 30). Pre- (n = 37) and peri-pandemic (n = 38) age-, and education-matched typically developing (TD) girls (n = 75) were used as a reference cohort. ED features and psychopathology were assessed at baseline. After 1 year of follow-up the association between pandemic timing and clinical course was assessed. Analyses of covariance were used to examine differences in ED features and psychopathology.

Peri-pandemic AN participants experienced less ED symptoms at baseline compared to pre-pandemic AN participants. In particular, they were less dissatisfied with their body shape, and experienced less interpersonal insecurity. In addition, the peri-pandemic AN group met fewer DSM-IV criteria for comorbid disorders, especially anxiety disorders. In contrast, peri-pandemic AN participants had a smaller BMI increase over time. In TD girls, there were no differences at baseline in ED features and psychopathology between the pre- and peri-pandemic group.

Overall, peri-pandemic AN participants were less severely ill, compared to pre-pandemic AN participants, which may be explained by less social pressure and peer contact, and a more protective parenting style during the pandemic. Conversely, peri-pandemic AN participants had a less favorable clinical course, which may be explained by reduced access to health care facilities during the pandemic.

Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

This study examined the impact of the COVID-19 pandemic on healthcare engagement for anorexia nervosa (AN) and bulimia nervosa (BN) in a large, geographically diverse population.

This repeated monthly, cross-sectional study queried Military Health System records of individuals aged 10-21 before and during the pandemic (February 2019-January 2022). ICD-10 codes identified encounters for AN and BN. Monthly rates of care were modeled as the number of unique individuals with an ICD-10-identified eating disorder-related encounter per month divided by the enrolled population. Poisson regression analysis evaluated rates of care stratified by eating disorder, clinical setting, and sex.

In a population of 1.76 million adolescents and young adults, 1629 individuals with AN or BN received care during the pre-pandemic period; 3256 received care during the pandemic. The monthly rate of care for females with AN during the pandemic increased in inpatient settings (adjusted relative risk [aRR]: 1.31 [1.16-1.49]) and outpatient settings (aRR: 1.42 [1.37-1.47]); monthly care rates in males with AN increased in the outpatient setting (aRR: 1.46 [1.28-1.67]). Females with BN had increased engagement in outpatient settings (aRR: 1.09 [1.03-1.16]); BN care for males showed no significant monthly changes during the pandemic period in either healthcare setting.

With increased rates of AN and BN disorder-related care during the pandemic, screening for eating disorder symptomatology may allow for timely diagnosis and intervention in periods of heightened stress. Pandemic-related increases in healthcare engagement may strain limited resources, emphasizing a need to expand accessibility of clinical expertise.

This study indicates that monthly rates of healthcare engagement during the COVID-19 pandemic for AN and BN varied based on clinical setting and sex in an adolescent and young adult population. The increased number of individuals seeking eating disorder-related care, especially outpatient care, attributed to heightened stressors necessitates accessible professionals with eating disorder clinical expertise.

Adolescence has emerged as a particularly vulnerable phase during the COVID-19 pandemic, with eating disorders (EDs) representing a prominent psychopathological challenge linked to the restrictions imposed by the pandemic. Emerging evidence suggests that not only individuals with EDs but also their healthy siblings (HS) may experience unique psychological effects in this context. However, the existing literature on this topic remains limited. This study seeks to examine and compare the effects of the pandemic on adolescents and adults, with a specific focus on the impact of containment measures, disruptions in daily routines, and alterations in life trajectories, for both individuals with EDs and their HS.

We enrolled 273 individuals, including those diagnosed with EDs and their HS. Among the participants, 120 were under the age of 19. Multiple self-report questionnaires were administered to assess the psychological impact of 1 year of the COVID-19 pandemic. These assessments covered a range of psychological constructs, including posttraumatic symptoms, general psychopathology, and eating-related concerns.

Notably, adolescent patients with EDs demonstrated the highest psychopathological scores within our sample. They were the sole subgroup to surpass clinical cutoffs, exhibiting more pronounced issues concerning eating-related concerns and general psychological well-being. Our findings also shed light on the unique experiences of HS during the pandemic.

Our findings highlight the specific psychological burden endured by adolescents with EDs throughout the COVID-19 pandemic, emphasizing the vulnerability of this demographic. Moreover, the experiences of HS, often overlooked in the literature, warrant increased attention in future health programs and interventions.

During the COVID-19 pandemic, an increase in the incidence of overweight and obesity in children was observed. It appears that unhealthy food choices, an unbalanced diet, and a sedentary lifestyle, as well as experiencing stress related to the pandemic, may be contributing to this disturbing trend. Chronic stress is a significant factor contributing to eating disorders and obesity in youngsters, involving medical, molecular, and psychological elements. Individuals under chronic stress often focus on appearance and weight, leading to negative body image and disrupted relationships with food, resulting in unhealthy eating behaviors. Chronic stress also impacts hormonal balance, reducing the satiety hormone leptin and elevating the appetite-stimulating hormone ghrelin, fostering increased hunger and uncontrolled snacking. Two systems, the hypothalamic-pituitary-adrenal axis and the sympathetic system with the adrenal medulla, are activated in response to stress, causing impaired secretion of noradrenaline and cortisol. Stress-related obesity mechanisms encompass oxidative stress, neuroinflammation, insulin resistance, and neurohormonal and neurotransmission disorders. Stress induces insulin resistance, elevating obesity risk by disrupting blood sugar regulation and fat storage. Stress also affects the gut microbiome, potentially influencing chronic inflammation and metabolic processes linked to obesity. In conclusion, chronic stress is a multifaceted risk factor for eating disorders and obesity in children, necessitating a comprehensive understanding of effective preventive and intervention strategies amid the escalating prevalence of childhood overweight and obesity.

To determine whether the coronavirus disease 2019 (COVID-19) pandemic was associated with a change in psychiatric symptoms in people with preexisting obsessive-compulsive, eating, anxiety, and mood disorders compared to their prepandemic levels.

We searched MEDLINE, CINAHL, PsycINFO, and Embase from inception until February 16, 2022. Studies were included if they reported prepandemic and during-pandemic psychiatric symptoms, using validated scales, in people with preexisting mood, anxiety, eating, or obsessive-compulsive disorders. Two reviewers independently screened studies, extracted data, and assessed evidence certainty. Random-effects meta-analyses were conducted. Effect sizes were reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs).

Eighteen studies from 10 countries were included. Of the 4465 included participants, 68% were female and the average age was 43 years. Mood and obsessive-compulsive disorders were the most studied disorders. During-pandemic psychiatric measurements were usually collected during nationwide lockdown. Obsessive-compulsive symptoms worsened among people with obsessive-compulsive and related disorders, with a moderate effect size (N = 474 [six studies], SMD = -0.45 [95% CI, -0.82 to -0.08], I2  = 83%; very low certainty). We found a small association between the COVID-19 pandemic and reduced anxiety symptoms in people with mood, anxiety, obsessive-compulsive, and eating disorders (N = 3738 [six studies], SMD = 0.11 [95% CI, 0.02-0.19], I2  = 63%; very low certainty). No change in loneliness, depressive, or problematic eating symptoms was found.

People with obsessive-compulsive and related disorders may benefit from additional monitoring during the COVID-19 pandemic and possibly future pandemics. Other psychiatric symptoms were stable in people with the specific disorders studied. Overall, evidence certainty was very low.

Increased rates of pediatric eating disorders have been observed during the COVID-19 pandemic, but little is known about trends among adults. We aimed to evaluate rates of emergency department visits and hospital admissions for eating disorders among adolescents and adults during the pandemic.

We conducted a population-based, repeated cross-sectional study using linked health administrative data for Ontario residents aged 10-105 years during the prepandemic (Jan. 1, 2017, to Feb. 29, 2020) and pandemic (Mar. 1, 2020, to Aug. 31, 2022) periods. We evaluated monthly rates of emergency department visits and hospital admissions for eating disorders, stratified by age.

Compared with expected rates derived from the prepandemic period, emergency department visits for eating disorders increased during the pandemic among adolescents aged 10-17 years (7.38 v. 3.33 per 100 000; incidence rate ratio [IRR] 2.21, 95% confidence interval [CI] 2.17-2.26), young adults aged 18-26 years (2.79 v. 2.46 per 100 000; IRR 1.13, 95% CI 1.10-1.16) and older adults aged 41-105 years (0.14 v. 0.11 per 100 000; IRR 1.15, 95% CI 1.07-1.24). Hospital admissions for eating disorders increased during the pandemic for adolescents (8.82 v. 5.74 per 100 000; IRR 1.54, 95% CI 1.54-1.54) but decreased for all adult age groups, especially older adults aged 41-105 years (0.21 v. 0.30 per 100 000; IRR 0.72, 95% CI 0.64-0.80).

Emergency department visits for eating disorders increased among adolescents, young adults and older adults during the pandemic, but hospital admissions increased only for adolescents and decreased for all adult groups. Differential rates of acute care use for eating disorders by age have important implications for allocation of inpatient mental health resources.

Early onset anorexia nervosa (EOAN) is a subclassification of AN, defined by an onset before 14 years, and characterized by specific demographic, neuropsychological, and clinical features. The present study aims to provide naturalistic data on a wide sample with EOAN, focusing on psychopathological and nutritional changes occurring in the context of a multidisciplinary hospital intervention, as well as the rate of rehospitalizations during a 1-year follow-up.

Observational, naturalistic study adopting standardized criteria for EOAN (onset before 14 years). EOAN were compared to adolescent-onset AN (AOAN) patients (onset after 14 years) by demographic, clinical, psycho and treatment variables. Psychopathology was assessed at admission (T0) and discharge (T1) with self-administered psychiatric scales for children and adolescents (SAFA) subtests for Eating Disorders, Anxiety, Depression, Somatic symptoms, and Obsessions. Then, potential differences of T0-T1 changes in psychopathological and nutritional variables were assessed. Finally, rates of re-hospitalizations at 1-year post-discharge follow-up were assessed with Kaplan-Meier analyses.

Two-hundred thirty-eight AN individuals (EOAN = 85) were enrolled. When compared to AOAN, EOAN participants were more frequently males (X2 = 5.360, p = .021), more frequently received nasogastric-tube feeding (X2 = 10.313, p = .001), and risperidone (X2 = 19.463, p < .001), obtained a greater T0-T1 improvement in body-mass index percentage (F[1.229] = 15.104, p < .001, η2 = 0.030), with higher 1-year freedom from re-hospitalization (hazard ratio, 0.47; Log-rank: X2 = 4.758, p = .029).

In this study, describing the broadest EOAN sample available in literature so far, EOAN patients received specific interventions and obtained better outcomes at discharge and follow-up when compared to AOAN. Longitudinal, matched studies are required.

We examined the pattern of access to hospital emergency room (hER) in 2018-2021 among patients with eating disorders (ED) from Florence, Italy, diagnosed during 1994-2018, using a matched cohort design. We included 902 ED patients and an equal number of sex-, age-, and residence-matched individuals. We fitted conditional Poisson regression models with robust variance estimator to estimate incidence rate ratios (IRR) and 95% confidence intervals. ED patients accessed hER more than twice as often as matched individuals: the IRR was 2.11 (1.21-3.70), 2.02 (1.36-3.00), and 2.49 (1.71-3.61) among AN, BN, and BED patients. Factors associated with increased hER use were older age (≥40 years; for AN patients, also younger age, <20 years), BMI ≤ 16 kg/m2 (for AN), and psychopathological severity. The rise in access to hER was particularly marked during the early phases of the COVID-19 pandemic and declined only partially thereafter. Acute psychiatric symptoms and non-specific medical conditions represented the main causes of increased access to hER. Use of hER was more often inappropriate among ED patients than matched individuals. Integration of primary and mental health care may be necessary to counteract the high and often inappropriate use of hER by patients with ED.

The aim of the present study is to describe the prevalence and individual predictors of mental distress (anxiety, depression, and burnout) in a sample of volunteers engaged in emergency services. A total of 823 volunteers enrolled in the Red Cross auxiliary corps were surveyed between 28 June 2021 and 28 August 2021 (299 men and 524 women). After deployment in anti-COVID-19 operations, participants completed the Patient Health Questionnaire, Generalized Anxiety Disorder Questionnaire, Maslach Burnout Inventory, and Big Five Inventory through an online platform. A moderately severe risk of depression was found in 1.70% of the sample. A severe risk for anxiety disorders was found in 1.82%. A high risk for emotional exhaustion was found in 3.40%, depersonalization in 12.88%, and low personal accomplishment in 7.53%. Women showed a higher risk of both depression and anxiety in comparison to males. Personality factors were significant predictors for all dimensions. In contrast to the current literature, openness was found to be a predisposing personality factor in developing burnout dimensions. The relevance of the current findings for the development of effective screening tools before the deployment of reserve forces during medical crises is discussed.

Hemodialysis patients are vulnerable to serious complications such as prolonged hospital stay and psychosocial issues like depression and death anxiety. Studies on psychosocial factors on end-stage renal disease patients' outcomes during COVID-19 pandemic are limited. We aimed to determine the prevalence of depression and death anxiety among Palestinian hemodialysis patients and the evaluate the relationship between their sociodemographic and clinical characteristics during COVID-19 Pandemic.

A cross-sectional study was conducted using a convenience sampling technique. We recruited 308 hemodialysis patients from five hemodialysis units located in government hospitals in Palestine. Beck Depression Inventory and the Templers Death Anxiety Scale were used to collect data, which were then analyzed using SPSS version 20. Descriptive statistics (frequencies and means), t-test, ANOVA and multiple linear regression models were used for data analysis.

Nearly 66.2% of the sample had depression symptoms, 61.4% met the diagnostic threshold for depression, and 69.8% had death anxiety. Furthermore, the multivariate analysis revealed that having a female identity, residing in a city or refugee camp, and patients who reported not experiencing depression had a significant relationship with death anxiety, while having a higher educational level than 12 years, having one or more chronic co-morbidities, and patients who reported experiencing death anxiety had a significant correlation with depression.

Patients receiving hemodialysis frequently experience depression and death anxiety. These patients should receive a psychiatric evaluation in the early stages of their illness so that timely and appropriate psychological interventions can be given in hemodialysis facilities in Palestine during and after future pandemics.

The aim of this systematic review was to synthesise the impact of the COVID-19 pandemic on binge eating disorder (BED) the new onset and course. Inclusion criteria: original articles and BED diagnosis; and the main outcomes: relationships between the COVID-19 pandemic and the new onset/clinical changes in BED, and specific results for BED. Exclusion criteria: mixed/inaccurate diagnoses and articles not written in English. We searched four databases and one registry until 5 May 2023. The quality appraisal was conducted using the Effective Public Health Practice Project (EPHPP) tool. Twelve studies with 4326 participants were included. All studies were observational with nine cross-sectional and three longitudinal. Four of the included studies investigated new-onset BED, while eight examined the BED clinical course of patients with a previous diagnosis. With the exception of one study, the available literature indicates both an increase in BED diagnoses and a clinical worsening during COVID-19. Major limitations include study quality (weak-to-moderate) and high heterogeneity in terms of pandemic phase, population, geographical areas, and psychometric tools. Our findings indicate that BED patients are particularly vulnerable to events characterised by social distancing and over-worry, and should be, therefore, carefully monitored. Further studies are needed to corroborate our findings, implement preventive strategies, and promote personalised treatments. PROSPERO registration number: CRD42023434106.

The aim of this systematic review and meta-analysis was to examine the prevalence of feeding and eating disorder (FED) symptoms or dysfunctional eating behaviours (DEB) in the general population during the COVID-19 outbreak.

We searched eligible articles in biomedical databases from 1 January 2020 to 31 March 2022. Prevalence rates of FED or DEB changes between pre-pandemic and pandemic time and correlation with psychological distress were pooled with a meta-analysis using a random-effects model. Heterogeneity was tested using I-squared (I2) statistics. A total of 186 studies with 406,076 participants met the inclusion criteria.

The more prevalent FED or DEB during the COVID-19 outbreak were: body image concerns (52%, 95% CI 0.38, 0.66), binge eating (40%, 95% CI 0.25, 0.55), and overeating (40%, 95% CI = 0.32-0.48). Pooled data of longitudinal studies (k = 8) only showed a significant difference in the prevalence of weight gain from pre-pandemic to the pandemic time. Finally, increased levels of psychological distress (k = 35) positively correlated with some ED symptoms.

This meta-analysis evidenced a negative impact of the pandemic on eating symptoms and DEB in the general population.

The aim of the present study was to identify eaters profiles using the latest advantages of Machine Learning approach to cluster analysis.

A total of 317 participants completed an online-based survey including self-reported measures of body image dissatisfaction, bulimia, restraint, and intuitive eating. Analyses were conducted in two steps: (a) identifying an optimal number of clusters, and (b) validating the clustering model of eaters profile using a procedure inspired by the Causal Reasoning approach.

This study reveals a 7-cluster model of eaters profiles. The characteristics, needs, and strengths of each eater profile are discussed along with the presentation of a continuum of eaters profiles.

This conceptualization of eaters profiles could guide the direction of health education and treatment interventions targeting perceptual and eating dimensions.

COVID-19 is highly linked with hyperinflammation and dysfunction of the immune cells. Studies have shown that adequate nutrition, a modifiable factor affecting immunity and limiting systemic inflammation, may play an adjunct role in combating the negative consequences of SARS-CoV-2 infection. Due to the global lockdown conditions, the COVID-19 pandemic has contributed, among others, to restrictions on fresh food availability and changes in lifestyle and eating behaviors. The aim of this paper was to review the data regarding eating habits in European countries within the general population of adults and some specific subpopulations, including obese, diabetic, and psychiatric patients, during the COVID-19 pandemic. The PubMed database and the official websites of medical organizations and associations were searched for the phrases "COVID" and "eating habits". Papers regarding the pediatric population, non-European countries, presenting aggregated data from different countries worldwide, and reviews were excluded. During the COVID-19 pandemic, unhealthy lifestyles and eating behaviors were commonly reported. These included increased snacking, intake of caloric foods, such as sweets, pastries, and beverages, and a decline in physical activity. Data suggest that poor eating habits that create a positive energy balance have persisted over time as an additional post-COVID negative consequence.

The COVID-19 pandemic experience was different in each country (e.g., prevalence, societal restrictions). There is limited data on eating disorder (ED) diagnosis and service activity trends within Ireland. The aim of this study is to describe the ED referral and hospitalization trends during COVID-19 in Ireland.

Monthly data (2019-2021) from three regional community ED services (two-child and one-adult) were collected. National psychiatric and medical hospitalization data were analyzed. A descriptive and trend analysis was performed.

There was a trend of referrals to community ED services during the COVID-19 pandemic for children (p < .0001) and adults (p = .0019). Albeit the increase in child referrals was evident at an earlier point before adult referrals. There was a trend of a diagnosis for children and adults of anorexia nervosa (p < .0001; p = .0257) and other-specified-feeding-or-eating-disorder (OSFED) respectively (p = .0037; p = .0458). There was no trend in psychiatric co-morbidity. There was a trend of child (p = .0003) not adult (n = 0.1669) psychiatric hospitalization. There was a trend of medical hospitalization for child and adult combined (p < .0001).

This study adds to the growing literature on the association of the COVID-19 pandemic on ED trends and the need for future public health and service provision funding to be allocated for mental health services during periods of international crisis.

This study illustrates the referral and hospitalization trend in young persons and adults with an ED in Ireland during the COVID-19 pandemic. This study highlights that there was a trend of Anorexia Nervosa and OSFED presentations during the COVID-19 pandemic.

Eating disorders (EDs), fear of COVID-19, and insomnia have all increased during the COVID-19 pandemic in Western societies. Additionally, fear of COVID-19 and sleep disturbances relate to ED symptoms in Western societies. However, it is unknown whether fear of COVID-19 and insomnia relate to ED symptoms in non-Western countries, such as Iran. Thus, this study examined the relation between fear of COVID-19, insomnia, and ED symptoms among Iranian college students. Specifically, we hypothesized that insomnia and fear of COVID-19 would each uniquely relate to ED symptoms and the interaction between insomnia and fear of COVID-19 would also associate with increased ED symptoms.

College students (N =1,043) filled out measures assessing fear of COVID-19, insomnia, and ED symptoms. We ran moderation analyses using linear regression for global ED symptoms and negative binomial regressions for binge eating and purging.

Fear of COVID-19 and insomnia had unique effects on global ED symptoms and binge eating. Insomnia, but not fear of COVID-19, had a unique effect on purging. No significant interaction effect was found.

This study was the first to examine the association between fear of COVID-19 and insomnia on ED symptoms in Iran. Fear of COVID-19 and insomnia should be incorporated into novel assessments and treatments for EDs.

The coronavirus pandemic is considered the worst-hit that the world had witnessed in the current century. The impact of the pandemic, especially during the lockdown, was not only diverse but also worldwide. The African continent, including the Maghreb, was no exception. The aim of this study was to assess the levels of anxiety and eating behaviors and their correlations in three Maghrebian countries following the official outbreak of the COVID19 pandemic. It is a cross-sectional study of 754 participants from Tunisia, Algeria and Morocco. It took place between 30 April and 2 July 2020. The survey showed that eating disorders represented 45.9% of the sample while 26.8% (202 participants) matched the anxiety criteria. Statistical significant factors for eating disorders were gender (p = 0.002; OR = 1.760), underweight (p = 0.021; OR = 0.306), anxiety (p = 0.001; OR = 0.470), bulimia (p = 0.000; OR = 0.794) and body dissatisfaction (p = 0.000; OR = 0.920). This rise goes along with other surveys in different parts of the world. These results can be explained by multiple reasons such as the 'food insecurity' mechanism, the excessive feeling of boredom and loneliness resulting from social distancing and the overwhelming overthinking about the onset of a serious economic crisis.

The COVID-19 pandemic caused immediate and far-reaching disruption to society, the economy, and health-care services. We synthesised evidence on the effect of the pandemic on mental health and mental health care in high-income European countries. We included 177 longitudinal and repeated cross-sectional studies comparing prevalence or incidence of mental health problems, mental health symptom severity in people with pre-existing mental health conditions, or mental health service use before versus during the pandemic, or between different timepoints of the pandemic. We found that epidemiological studies reported higher prevalence of some mental health problems during the pandemic compared with before it, but that in most cases this increase reduced over time. Conversely, studies of health records showed reduced incidence of new diagnoses at the start of the pandemic, which further declined during 2020. Mental health service use also declined at the onset of the pandemic but increased later in 2020 and through 2021, although rates of use did not return to pre-pandemic levels for some services. We found mixed patterns of effects of the pandemic on mental health and social outcome for adults already living with mental health conditions.

The prevalence of psychiatric disorders has not shifted widely through the COVID pandemic, except for some specific groups such as young people or women. Our objective is to examine prospectively the evolution of children and adolescents who consulted in a psychiatric emergency service during the COVID-19 confinements.

We collected prospective clinical information about 296 young people under 18 who visited a tertiary hospital for psychiatric reasons during the confinement periods in Spain. Clinical diagnoses, suicide attempts, hospital admissions, and pharmacological prescriptions were extracted from electronic health records through 2020, 2021, and 2022. Features of those who maintained psychiatric care and those who did not were compared.

Three out of four children and adolescents who visited the psychiatric emergency department during the confinements continued psychiatric care at the end of 2022. Those who did not showed better premorbid adjustment at baseline. During follow-up, diagnoses of neurodevelopmental disorders and eating disorders, as well as the dosage of psychotropic drug prescriptions, increased. The diagnoses of major depressive disorder and eating disorder at baseline were associated with attempting suicide during follow-up. Patients with internalizing symptoms were admitted earlier than those with externalizing symptoms but no differences were found in terms of suicide attempts.

The continuity of psychiatric care after an initial emergency visit during the confinements implied greater clinical severity, as reflected by changes in clinical diagnoses and pharmacological regimens. Emergent symptoms of depression or eating disorders after social distancing or isolation could predict subsequent suicidal behavior in young populations.

This article emphasizes that patients presenting with COVID-19 infection especially presenting with predominantly gastrointestinal symptoms and a history of eating disorder or even other mental disorders should be evaluated thoroughly and differential diagnoses should be considered. Clinicians should keep in mind that eating disorders may happen after COVID infection or vaccination.

The emergence and global spread of the 2019 novel coronavirus (COVID-19) have caused a significant mental health burden on communities around the world. Factors related to COVID-19 affect mental health in the general community, but may have more adverse effects on individuals with pre-existing mental illnesses. Additionally with the new living conditions and increased focus on hand hygiene and fear of contracting COVID-19, depression, anxiety, and obsessive-compulsive disorder (OCD) are more likely to be exacerbated. Eating disorders such as anorexia nervosa (AN) have exhibited an alarming increase due to social pressure especially through social media. Also, many patients reported relapses since the commencement of the COVID-19 pandemic. We report five cases of AN that developed or exacerbated after COVID-19 infection. Four patients have newly developed (AN) and one case relapsed after COVID-19 infection. Also, one of the patient's symptoms exacerbated after remission following a COVID-19 vaccine shot. The patients were managed medical and non-medically. Three of cases have reported improvements while two other cases were lost because of poor compliance. It might be possible that people with history of eating disorder, or other mental disorders may be more susceptible to newly develop or exacerbate eating disorders after COVID-19 infection especially when symptoms are gastrointestinal dominant. There is currently minimal evidence on the specific risk of COVID-19 infection in patients with AN and reporting cases of AN after COVID-19 infection could help learn the risk, prevent and manage patients. Clinicians should keep in mind that eating disorders may happen after COVID infection or vaccination.

To identify patterns of psychiatric comorbidity among children and adolescents with a serious self-harm event.

We studied children aged 5 to 18 years hospitalized with a neuropsychiatric event at 2 children's hospitals from April 2016 to March 2020. We used Bayesian profile regression to identify distinct clinical profiles of risk for self-harm events from 32 covariates: age, sex, and 30 mental health diagnostic groups. Odds ratios (ORs) and 95% credible intervals (CIs) were calculated compared with a reference profile with the overall baseline risk of the cohort.

We included 1098 children hospitalized with a neuropsychiatric event (median age 14 years [interquartile range (IQR) 11-16]). Of these, 406 (37%) were diagnosed with a self-harm event. We identified 4 distinct profiles with varying risk for a self-harm diagnosis. The low-risk profile (median 0.035 [IQR 0.029-0.041]; OR 0.08, 95% CI 0.04-0.15) was composed primarily of children aged 5 to 9 years without a previous psychiatric diagnosis. The moderate-risk profile (median 0.30 [IQR 0.27-0.33]; reference profile) included psychiatric diagnoses without depressive disorders. Older female adolescents with a combination of anxiety, depression, substance, and trauma disorders characterized the high-risk profile (median 0.69 [IQR 0.67-0.70]; OR 5.09, 95% CI 3.11-8.38). Younger males with mood and developmental disorders represented the very high-risk profile (median 0.76 [IQR 0.73-0.79]; OR 7.21, 95% CI 3.69-15.20).

We describe 4 separate profiles of psychiatric comorbidity that can help identify children at elevated risk for a self-harm event and subsequent opportunities for intervention.

Eating disorders (EDs) are a non-heterogeneous group of illnesses with significant physical and mental comorbidity and mortality associated with maladaptive coping. With the exception of lisdexamfetamine (Vyvanse) for binge eating disorder, no medications have been effective for the core symptoms of ED. ED requires a multimodal approach. Complementary and integrative medicine (CIM) can be helpful as an adjunct. The most promising CIM interventions are traditional yoga, virtual reality, eye movement desensitization and reprocessing, Music Therapy, and biofeedback/neurofeedback.