Incidence of Eating Disorders During COVID-19: A Retrospective Review

Background The COVID-19 pandemic has had marked effects on mental health, including in pediatric populations. Pediatric patients have faced mental health concerns at increased rates including anxiety and depression. Furthermore, patients with eating disorders represent a vulnerable group who have been negatively impacted as well, as a result of lack of support, loss of in-person follow-up and increased relapse. In our centre, and nationally, clinicians have noted a trend towards increased eating disorder referrals and increased hospitalizations during the pandemic. Objectives The objective of this study was to determine the incidence, severity and triggers for eating disorders in the adolescent population during the COVID-19 pandemic and how it compares to the year prior. As well, the subset of patients who were hospitalized for medical stabilization were further analyzed to determine severity of illness. Design/Methods A retrospective chart review compared the first year of the COVID-19 pandemic (March 2020-March 2021), to the previous 12 months. Inclusion criteria included referrals to an eating disorder clinic and inpatient admissions to pediatrics or mental health services during the specified time frame. Data collected included age of onset, triggers, comorbid mental health conditions, and weight measures. Among hospitalized patients, orthostatic vital changes, need for NG feeds, length of medical stabilization and length of mental health hospitalization were included. Results Overall, 76 patients were included in the study. 44 (57.9%) were referred after COVID, which was significantly increased from the prior year (p=0.05). On average, patients presented at a younger age (14.2 ± 2.3 vs. 14.9 ± 1.9;p=0.08). Pre-COVID, approximately 44% of referrals were from family physicians and 19% from pediatrics. During COVID, approximately 39% were from family doctors and 25% from pediatricians. There was an increase in the number of patients requiring hospitalization for treatment (16 vs. 3), with 50% of the post-COVID admissions being direct from the ED Clinic on initial assessment. The reason for hospitalization was unstable vitals/ bradycardia in 68.7% of admissions;self-harm comprised the majority of the other admissions. Conclusion Our results support national and international reports that eating disorder incidence has increased during COVID-19. Patients described loss of routine, anxiety, and isolation as triggers related to the pandemic. Disruptions to daily life including school, sports, recreation, and relationships had profound effects on the mental health of children. The effect of social media on body image has also contributed. It is important for clinicians to screen for mental health conditions, including eating disorders at all available opportunities. Furthermore, this study demonstrates the need for increased services at our centre. Limitations for this study include that it is a single-centre study with a relatively small patient population. As well, it does not capture patients who may have been referred only to psychiatry.

Healthy Body as a Normative Model in the Perceptions of Student Youth

Introduction. The relevance of the study is due to the need to analyse the ideas of norma- tive body image in the minds of students in the context of current social changes, including those related to the consequences of the Coronavirus pandemic, as well as updating ideas about the properties and characteristics of the body, its ability to function effectively in modern conditions.Aim. The article aimed to analyse students' ideas about the normative body and to determine its model that is relevant in modern reality.Methodology and research methods. The theoretical and methodological basis of the article is a com- plex of sociological concepts of the body and corporality. An online survey method was used to collect empirical data. The sample consisted of 380 students living in large cities of the Sverdlovsk Region: Ekaterinburg, Nizhny Tagil and Kamensk-Uralsky. The results obtained were processed using the SPSS statistical data processing software. In order to deepen the data obtained, projective methods were ap- plied - the method of an unfinished sentence and the drawing method.Results and scientific novelty. The survey materials showed that students' ideas about the normative body correspond to traditional body stereotypes: attractiveness and beauty are attributed to the female body, and working capacity and endurance are attributed to the male body. However, when using projec- tive methods, the rhetoric of corporality shifted into the normative model of a healthy body. The analysis of body care practices indicates the presence of a core, including physical activity and balanced nutrition, which students use to achieve a healthy body as a body that is aesthetically attractive and functionally hardy. Highly appreciating satisfaction with their body, the younger generation strives for a normative model of a healthy body, which gives a sense of comfort to its wearer and allows the realisation of a wide range of needs and interests. In the post-pandemic context, students more often, compared to the pre-pandemic situation, began to include personal hygiene, mental health care, and physical activity in their daily practices.Practical significance. Empirical data contribute to the understanding of students' ideas about the normative body, the motives for its construction and care for it, and can also serve as the basis for the development of recommendations and programmes for the formation of students' culture of a healthy body in terms of physical and mental characteristics.

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.

Preparing for the next pandemic by understanding the impact of COVID-19 mitigation measures on patients with eating Disorders: observations from an inpatient setting.

OBJECTIVE: The COVID-19 pandemic overwhelmed eating disorder (ED) services worldwide. Data suggests a worsening of psychopathology and an increased request for specialised treatments. Still, the studies are mostly based on experimental protocols with underpowered short-term opportunistic experimental designs. Thus, this study aims to assess the clinical and psychological differences between patients admitted to a specialised ED Unit before and after the COVID-19 breakout. METHODS: Consecutive patients admitted from June 2014 to February 2022 in a specialised EDs Unit were enrolled. A total sample of 498 individuals was enrolled in this retrospective study, collecting demographic and psychopathological data at admission. RESULTS: An increase in the admission of patients with anorexia nervosa has been reported, with lower age and higher levels of specific and general psychopathology, especially linked to body uneasiness. CONCLUSIONS: Results are put into the context of the preparation for the next pandemic that may require similar mitigation measures as COVID-19 to ensure the impact on existing and new patients. Covering an extended period with validated tools, our results might help psychiatric services to reassess their treatment pathways after the pandemic, helping clinicians to delineate future treatment interventions.KEYPOINTSAfter the COVID-19 breakdown, there was an increase in the admission of patients with anorexia nervosa to specialised services.More severe psychopathology was not accompanied by lower body mass index.Specialised eating disorders services should face sudden changes in patients' requests for treatment.Understanding the impact of the Covid-19 pandemic and the resulting mitigation measures taken can lead to better preparations for the next pandemic.

Medical morbidity and risk of general hospital admission associated with concurrent anorexia nervosa and COVID-19: An observational study.

OBJECTIVE: Investigate medical morbidity and risk of general hospital admission for patients with concurrent coronavirus disease 2019 (COVID-19) and anorexia nervosa (AN) who have not received severe acute respiratory syndrome coronavirus 2 vaccination. METHODS: United Kingdom eating disorders clinicians contributed to a database of patients with an eating disorder and COVID-19. We used this to investigate demography, symptoms, hospitalization, treatment, and outcomes for those with AN. RESULTS: We describe data for 49 patients (median age 21.5 years [interquartile range 17.0-33.5], 46 female) including 36 adults and 13 under-18-year-olds. Three (6.1% [95% confidence interval 1.3%-17.9]) were admitted to a general hospital. For this sample, the expected age-standardized hospital admission rate per COVID-19 case (based on the general population of England) was 2.6% and therefore not significantly different to the hospitalization rate we observed. Three (including two of those admitted to hospital) contracted pneumonia. One had severe pneumonia and was admitted to an intensive care unit. No deaths or use of mechanical ventilation were recorded. DISCUSSION: To our knowledge, this represents the first study investigating medical morbidity or frequency of hospitalization for patients with COVID-19 and AN. We did not find evidence that patients with AN are at increased risk of severe COVID-19. PUBLIC SIGNIFICANCE: Medical morbidity and risk of hospitalization associated with concurrent COVID-19 and anorexia nervosa (AN) had not, to our knowledge, been studied before. We used a database of patients with eating disorders and COVID-19 (to which United Kingdom clinicians had contributed) to investigate presentation, treatment, outcomes, and COVID-19 severity for those with AN and COVID-19. We did not find evidence that patients with AN are at increased risk of severe COVID-19.

Medical maladies in eating disorders-there is still much work to be done.

During the COVID-19 pandemic, the eating disorder clinician community saw an increase in severity and number of people seeking care for eating disorders. Due to this, its even more important for those who work with people with eating disorders to understand the medical complications these people are at risk for. The special issue of the Journal of Eating Disorders provides a comprehensive look at medical complications and also makes apparent deficits in the scientific literature.

Emotion regulation and disordered eating behaviour in youths: Two daily-diary studies.

OBJECTIVE: Disordered eating cognitions and behaviours in childhood and adolescence have been identified as precursors for the development of eating disorders. Another important contributor to eating disorder risk is maladaptive emotion regulation. However, while the regulation of negative affect has been the focus of much research, the literature on the role of positive emotion regulation in eating pathology is extremely limited. The present study extends previous research by examining the regulation of both positive and negative affect in disordered eating using two waves of a daily diary design. METHOD: Every evening for 21 days, 139 youths (8-15 years) reported their use of rumination, dampening, and disordered eating cognitions and behaviours. 1 year later, during the onset of the COVID-19 pandemic, 115 of these youths were followed-up. RESULTS: As predicted, higher levels of rumination and dampening were found to be associated with a higher frequency of weight concerns and restrictive eating on person-level (both Waves) and day-level (Wave 2). Further, a higher frequency of rumination at Wave 1 predicted increases in the frequency of restrictive eating 1 year later. CONCLUSIONS: Our findings underline the importance of examining regulation of both positive and negative emotion in order to understand eating disorder risk.

Assessment and treatment of eating disorders in adolescents

Pediatric health care providers understand that eating disorders are not lifestyle choices but lifethreatening mental health conditions Among patients of all ages, anorexia nervosa (AN) has the second-highest mortality rate of all mental health conditions, after substance abuse.1 Both suicide and the physical effects of nutritional deficit are implicated. Prevalence Analyses of prevalence vary widely in their findings.2 One meta-analysis found lifetime prevalence of AN from 1.7% to 3.6% for female patients and 0.1% for male patients;lifetime prevalence of BN for female patients was about 2.1%.3 BED, with reported prevalence rates of approximately 2% to 4%, is almost as common among male as female patients.2 4 Among adolescents aged 13 to 18 years, one study found prevalence rates of 0.3% for AN, 0.9% for BN, and 1.6% for BED.5 Long characterized as affecting primarily affluent White adolescent girls, eating disorders now affect people from lower socioeconomic groups, members of non-White ethnic groups, preteen children, and boys.2 LGBTQIA+ young people may be at particular risk.6 During the early months of the COVID-19 pandemic, hospitalizations for eating disorders doubled,7 and patients reported significant increases in unhealthy behaviors.8 Screening Caregiver reports about a child's weight or eating habits or clinical observation of unexpected weight changes are likely to alert the pediatrician to the possibility of an eating disorder. Presence of any one of the following symptoms indicates the need for immediate medical hospitalization for refeeding2'14: O Heart rate less than 50 beats per minute (bpm) while awake;less than 45 bpm while asleep O Systolic pressure less than 90/45 mm Hg O Orthostatic changes: decrease in blood pressure of more than 20 mm Hg systolic or 10 mm Hg diastolic;heart rate increase of more than 20 bpm O ECG abnormalities: Prolonged corrected QT interval or other arrhythmia O Syncope O Temperature less than 96 °F (35.6 °C) O Electrolyte abnormalities O Uncontrollable binge eating and purging Dehydration Suicide risk O Less than 75% of expected body weight O Failed outpatient management O Acute weight loss and food refusal Communication Today's young people typically know what anorexia and bulimia are.

Using health administrative data to model associations and predict hospital admissions and length of stay for people with eating disorders.

BACKGROUND: Eating disorders are serious mental illnesses requiring a whole of health approach. Routinely collected health administrative data has clinical utility in describing associations and predicting health outcome measures. This study aims to develop models to assess the clinical utility of health administrative data in adult eating disorder emergency presentations and length of stay. METHODS: Retrospective cohort study on health administrative data in adults with eating disorders from 2014 to 2020 in Sydney Local Health District. Emergency and admitted patient data were collected with all clinically important variables available. Multivariable regression models were analysed to explore associations and to predict admissions and length of stay. RESULTS: Emergency department modelling describes some clinically important associations such as decreased odds of admission for patients with Bulimia Nervosa compared to Anorexia Nervosa (Odds Ratio [OR] 0.31, 95% Confidence Interval [95%CI] 0.10 to 0.95; p = 0.04). Admitted data included more predictors and therefore further significant associations including an average of 0.96 days increase in length of stay for each additional count of diagnosis/comorbidities (95% Confidence Interval [95% CI] 0.37 to 1.55; p = 0.001) with a valid prediction model (R2 = 0.56). CONCLUSIONS: Health administrative data has clinical utility in adult eating disorders with valid exploratory and predictive models describing associations and predicting admissions and length of stay. Utilising health administrative data this way is an efficient process for assessing impacts of multiple factors on patient care and predicting health care outcomes.

Developing the "single-session mindset" in eating disorder research: Commentary on Schleider et al., 2023 "Realizing the untapped promise of single-session interventions for eating disorders".

Schleider and colleagues' paper on the application of single-session interventions (SSIs) to eating disorders is timely given the broader focus in mental health on flexible approaches to delivering support at the time the person needs it most. The eating disorder field needs to embrace these innovations including developing a "single-session mindset" with greater attention paid to testing the relevance of SSI for eating disorders. The use of well-powered trials of brief, focused and rapidly scalable interventions is an ideal vehicle for generation and evaluation of new and longer interventions. Our future research agenda needs to carefully consider our target audience, the primary outcome variable of most relevance, and the SSI topic that would be most likely to effect change. Research in prevention might focus on weight concern and evaluation of SSIs that focus on self-compassion or cognitive dissonance related to appearance ideals in the media. Work in early intervention could target denial and disordered eating using SSIs on growth mindset, behavioral activation, and imagery rescripting. Treatment waitlists provide another suitable opportunity, evaluating SSIs that aim to increase hope for change, treatment retention, and kick start early change in therapy, a robust predictor of better treatment outcome.

Parental perception of the relationship between stress responses and the changes in lifestyle habits of elementary school students during a temporary leave of absence for COVID-19

This study was conducted to investigate the relationship between stress responses and the lifestyle habit changes of elementary school students during a temporary leave of absence from school during measures to prevent the spread of COVID-19 infections. We surveyed 637 parents of elementary school students about their lifestyle habit changes and stress responses during their temporary leave and finally analyzed 510 subjects. Variance analysis, showed that there were significant differences in "irregular sleep," "disordered eating habits," and "increased use of games and smartphones," but the effect size was small. When the correlation was calculated, "disordered eating habits" was associated with all stress responses, and six lifestyle-related changes were associated with lethargy. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

University Rumination in Pandemic Context

Emotions are part of every human being;they are part of the biological structural system. They are sensations that are acquired through neurological transmitters. Therefore, they play an important role in the development ofpeople. From the sentimental perspective, which are internal feelings that, in turn, are divided into secondary and adaptive emotions, rumination consists of repetitive, intrusive, and unwanted ideas with feelings of worry, sadness, among others, that generate symptoms of emotional discomfort. Therefore, obsessive and difficult to handle ideas are presented. The general objective of the research was to know the rumination levels of university students according to age and gender. The quantitative approach was used, the descriptive method, the type of study was substantive with a sample of850 students of the health career under a random probabilistic sampling. The Ruminative Response Scale instrument was used with two dimensions: reproaches and reflection. The results showed that women obtained a high level of rumination with 44.4%;regarding age, between 21 and 23 years old, they obtained a high level of rumination of 39.4 and, in the reproach dimension, they obtained a percentage of 42%. It is concluded that these students presented obsessive ideas and, sometimes, were compulsive due to the situation of confinement to which they were subjected for more than two years of the pandemic.

This Week in the Journal

Issue Highlights, April 02, 2020Timing of Endoscopy for Acute GI BleedingMDR Bacterial Infection in the U.S.Anorexia NervosaTuberculosis in 2020Stigma and the Toll of Addiction

The economic impact of eating disorders in children and youth in Canada: a call to action to improve youth eating disorder research and care.

The COVID-19 pandemic has led to an unprecedented rise in rates and symptoms of eating disorders among Canadian youth. To date, there is a lack of national surveillance and costing data in Canada to inform policymakers and healthcare leaders on how to best address the surge in new and existing cases. This has resulted in the Canadian healthcare system being unprepared to adequately respond to the increased needs. Therefore, clinicians, researchers, policymakers, decision-makers, and community organizations across Canada are collaborating to compare pre-and post-pandemic costing data from national and province-level healthcare systems in an effort to address this gap. Results from this economic cost analysis will be an important first step in informing and guiding policy on possible adaptations to services to better fulfill the needs of youth with eating disorders in Canada. We highlight how gaps in surveillance and costing data can impact the field of eating disorders in an international context.

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 increase in medical admissions with anorexia nervosa during the COVID-19 pandemic in Western Australia.

OBJECTIVE: A comparative study to describe the increase in medical admissions of children and adolescents with anorexia nervosa (AN) in Western Australia in 2019 (pre-pandemic) and 2020 (peri-pandemic). METHOD: Patient demographics, physiological parameters, length of stay, time to assessment by the Eating Disorder Service (EDS), and commencement of specialist eating disorder (ED) outpatient treatment was collected for adolescents admitted with AN between 1st January 2019 and 31st December 2020. RESULTS: The number of admissions doubled from 126 in 2019 to 268 in 2020. The number of children admitted increased by 52%. The median length of hospital stay was shorter in 2020 (12 vs. 17 days; p < .001), but the 28-day readmission rate was greater (39.9% vs. 22.2%; p < .001). At the time of hospital discharge in 2020, only 60% of patients were able to step-down into specialist ED outpatient treatment, compared to 93% in 2019. The mean number of admissions per child before completing EDS assessment increased significantly in 2020 (2.75 vs. 0, p < .001). DISCUSSION: Shorter inpatient stays and delays in the commencement of specialist ED outpatient treatment may have contributed to the increased readmission rate seen in 2020. PUBLIC SIGNIFICANCE: This research is important as it explores the reasons for increased medical presentations and admissions of youth with AN during the COVID-19 pandemic in Western Australia. We hope that our lessons learned may be helpful to others trying to balance similar clinical workloads.

Trauma-Informed Care for Hospitalized Adolescents.

Purpose of Review: Exposure to trauma accelerates during the adolescence, and due to increased behavioral and psychiatric vulnerability during this developmental period, traumatic events during this time are more likely to cause a lasting impact. In this article, we use three case studies of hospitalized adolescents to illustrate the application of trauma-informed principles of care with this unique population. Recent Findings: Adolescents today are caught in the crosshairs of two syndemics-racism and other structural inequities and the COVID-19 pandemic. Increased hospitalizations and mental health diagnoses during the past two years signal toxic levels of stress affecting this group. Trauma-informed care promotes health, healing, and equity. Summary: This concept of the "trauma-informed approach" is still novel; through examples and practice, providers can learn to universally apply the trauma-informed care framework to every patient encounter to address the harmful effects of trauma and promote recovery and resilience.

#How Can We Help You?: An Instagram-Based Online Self-Help for Eating Disorders

In recent years, there has been a noticeable increase in online self-help treatments and peer-support programs for eating disorders. The possibility of easily accessing them anytime makes these programs an important support tool and an influencing source for increasing motivation to change. The aim of this work is to describe the #How can we help you? project, its initial feedback received from users, and its future directions. Researchers and clinicians developed an Instagram profile (Dicci Come Aiutarti) based on psychoeducation, aimed at orienting those suffering from a self-reported eating disorder towards clinical care, providing information about eating concerns and related constructs, and increasing motivation for treatment and illness awareness. The contents shared are based on narratives about people who had recovered from an eating disorder, importance and ability to change, and nutrition management. We have provided an overview of the needs of the Instagram profile users, a description of the main interactions recorded since the profile was opened, and examples of the unmet needs shared by users in direct messages. Future directions of the project concern the definition and formalization of the type of support provided by developing a psychoeducational and integrated program and also, the formulation of a research protocol able to assess the usability, effectiveness, and satisfaction of the Instagram profile.

Policy effects of the expansion of telehealth under 1135 waivers on intentions to seek counseling services: Difference-in-difference (DiD) analysis

Practicing counselors swiftly shifted to telehealth after insurance payers changed their policy to cover telehealth counseling under the expansion of telehealth with 1135 waivers, which has led to concerns over the policy effects on clients' continuing counseling service-seeking intentions. To determine if this shift to telehealth was associated with a change in clients' counseling service-seeking intentions while adjusting for unmeasured confounders and time trends, we performed a difference-in-difference analysis (a quasi-experimental design) to compare changes between the client (treated) and non-client (control) groups through a large national sample of emerging adults (N = 52,237). The study findings indicated that the shift to telehealth was not associated with a change in clients' counseling service-seeking intentions, providing support for the utility of telehealth counseling. Implications of these findings should be considered when assessing the merit of telehealth counseling to inform public policies and counseling practice in the post-pandemic era.

Compassion focused therapy: An evolutionary and biopsychosocial understanding of depression and its management

Compassion focused therapy (CFT) is an evolution-informed biopsychosocial approach and thereby has sought to explore some of the evolved mechanisms that may underpin depression and how they are activated and regulated throughout the course of a person's life. The essence of a CFT approach is that motivations (social mentalities) regulate multiple functions, and that, when individuals get caught in threat-focused competitiveness and a sense of social isolation and disconnection, they are at risk of stimulating a whole range of psychophysiological states that will move them towards depression states. Depression is often comorbid with many other conditions such as eating disorders, substance abuse, and post-traumatic stress disorder. In regard to the cognitive competencies, depression affects attention, concentration and memory, styles of reasoning, and rumination. There are also multiple changes in the autonomic nervous system and increasing evidence that diets that are 'inflammatory' and can affect the immune system are linked to increasing rates of depression. Sleep difficulties are particularly important and can lead to a spiral of fatigue and depression. Lockdowns associated with Covid-19 have significantly increased the incidence of depression. (PsycInfo Database Record (c) 2023 APA, all rights reserved)