Has COVID-19 Complicated Eating Disorder Treatment? An Examination of Comorbidities and Treatment Response Before and During the COVID-19 Pandemic

Brian Cook, PhD^a; Margherita Mascolo, MD^b; Garrett Bass, BA^a; Mary E. Duffy, MS^c; Brad Zehring, DO^b; Tammy Beasley, MS, RD^a

Prim Care Companion CNS Disord 2022;24(1):21m03087

ABSTRACT

Objective: Recent evidence suggests psychosocial stressors stemming from coronavirus disease 2019 (COVID-19) exposure and public health recommendations and policies have exacerbated eating disorder symptoms. Consequentially, eating disorder acuity has increased during the COVID-19 pandemic. Currently, it is still unclear how the COVID-19 pandemic may be impacting individuals receiving treatment for eating disorders at higher levels of care. The purpose of this study was to examine the impact of COVID-19 on eating disorder symptoms and associated outcomes in a sample of individuals receiving eating disorder treatment compared to individuals receiving treatment in 2019.

Methods: Blinded outcomes data from 272 adults who completed treatment at an eating disorder treatment center between April and October of 2019 (pre–COVID-19 group) and 2020 (COVID-19 group) were examined. Repeated measures analyses of variance with Bonferroni correction were used to examine differences in outcome variables and treatment response.

Results: Fewer participants reported trauma in 2020, but symptoms were more severe when present. A significant interaction effect for treatment (eg, admission, discharge) and year (eg, pre–COVID-19, COVID-19) was found for eating disorder and trauma symptoms. Moreover, trauma symptom scores were higher in 2020 than in 2019. The interaction among year, trauma, and treatment was significant (F_3,268 = 2.11, P = .027, η² = 0.034), indicating that individuals with severe trauma in 2020 reported less eating disorder symptom score reduction.

Conclusions: Results extend understanding of effects during the COVID-19 pandemic on treatment-seeking individuals with eating disorders. Clinical implications suggest that greater attention to trauma when screening eating disorder patients and selecting treatment approaches are needed, particularly during the COVID-19 pandemic.

Free Access: Please Log In

This content is completely free—but you need to be logged in to read the full article. If you already have an account, please log in below. Otherwise, register for free to unlock instant access.

References (31)

Holmes EA, O’Connor RC, Perry VH, et al. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry. 2020;7(6):547–560. PubMed CrossRef
Pierce M, McManus S, Hope H, et al. Mental health responses to the COVID-19 pandemic: a latent class trajectory analysis using longitudinal UK data. Lancet Psychiatry. 2021;8(7):610–619. PubMed CrossRef
Rajkumar RP. COVID-19 and mental health: a review of the existing literature. Asian J Psychiatr. 2020;52:102066. PubMed CrossRef
Schimmenti A, Billieux J, Starcevic V. The four horsemen of fear: an integrated model of understanding fear experiences during the COVID-19 pandemic. Clin Neuropsychol. 2020;17(2):41–45.
Schimmenti A, Starcevic V, Giardina A, et al. Multidimensional Assessment of COVID-19–Related Fears (MAC-RF): a theory-based instrument for the assessment of clinically relevant fears during pandemics. Front Psychiatry. 2020;11:748–748. PubMed CrossRef
Levinson CA, Williams BM. Eating disorder fear networks: identification of central eating disorder fears. Int J Eat Disord. 2020;53(12):1960–1973. PubMed CrossRef
Rodgers RF, Lombardo C, Cerolini S, et al. The impact of the COVID-19 pandemic on eating disorder risk and symptoms. Int J Eat Disord. 2020;53(7):1166–1170. PubMed CrossRef
Touyz S, Lacey H, Hay P. Eating disorders in the time of COVID-19. J Eat Disord. 2020;8(1):19. PubMed CrossRef
Shah M, Sachdeva M, Johnston H. Eating disorders in the age of COVID-19. Psychiatry Res. 2020;290:113122. PubMed CrossRef
Termorshuizen JD, Watson HJ, Thornton LM, et al. Early impact of COVID-19 on individuals with self-reported eating disorders: survey of ~1,000 individuals in the United States and the Netherlands. Int J Eat Disord. 2020;53(11):1780–1790. PubMed CrossRef
Janse van Rensburg M. COVID-19, the pandemic which may exemplify a need for harm-reduction approaches to eating disorders: a reflection from a person living with an eating disorder. J Eat Disord. 2020;8(1):26. PubMed CrossRef
Fernández-Aranda F, Casas M, Claes L, et al. COVID-19 and implications for eating disorders. Eur Eat Disord Rev. 2020;28(3):239–245. PubMed CrossRef
Phillipou A, Meyer D, Neill E, et al. Eating and exercise behaviors in eating disorders and the general population during the COVID-19 pandemic in Australia: initial results from the COLLATE project. Int J Eat Disord. 2020;53(7):1158–1165. PubMed CrossRef
Rogers AH, Wieman ST, Baker AW. Anxiety Comorbidities: Mood Disorders, Substance Use Disorders, and Chronic Medical Illness. In: Bui E, Charney M, Baker A, eds. Clinical Handbook of Anxiety Disorders. Current Clinical Psychiatry. Cham: Humana; 2020:77–77.
Suarez-Jimenez B, Albajes-Eizagirre A, Lazarov A, et al. Neural signatures of conditioning, extinction learning, and extinction recall in posttraumatic stress disorder: a meta-analysis of functional magnetic resonance imaging studies. Psychol Med. 2020;50(9):1442–1451. PubMed CrossRef
Castellini G, Cassioli E, Rossi E, et al. The impact of COVID-19 epidemic on eating disorders: a longitudinal observation of pre versus post psychopathological features in a sample of patients with eating disorders and a group of healthy controls. Int J Eat Disord. 2020;53(11):1855–1862. PubMed CrossRef
Rijkers C, Schoorl M, van Hoeken D, et al. Eating disorders and posttraumatic stress disorder. Curr Opin Psychiatry. 2019;32(6):510–517. PubMed CrossRef
Vitagliano JA, Jhe G, Milliren CE, et al. COVID-19 and eating disorder and mental health concerns in patients with eating disorders. J Eat Disord. 2021;9(1):80. PubMed CrossRef
Liang CS, Chung CH, Tsai CK, et al. Seasonality of hospital admissions and birth dates among inpatients with eating disorders: a nationwide population-based retrospective study. Eat Weight Disord. 2018;23(2):233–240. PubMed CrossRef
Fairburn CG, Beglin SJ. Eating Disorder Examination Questionnaire (6.0). In: Fairburn CG, ed. Cognitive Behavior Therapy and Eating Disorders. New York: Guilford Press; 2008: 309–313.
Spielberger CD. Manual for the State-Trait Anxiety Inventory (STAI). Palo Alto, CA: Consulting Psychologists Press; 1983.
Blevins CA, Weathers FW, Davis MT, et al. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J Trauma Stress. 2015;28(6):489–498. PubMed CrossRef
Victor SE, Klonsky ED. Validation of a Brief Version of the Difficulties in Emotion Regulation Scale (DERS-18) in five samples. J Psychopathol Behav Assess. 2016;38(4):582–589. CrossRef
Taranis L, Touyz S, Meyer C. Disordered eating and exercise: development and preliminary validation of the Compulsive Exercise Test (CET). Eur Eat Disord Rev. 2011;19(3):256–268. PubMed CrossRef
Brewerton TD, Brady K. The Role of Stress, Trauma, and PTSD in the Etiology and Treatment of Eating Disorders, Addictions, and Substance Use Disorders. In: Brewerton T, Baker Dennis A, eds. Eating Disorders, Addictions and Substance Use Disorders. Berlin, Heidelberg: Springer; 2014: 379–404.
Brown TA, Berner LA, Jones MD, et al. Psychometric evaluation and norms for the Multidimensional Assessment of Interoceptive Awareness (MAIA) in a clinical eating disorders sample. Eur Eat Disord Rev. 2017;25(5):411–416. PubMed CrossRef
Brown TA, Vanzhula IA, Reilly EE, et al. Body mistrust bridges interoceptive awareness and eating disorder symptoms. J Abnorm Psychol. 2020;129(5):445–456. PubMed CrossRef
Thapliyal P, Mitchison D, Mond J, et al. Gender and help-seeking for an eating disorder: findings from a general population sample. Eat Weight Disord. 2020;25(1):215–220. PubMed CrossRef
Peckmezian T, Paxton SJ. A systematic review of outcomes following residential treatment for eating disorders. Eur Eat Disord Rev. 2020;28(3):246–259. PubMed CrossRef
Roaten K, Johnson C, Genzel R, et al. Development and implementation of a universal suicide risk screening program in a safety-net hospital system. Jt Comm J Qual Patient Saf. 2018;44(1):4–11. PubMed CrossRef
Brewerton TD. Eating Disorders, Victimization and Comorbidity: Principles of Treatment. In: Brewerton TD, ed. Clinical Handbook of Eating Disorders: An Integrated Approach. New York: Marcel Dekker, Inc; 2004:509–545.