Online adaptation of a compassion-focused intervention to treat comorbid eating disorders and posttraumatic stress disorder during the COVID-19 pandemic

Aims: To provide psychological support for individuals recovering from comorbid eating disorders (EDs) and posttraumatic stress disorder (PTSD) during the COVID-19 pandemic, we adapted a 10-session compassion-focused group-based intervention for delivery online using video conferencing technology. This study describes how the group content and resources were adapted and synthesizes qualitative feedback from participants and facilitators. Method(s): Content and format were modified and a new website to host supporting material was developed. Clear guidelines regarding recruitment and acceptance into the group, boundaries within the group, and risk management were implemented. Structured qualitative interviews regarding participants' online group experiences were conducted with 17 women following the group completion. Result(s): In-depth communication concerning group expectations and activities was important during assessment to ensure the intervention was well-suited to prospective participants. Consistent implementation of group guidelines by facilitators was critical in maintaining a safe online environment. Participants indicated online delivery increased logistical accessibility, as many reported they would have been unable to attend otherwise (e.g., time, geographical location), and reduced fear of judgement and anxiety about in-person attendance. Favourable online adaptations reported by participants included inclusion of all group members, opportunities to share in smaller groups/pairs and online resources. Conclusion(s): Delivery of group-based compassion-focused interventions for individuals with comorbid EDs and PTSD are appropriate for overcoming barriers that may otherwise prevent participation. Online resources could potentially increase intervention uptake among individuals in the early stages of recovery from these disorders.

Complementary and Integrative Medicine and Eating Disorders in Youth: Traditional Yoga, Virtual Reality, Light Therapy, Neurofeedback, Acupuncture, Energy Psychology Techniques, Art Therapies, and Spirituality.

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.

Network analysis of eating disorder and depression symptoms among university students in the late stage of COVID-19 pandemic in China.

Background: Eating disorders (EDs) and depression are common in university students, especially during the COVID-19 pandemic. The aim of this study was to elucidate characteristics of EDs and depression symptoms networks among Chinese university students in the later stage of the COVID-19 pandemic in China. Methods: A total of 929 university students completed the SCOFF questionnaire measuring EDs and Patient Health Questionnaire with 9 items (PHQ-9) measuring depression in Guangzhou, China. The network model was applied to identify central symptoms, bridge symptoms, and important connections between SCOFF and PHQ-9 using R studio. The subgroup analyses of both genders in medical and non-medical students were further explored. Results: In the networks of the whole sample, central symptoms included "Loss of control over eating" (EDs) and "Appetite changes" (depression). The bridge connections were between "Loss of control over eating" (EDs) and "Appetite changes" (depression), between "Deliberate vomiting" (EDs) and "Thoughts of death" (depression). "Appetite changes" (depression) and "Feeling of worthlessness" (depression) were central symptoms in both subgroups of medical and non-medical students. "Fatigue" (depression) was the central symptom in the female and medical students group. The edge between "Loss of control over eating" (EDs) and "Appetite changes" (depression) acted as a bridge in all subgroups. Conclusion: Social network approaches offered promising ways of further understanding the association between EDs and depression among university students during the pandemic of COVID-19 in China. Investigations targeting central and bridge symptoms would help to develop effective treatments for both EDs and depression for this population.

Eating disorder symptoms among children and adolescents in Germany before and after the onset of the COVID-19 pandemic.

Background: Disordered eating is highly prevalent among children and adolescents. Since the outbreak of the COVID-19 pandemic, hospitalizations due to eating disorders have peaked and overweight has risen. The aim of this study was to determine differences in the prevalence of eating disorder symptoms among children and adolescents in Germany before and after the onset of the COVID-19 pandemic and to identify associated factors. Materials and methods: Eating disorder symptoms and associated factors were examined in a sample of n = 1,001 participants of the nationwide population-based COPSY study in autumn 2021. Standardized and validated instruments were used to survey 11-17-year-olds along with a respective parent. To identify differences in prevalence rates, logistic regression was used to compare results with data from n = 997 participants of the prepandemic BELLA study. Multiple logistic regression analyses were performed to examine associations with relevant factors in the pandemic COPSY sample. Results: Eating disorder symptoms were reported by 17.18% of females and 15.08% of males in the COPSY study. Prevalence rates were lower overall in the COPSY sample compared to before the pandemic. Male gender, anxiety, and depressive symptoms were associated with increased odds for eating disorder symptoms in the pandemic. Conclusion: The pandemic underscores the importance of further research, but also prevention and intervention programs that address disordered eating in children and adolescents, with a focus on age - and gender-specific differences and developments. In addition, screening instruments for eating disorder symptoms in youths need to be adapted and validated.

Eating disorders and anxiety in students during the COVID-19 pandemic: A cross-sectional study

Introduction: Due to the 2019 coronavirus (COVID-19) pandemic, worldwide daily life has profoundly disrupted, with profound negative effects on physical and mental health, pri-marily in the student population. Objetive: To determine the prevalence of eating disorder (ED) risk and anxiety levels in college students during the COVID-19 pandemic. Additionally, to explore the association of ED and anxiety with gender, age, semester, and educa-tional program variables. Materials and methods: A descriptive cross-sectional correlational study was conducted in a non-probabilistic con-venience sample of 572 students from a university in north-western Mexico, with prior informed consent. An online ques-tionnaire was designed using the Google Forms platform that included four identification questions, the Eating Attitudes Test 26 (EAT-26) instrument and the BAI Anxiety Inventory. Descriptive statistics, Chi-square test were calculated to ex-plore the association between categorical variables and Odds Ratio (OR) and confidence interval were calculated by logistic regression considering as dependent variables risk of ED and presence of anxiety in the models. Results: Given the cut-off point of 20 for the EAT-26, 20.1% of students were found to be at risk of developing ED. The risk was significantly higher in females (22.4%) compared to males (14.7%) (chi 2(1) = 4.39;p < .001, Phi =-0.088). Moderate level of anxiety predominated in 32.2% of students and severe in 24.3%. The risk of ED may increase up to four times more if anxiety symptoms are present (OR = 2.179;95%CI: 1.20, 3.97). Conclusions: A significant portion of respondents pre-sented risky eating behaviors associated in the levels of anx-iety displayed during the pandemic.

Fear of COVID-19, insomnia, and eating disorder symptoms among Iranian college students.

Objective: 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. Method: 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. Results: 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. Discussion: 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.

Locked down with my eating disorder: a retrospective study on the impact of COVID-19 lockdown on adolescents with eating disorders.

BACKGROUND: Negative effects of COVID-19 lockdowns have been reported in adult patients with feeding and eating disorders (FED) whereas evidence of its impact on young clinical populations is still limited and somewhat inconsistent. The present study aims to investigate the effect of the first COVID-19 lockdown on a range of FED symptoms in children and adolescents: (a) already receiving treatment in our specialist service for FED when the pandemic hit, and (b) prospectively evaluated in our service from October 2020 to July 2021. METHODS: Out of sixty-one eligible patients with a broad spectrum of FED invited, forty-five young patients (aged 11-18) consented to participate and were included. An ad-hoc survey, consisting of open questions, multiple choice questions, yes/no questions, and a symptoms checklist, was administered online. RESULTS: About half of the participants (46.7%) reported a positive effect of lockdown on FED symptomatology. Patients with anorexia nervosa (AN) reported the highest rate of symptomatology worsening (58.6%). Younger patients (11-13 years) showed a greater improvement of symptoms compared to older ones (14-18 years of age). COVID-19 lockdown was identified as the precipitating factor for FED onset in 60.7% of newly evaluated patients. CONCLUSIONS: Evidence from our investigation points out that although the COVID-19 pandemic was a precipitating factor for a FED for many active and newly referred patients, it had a positive impact on youth who were already in treatment and younger participants.

The experiences of individuals with body positive online social media content during recovery from disordered eating

Disordered eating behaviors and experiences of body image disturbance continue to affect individuals in Westernized society. The widespread use of social media that has increased since the COVID-19 pandemic presents a platform where body image and eating concerns are constantly discussed. Body positive social media content exists as media where individuals often explore themes of positive body image, society's influence on personal beliefs, and eating behaviors. Understanding the implications of body positive social media use during the disordered eating recovery process is important for counselors and individuals to increase positive behaviors. This study explored the experiences of individuals in recovery from disordered eating with body positive social media content on platforms such as InstagramTM and TikTokTM. A total of six participants were interviewed for this hermeneutic phenomenological qualitative study. This study resulted in the identification of five themes and 11 subthemes. The themes and corresponding subthemes identified were as follows: social media as a safe space to explore recovery (subthemes-(a) understanding the personal nature of recovery, (b) education on recovery), representation (subthemes-(a) everyday representation, (b) normalizing), intentionality in social media use (subthemes-(a) curating your feed, (b) social media for reinforcement), two sides of the same coin (subthemes-(a) negativity in "positive" spaces, (b) authentic BoPo vs. co-opted BoPo, (c) comparisons), and community (subthemes-(a) connection, (b) seeking support not found elsewhere). This study helped to identify what aspects of body positive social media use are both supportive and unhelpful during the recovery process for disordered eating behaviors. Implications for future research include exploring what factors contribute to positive and negative experiences of body positive social media use during recovery from disordered eating and analyzing the relationship between protective factors such as support systems, family experiences with disordered eating and dieting, and disordered eating history in relation to the efficacy of body positive social media content. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

HSE National Clinical Programme for Eating Disorders in Ireland: COVID-19 pandemic and eating disorder care in a new national eating disorder service.

BACKGROUND: 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. METHOD: 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. RESULTS: 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). CONCLUSION: 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. PUBLIC SIGNIFICANCE: 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.

Associations between gender identity, eating disorder psychopathology, and food insecurity among Canadian adolescents and young adults during the COVID-19 pandemic.

There is a clear association between food insecurity and eating disorder (ED) psychopathology, mainly among samples in the United States and prior to the COVID-19 pandemic. However, Canadians experience food insecurity as well, which may have been heightened by the pandemic and its associated restrictions. The associations between food insecurity and ED psychopathology among Canadians remains underexamined. Therefore, the purpose of this study was to explore associations between food insecurity and ED psychopathology by gender identity among a national sample Canadian adolescents and young adults. Data were collected from 2714 participants aged 16 to 30 years old from across Canada. Participants reported sociodemographic characteristics, ED psychopathology, and food insecurity experienced during the COVID-19 pandemic through an online survey. Descriptive statistics, chi-square tests, ANOVAs, and regression analyses were conducted. Overall, 8.9% of the sample experienced food insecurity, with the highest prevalence among transgender and gender nonconforming individuals. Generally, those with no food insecurity reported the lowest ED psychopathology compared to higher ED psychopathology among those with food insecurity. Several unique differences were observed between cisgender men and cisgender women, while there were no significant associations between food insecurity and ED psychopathology found among transgender and gender nonconforming individuals. Further research is needed to investigate how the relationship between food insecurity and ED psychopathology differs based on gender, and to continue to explore food insecurity experienced beyond the COVID-19 pandemic as food insecurity possesses a considerable health threat to all.

Community Women's Lifestyle and Eating Disorders in the Era of COVID-19 Pandemic: A 15-Year Follow-Up Study.

Most studies suggest that COVID-19 has adversely affected the quality of life and mental health, including eating disorders. However, studies have yet to examine longitudinally the impact of COVID-19 on eating disorder symptomatic individuals. This study aims to examine longitudinally the impact of the COVID-19 pandemic on the lifestyle and eating disorder symptoms of a symptomatic group of community-dwelling women. These women (n = 171) were enrolled in a longitudinal study, completed a COVID-19 modular self-report (post or Qualtrics, 2020/21), and participated in the current study. This study examined a 15th year follow-up. In 2020, 40% were tested for COVID-19. Of these, 87% had negative results; 5.3% self-isolated at home; 20.5% stopped working/studying in person; 28% continued online work/study; and 28% stopped work/studying in person. The pandemic affected sporting activities, music, and club activities (32.7% discontinued); 38% socialized in person; 16% socialized online; and 10% completely stopped socializing. Findings showed that the respondents showed no significant changes in levels of psychological distress (K10: 21.4 ± 9.8 vs. 19.0 ± 7.1, p < 0.171), and impaired quality of life (SF12: 50.9 ± 8.0 vs. 48.3 ± 9.5, p < 0.055) at 15-year follow-up. Eating disorder symptoms increased over time (EDE-Q global: 2.1 ± 1.4 vs. 2.9 ± 1.4, p < 0.013). Observed worsening of eating disorder-related symptoms during the COVID-19 pandemic may be due to interrupted eating patterns, exercise restrictions and the absence of social support. Provision and access to interventions to support those affected by eating disorders are a high priority, especially during these times.

Gender differences in individuals with obesity and binge eating disorder: A retrospective comparison of phenotypical features and treatment outcomes.

OBJECTIVE: Phenotypical comparisons between individuals with obesity without binge eating disorder (OB) and individuals with obesity and comorbid binge eating disorder (OB + BED) are subject to ongoing investigations. At the same time, gender-related differences have rarely been explored, raising the question whether men and women with OB and OB + BED may require differently tailored treatments. METHOD: We retrospectively compared pre- versus post-treatment data in a matched sample of n = 180 men and n = 180 women with OB or OB + BED who received inpatient treatment. RESULTS: We found that men displayed higher weight loss than women independent of diagnostic group. In addition, men with OB + BED showed higher weight loss than men with OB after 7 weeks of treatment. CONCLUSIONS: The present findings add to an emerging yet overall still sparse body of studies comparing phenotypical features and treatment outcomes in men and women with OB and OB + BED; implications for further research are discussed. CLINICAL TRIAL REGISTRATION: The study was prospectively registered with the German Clinical Trial Register as part of application DRKS00028441.

Virtual Schooling and Pediatric Mental Health During the COVID-19 Pandemic

Introduction: The first six months of the COVID-19 pandemic saw a nearly 50% increase in pediatric mental health emergencies. Specific factors contributing to this rise remain poorly characterized. One frequently cited contributor is pandemic-related interruptions of in-person schooling. Early studies indicate that students have experienced significantly greater psychological distress during such disruptions. We set out to investigate what correlation, if any, exists between school modality (ranging from exclusively virtual to exclusively in-person) and pediatric mental health status. Method(s): This is a retrospective, descriptive study combining patient chart review and parental telephone survey, exploring the prevalence and severity of mental illness among inpatients at a single urban, academic, midwestern tertiary care center. The study population included all patients ages 6-18 admitted to the study site during the 2015-19 and 2020- 21 school years who received Psychiatry and/or Psychology consults and/or were admitted to the inpatient psychiatry unit. Parents/guardians of participants from 2020-21 were surveyed regarding their child' educational experiences. We describe and compare participants between school years prior to and during the pandemic using descriptive demographic data and clinical data highlighting monthly admission rates and proxies for illness severity. We then assess for any correlation between these measures and recent virtual schooling. Result(s): Total mental health-related admissions rose from an average of 1070 during pre-pandemic school years to 1111 in 2020-21. Patients admitted in 2020-21 were more likely to be female, non-white, and from ZIP codes with higher median income. Primary diagnosis was more likely to be a mood or eating disorder. Patients were less likely to present primarily for suicidal ideation or self-harm. Proxies of illness severity, including utilization of PRN antipsychotics/benzodiazepines and readmission rates, rose in 2020-21. 255 of 800 (31.9%) families responded to the telephone survey. Respondents were more likely to have a child who was female and slightly younger compared to non-respondents. 98% of respondents reported some virtual schooling for their child, with 77% reporting virtual schooling for the majority of the three months prior to their child' first hospital admission. 61% indicated their child was exclusively in virtual school. No significant relationships were observed between virtual schooling and any outcome measures relating to mental health. Conclusion(s): Pediatric mental health emergencies and hospitalizations have grown and evolved since the start of the COVID-19 pandemic. This study characterizes some of the changes in patient demographics and experience with virtual schooling prior to and following the pandemic. Our results do not support any correlation between virtual schooling and mental illness requiring emergent care or hospitalization. However, this study has many significant limitations. Respondents were not representative of all admitted patients, and survey data were gathered for only one-third of families whose children were admitted at one site. Very few respondents remained in school in person throughout the pandemic, complicating efforts to make meaningful comparisons. Future work should attempt to capture a broader subject pool and obtain prospective data regarding the effects of school modality on mental health.

Dietary habit, physical activity and perceived barriers during movement control order among undergraduate students in Puncak Alam, Selangor

The emergence of COVID-19 had affected people in terms of their physical activity and nutritional changes which may increase the risk of various non-communicable diseases (NCD) among them. This study aimed to identify the physical activity level, nutritional changes, and perceived barriers to engage physical activity among students of UiTM Selangor, Puncak Alam Campus during the Movement Control Order (MCO) in Malaysia. A total of 234 students aged 18-24 years old were chosen to participate in this study by using convenience sampling. The International Physical Activity Questionnaire (IPAQ), Physical Activity Resource Assessment (PARA), and adapted questionnaire from the Ministry of Health (MOH) Malaysia were used in this study. Findings reveal that students were able to engage in physical activity level during the pandemic period which required them to be quarantined. Moreover, there was an increase in the frequency of healthy eating behaviour as well as unhealthy eating behaviour during MCO.Copyright © 2023 The Authors.

Effects of Covid-19 Pandemic on Dysfunctional Eating Behaviors and Symptoms among the General Population: A Systematic Review and Meta-Analysis

Introduction: The coronavirus outbreak has been publicly and formally defined a global pandemic by the World Health Organization on March 11th 2020. Some extreme but effective safety measures have been applied in order to limit the spread of the infection among the population. The price of COVID-19 restrictive measures and lockdowns has been especially heavy for individual's mental health. There is previous evidence that the COVID-19-related lockdown has impacted on mental health worsening among individuals with Feeding and Eating Disorders (EDs) and clinical obesity. Potential affecting aspects might have been restriction to daily activities and movements, excessive exposure to harmful eating patterns on social media, emotional distress, fear of contagion, and low access to treatment and care. Nevertheless, especially on the basis of the proven-detrimental impact of the COVID-19 lockdown on in- dividuals with clinical eating disorders, home confinement might analogously have had a negative impact also on the eating behaviors of individuals from the general population. The aim of this systematic review and meta-analysis is to investigate the impact of the COVID-19 pandemic on the prevalence of EDs symptoms and dysfunctional eating behaviours (i.e. emotional overeating, night eating, snacking, binge eating, undereating, food avoidance) among the general population. Method(s): We searched eligible articles in Medline, Embase, PsycInfo, Scopus, and Web of Science. Prevalence rates were pooled with meta-analysis using a random-effects model. Heterogeneity was tested using I-squared (I2) statistics. A total of 221 studies met the inclusion criteria. Result(s): The pooled prevalence of increased body weight was 33% (95% CI 30-35) among individuals in 84 studies. Forty-five percent (95% CI 31-59) of participants in 10 studies experienced body shape concern, body dissatisfaction and body misperception. Other EDs symptoms increased in the general population during the pandemic, such as overeating (41%;95% CI 33-48), food cravings (36%;95% CI 12- 59), binge eating (35%;95% CI 20-51), emotional eating (28%;95% CI 23-33) and snacking (27%;95% CI 23-32). Food restriction, excessive physical activity, weight loss and night eating were also common. Pooled data of longitudinal studies showed a significant difference in BMI and dysfunctional eating behaviours before and during the pandemic. Conclusion(s): This meta-analysis evidenced a negative impact of the pandemic on eating behaviors among the general population. Overall, these results highlight the need for further high-quality longitudinal studies that examine which specific populations experienced higher distress than others, and what are the long-term negative consequences of COVID-19.

Skills Training in Affective and Interpersonal Regulation Narrative Therapy Delivered via Synchronous Telehealth: A Case Study of a Rural Woman Veteran With Complex Posttraumatic Stress Disorder

The International Classification of Diseases-11 th Revision (ICD-11) includes the diagnosis of complex posttraumatic stress disorder (CPTSD). Clinical practice guidelines support the use of phased care for individuals with CPTSD. This case study illustrates the use of synchronous telehealth to deliver phased treatment to a rural woman veteran with CPTSD. Mrs. A experienced sexual, physical, and emotional abuse throughout her life, perpetrated by family members, intimate partners, and military authority figures. She sought treatment for posttraumatic nightmares and body image issues;she also had pain related to fibromyalgia and chronic migraine headaches. Mrs. A participated in 19 sessions of Skills Training in Affective and Interpersonal Regulation (STAIR) Narrative therapy via synchronous telehealth. Trauma and eating disorder symptoms were assessed before and after treatment and the patient demonstrated clinically significant improvement on measures of these disorders. Patient-provider working alliance and quality of life were assessed post-treatment. Synchronous telehealth use drastically increased with the onset of COVID-19;however, little information on treating CPTSD via synchronous video teleconferencing is available. This case study illustrates an evidence-based, phased therapy for CPTSD while highlighting the feasibility and value of in-home delivery of psychotherapy for CPTSD via synchronous telehealth.Copyright © The Author(s) 2023.

Psychopathological Symptoms and Mentalizing Capabilities in Adolescents with Anorexia Nervosa before and during Covid-19 Pandemic

Introduction: The COVID 19 pandemic, associated with confinement and social isolation, seems to have impacted the course of many mental disorders in children and adolescents. Specifically, it has created a global context likely to increase eating disorders' (Eds') risk and symptoms and to decrease factors that protect against EDs. Previous studies have highlighted a link between mentalizing deficits and clinical problems. This study aims to compare Covid-Period vs. NON-Covid Period adolescent patients affected by Anorexia Nervosa (AN) considering their psychopathological symptoms and their mentalizing capabilities. Method(s): 206 female adolescents (aged between 12 and 17 years) affected by AN were recruited from the Service for Eating Disorders at S. Gerardo Hospital in Monza. Exclusion criteria were the presence of intellectual disabilities and neurological disorders. The first group of 94 subjects was recruited between September 2018 and February 2020 (NON-Covid Period), and the second group of 112 individuals was recruited between August 2020 and May 2022 (Covid Period). The following instruments were administrated: EDI-3 (Eating Disorders Inventory-3) was used to provide a standardized clinical evaluation of symptomatology associated with eating disorders;SCL-90R (Symptom Checklist 90- Revised) was used to assess psychological problems and psychopathological symptoms;Reflective Functioning Questionnaire (RFQ) was used to assess mentalizing skills, considering that Reflective functioning (RF) is the operationalization of the mental processes underlying the capacity to mentalize. Result(s): A preliminary analysis of data showed worse values in primary and composites scales of EDI-3, higher levels of general psychopathological suffering (SCL-90 composite scales) and more marked levels of hypo-mentalization (RFQ-u) in the Covid-Period subjects: the differences were statistically significant. Conclusion(s): Although these results are still preliminary, it is possible to hypothesize a correlation between marked levels of hypo-mentalization and higher rates of psychopathological suffering and a worse clinical pattern of Anorexia Nervosa. It is also possible to hypothesize that a preventive intervention to strengthen the reflexive functions may result protective factor against the onset of more severe clinical manifestations and comorbidities;mentalizing abilities could be an important target for therapeutic interventions. Further research should be conducted on larger samples and with a new assessment after treatment interventions.

A Case of Eating Disorder Diagnosed As Orthorexia Nervosa.

A 13-year-old girl presented to our hospital with chief complaints of rapid weight loss, fatigue, discomfort, chills in the extremities, and alopecia. We initially suspected anorexia nervosa (AN). However, she did not express fear of gaining weight or have a distorted perception of her weight or body shape; thus, her presentation was not typical of AN. We also suspected avoidant/restrictive food intake disorder (ARFID), but she did not exhibit any food-avoidance behaviors. However, she was obsessed with nutrition control, so we diagnosed her with orthorexia nervosa (ON). She was hospitalized, given education on proper nutrition, and her eating behavior subsequently improved. After discharge, we administered the ORTO-15, which assesses the propensity for ON, and her score met the diagnostic criteria for ON. The incidence of ON has increased during the COVID-19 pandemic. In this case, her obsession was brought about by information she read in magazines and on social media that promoted an unbalanced diet centered almost exclusively on vegetables. Pediatricians should raise awareness of misinformation regarding children's health to ensure healthy growth.