Case Series of Consultation-Liaison Patients with Anorexia Nervosa during the Pandemic

ABSTRACT

Introduction: Anorexia Nervosa (AN) is an eating disorder defined by an abnormally low body weight due to purging behaviors/food intake restrictions and distorted self-image. Coronavirus disease 2019 (COVID-19) has changed our environment due to social distancing, lockdown, and reduced access to regular mental health services. Reports indicate a negative impact of COVID-19 on mental health1, including patients with AN2. Our Consultation-Liaison service noticed an increase in new-onset AN cases and a worsening of established AN cases attributed to the environment created by COVID-19. Methods: PubMed literature review with keywords “COVID-19” and “AN.” Review of seven AN cases seen during the pandemic. Case series Seven cases (COVID-19 negative) of worsening AN were seen by our Consultation-Liaison service between August 2020 and January 2021. Six cases were newly diagnosed, five cases presented severe dehydration, electrolyte imbalance, or bradycardia requiring inpatient stabilization, and five cases needed transfer to inpatient eating disorder units. The lack of structured activities and increased social media use leading to distorted self-image were found to be a trigger. Discussion: The impact of the Pandemic in AN can vary. The lack of structure, increased social media use, and reduced access to mental health services may increase AN incidence and worsening of symptoms3. However, a study reported a positive response to AN treatment during confinement4, possibly due to family dynamics5. It is important to note that patients with AN are a vulnerable population that requires greater support and monitoring to prevent worsening symptoms and long-term consequences. These observations suggest the need for further research to understand the impact of the pandemic on AN symptoms onset and severity. References 1. Phillipou, A., et al. (2020). Eating and exercise behaviors in eating disorders and the general population during the COVID-19 pandemic in Australia Initial results from the COLLATE project. The International journal of eating disorders, 53(7), 1158–1165. https//doi.org/10.1002/eat.23317 2. Termorshuizen, J. D., et al. (2020). Early impact of COVID-19 on individuals with self-reported eating disorders A survey of ∼1,000 individuals in the United States and the Netherlands. The International journal of eating disorders, 53(11), 1780–1790. https//doi.org/10.1002/eat.23353 3. Branley-Bell, D., et al. (2020). Exploring the impact of the COVID-19 pandemic and UK lockdown on individuals with experience of eating disorders. Journal of eating disorders, 8, 44. https//doi.org/10.1186/s40337-020-00319-y 4. Fernández-Aranda, F., et al. (2020). COVID Isolation Eating Scale (CIES) Analysis of the impact of confinement in eating disorders and obesity-A collaborative international study. European eating disorders review the journal of the Eating Disorders Association, 28(6), 871–883. https//doi.org/10.1002/erv.2784 5. Yaffa, S., et al. (2021). Treatment of eating disorders in adolescents during the COVID-19 pandemic a case series. Journal of eating disorders, 9(1), 17. https//doi.org/10.1186/s40337-021-00374-z