The Psychological and Medical Landscape of Anorexia Nervosa over a Decade: A Retrospective Study of Possible Physical and Psychological Shifts

Abstract

In recent years, the definition, clinical characteristics, and psychological aspects of anorexia nervosa (AN) have undergone notable changes, influenced by various factors such as biology, psychology, and the environment. The COVID-19 pandemic is one such external factor that has been preliminarily identified as affecting the clinical presentation of AN. This study specifically aims to assess the alterations in psychological and medical features observed in individuals with AN during the pandemic. This study is a retrospective case review of 252 people diagnosed with AN from two different cohorts: 2010–2012 and 2021. A comparison of psychological and medical data was conducted to identify specific differences in the initial clinical evaluation. Additionally, different effects of the pandemic on age cohorts were assessed, with a focus on distinctions between adolescents and adults. Results revealed that the pandemic cohort had a higher number of new cases, with patients being younger and experiencing more severe psychological symptoms. Hospitalization rates upon first access were also elevated, but no significant differences in medical values were observed. Adolescents during the pandemic showed increased episodes of binge eating, decreased obsessive–compulsive symptoms, and greater difficulty in interoceptive awareness. This study reveals distinct differences in symptomatology among patients, with a particular focus on psychological characteristics such as impulsive behaviors and interoceptive awareness. These behavioral and interoceptive changes could have potential considerations in the treatment pathway. Further investigations are warranted to gain a deeper understanding of the evolving clinical presentation of anorexia nervosa after the pandemic.

The implications of the COVID-19 pandemic on eating disorder features and comorbid psychopathology among adolescents with anorexia nervosa and matched controls: a comparative cohort design study

“…Interestingly, peri-pandemic AN participants reported less severe general ED symptomatology, perceived less concerns about diet, body weight and body shape compared to pre-pandemic AN participants. This appears to be in contrast with previous literature with a comparable case–case study design which showed either an increase in binge eating episodes [ 30 ] a trend towards more food restraint [ 29 ], or no significant differences in ED symptoms [ 28 ] among adolescents with an ED peri-pandemic versus pre-pandemic. The observed discrepancy could be explained by differences between the respective populations, e.g., age, severity of illness, duration of illness, specific time period during the pandemic, or differences in COVID-19 regulations imposed by different governments in response to the pandemic.…”

“…In addition, the current study collected data during a more extensive period during the pandemic (March 2020–October 2021), while previous studies [ 28 , 29 ] collected data during a relatively short period during the pandemic (6–9 months). The study by Meneguzzo [ 30 ] conducted a study on a patient population that was relatively comparable to ours. However, their patient population had a slightly longer disease duration and their study was conducted in another country with different COVID-19-related restrictions at that specific time point.…”

“…Another retrospective chart-review study, found no differences in BMI, but found greater medical instability and higher hospitalization rates in the peri-pandemic AN cohort compared to the pre-pandemic AN cohort [ 29 ]. Meneguzzo et al [ 30 ] discovered that the peri-pandemic AN cohort had an increase in binge eating episodes, more difficulties with interoceptive awareness, and fewer obsessive–compulsive disorder (OCD) symptoms compared to the pre-pandemic AN cohort.…”

“…Our study addresses several knowledge gaps that may help to improve our understanding of the impact of the COVID-19 pandemic on illness severity and disease course among adolescents with first-onset clinical AN. First, previous work of Springall [ 27 ], Spettigue [ 29 ], and Meneguzzo [ 30 ] was based on a retrospective chart review in which data were not systematically collected, whereas our study extensively assessed AN participants at two timepoints (at baseline and after 1 year of follow-up) in multiple domains during face-to-face appointments using structured interviews. Second, we are the first study to examine the one-year clinical course of adolescent AN during the pandemic.…”

Effects of the COVID-19 pandemic on youth mental health: a cross-sectional study on eating disorder patients and their unaffected siblings

“…Recently, it has also been proposed to consider the COVID-19 pandemic as a collective trauma or psychotrauma due to the presence of globally shared emotional connections arising from the discrepancy between the threat and coping abilities [ 24 ]. However, these aspects are not definitive, even though the pandemic has shed light on the relevance of environmental factors in EDs [ 25 ].…”