Histone serotonylation in dorsal raphe nucleus contributes to stress- and antidepressant-mediated gene expression and behavior.

Mood disorders are an enigmatic class of debilitating illnesses that affect millions of individuals worldwide. While chronic stress clearly increases incidence levels of mood disorders, including major depressive disorder (MDD), stress-mediated disruptions in brain function that precipitate these illnesses remain largely elusive. Serotonin-associated antidepressants (ADs) remain the first line of therapy for many with depressive symptoms, yet low remission rates and delays between treatment and symptomatic alleviation have prompted skepticism regarding direct roles for serotonin in the precipitation and treatment of affective disorders. Our group recently demonstrated that serotonin epigenetically modifies histone proteins (H3K4me3Q5ser) to regulate transcriptional permissiveness in brain. However, this non-canonical phenomenon has not yet been explored following stress and/or AD exposures. Here, we employed a combination of genome-wide and biochemical analyses in dorsal raphe nucleus (DRN) of male and female mice exposed to chronic social defeat stress, as well as in DRN of human MDD patients, to examine the impact of stress exposures/MDD diagnosis on H3K4me3Q5ser dynamics, as well as associations between the mark and depression-related gene expression. We additionally assessed stress-induced/MDD-associated regulation of H3K4me3Q5ser following AD exposures, and employed viral-mediated gene therapy in mice to reduce H3K4me3Q5ser levels in DRN and examine its impact on stress-associated gene expression and behavior. We found that H3K4me3Q5ser plays important roles in stress-mediated transcriptional plasticity. Chronically stressed mice displayed dysregulated H3K4me3Q5ser dynamics in DRN, with both AD- and viral-mediated disruption of these dynamics proving sufficient to attenuate stress-mediated gene expression and behavior. Corresponding patterns of H3K4me3Q5ser regulation were observed in MDD subjects on vs. off ADs at their time of death. These findings thus establish a neurotransmission-independent role for serotonin in stress-/AD-associated transcriptional and behavioral plasticity, observations of which may be of clinical relevance to human MDD and its treatment.

Simple Behavioral Analysis (SimBA) as a platform for explainable machine learning in behavioral neuroscience.

The study of complex behaviors is often challenging when using manual annotation due to the absence of quantifiable behavioral definitions and the subjective nature of behavioral annotation. Integration of supervised machine learning approaches mitigates some of these issues through the inclusion of accessible and explainable model interpretation. To decrease barriers to access, and with an emphasis on accessible model explainability, we developed the open-source Simple Behavioral Analysis (SimBA) platform for behavioral neuroscientists. SimBA introduces several machine learning interpretability tools, including SHapley Additive exPlanation (SHAP) scores, that aid in creating explainable and transparent behavioral classifiers. Here we show how the addition of explainability metrics allows for quantifiable comparisons of aggressive social behavior across research groups and species, reconceptualizing behavior as a sharable reagent and providing an open-source framework. We provide an open-source, graphical user interface (GUI)-driven, well-documented package to facilitate the movement toward improved automation and sharing of behavioral classification tools across laboratories.

Technical profiles of child sexual exploitation material offenders.

The idiographic technical profiles of child sexual exploitation material (CSEM) offenders provide insight into their behaviours and context for their interactions with technology, but minimal quantitative work has been done to evaluate their sociability, technical ability and technophilia compared to non-offenders. This work used an online survey to compare an offender group consisting of English-speaking adults previously convicted of CSEM offenses (N = 78) with a reference population of non-offenders (N = 254). The survey assessed sociability, technical ability and technophilia through self-rating and information on occupation, level of education and device ownership. The study found that CSEM offenders had slightly lower sociability than non-offenders, though not at a level of clinical interest. Additionally, CSEM offenders had no statistically significant difference in technical ability and lower overall technophilia when compared to non-offenders. This study fails to support popular perceptions of CSEM offenders being technically savvy loners who are early adopters of new technologies.

The Impact of a Public Health Campaign to Deter Viewing of Child Sexual Abuse Images Online: A Case Study of the UK Stop It Now! Campaign.

Public campaigns offer an opportunity to prevent child sexual abuse by raising awareness and promoting help available to bystanders, victims, and those at risk of perpetrating the abuse. This paper explores the impact of The Lucy Faithfull Foundation's 'Stop It Now!' campaign in the UK (2015-2018) on help-seeking. Helpline calls (11,190 unique callers), website analytics (109,432 new website visitors) and three website-hosted surveys (N = 252) provided data on help-seeking, awareness, and self-reported behavior. Results indicated that there were more visitors to the help website during active campaigning periods, and helpline callers and website visitors were more likely to seek help after viewing campaign materials during active than non-active campaign periods. Help-seekers were predominantly men concerned about their own behavior. Survey 2 respondents concerned about their own behavior (n = 53) indicated that their awareness of the law (75.5%), and legal and personal consequences (67.9%) had changed after hearing about the campaign, and 66% reported a change in behavior. Public health campaigns may be an effective way to promote help-seeking and prevent abuse.

Automatically annotated motion tracking identifies a distinct social behavioral profile following chronic social defeat stress.

Severe stress exposure increases the risk of stress-related disorders such as major depressive disorder (MDD). An essential characteristic of MDD is the impairment of social functioning and lack of social motivation. Chronic social defeat stress is an established animal model for MDD research, which induces a cascade of physiological and behavioral changes. Current markerless pose estimation tools allow for more complex and naturalistic behavioral tests. Here, we introduce the open-source tool DeepOF to investigate the individual and social behavioral profile in mice by providing supervised and unsupervised pipelines using DeepLabCut-annotated pose estimation data. Applying this tool to chronic social defeat in male mice, the DeepOF supervised and unsupervised pipelines detect a distinct stress-induced social behavioral pattern, which was particularly observed at the beginning of a novel social encounter and fades with time due to habituation. In addition, while the classical social avoidance task does identify the stress-induced social behavioral differences, both DeepOF behavioral pipelines provide a clearer and more detailed profile. Moreover, DeepOF aims to facilitate reproducibility and unification of behavioral classification by providing an open-source tool, which can advance the study of rodent individual and social behavior, thereby enabling biological insights and, for example, subsequent drug development for psychiatric disorders.

Histone H3 serotonylation dynamics in dorsal raphe nucleus contribute to stress- and antidepressant-mediated gene expression and behavior.

Background: Major depressive disorder (MDD), along with related mood disorders, is a debilitating illness that affects millions of individuals worldwide. While chronic stress increases incidence levels of mood disorders, stress-mediated disruptions in brain function that precipitate these illnesses remain elusive. Serotonin-associated antidepressants (ADs) remain the first line of therapy for many with depressive symptoms, yet low remission rates and delays between treatment and symptomatic alleviation have prompted skepticism regarding precise roles for serotonin in the precipitation of mood disorders. Our group recently demonstrated that serotonin epigenetically modifies histone proteins (H3K4me3Q5ser) to regulate transcriptional permissiveness in brain. However, this phenomenon has not yet been explored following stress and/or AD exposures. Methods: We employed a combination of genome-wide and biochemical analyses in dorsal raphe nucleus (DRN) of male and female mice exposed to chronic social defeat stress to examine the impact of stress exposures on H3K4me3Q5ser dynamics, as well as associations between the mark and stress-induced gene expression. We additionally assessed stress-induced regulation of H3K4me3Q5ser following AD exposures, and employed viral-mediated gene therapy to reduce H3K4me3Q5ser levels in DRN and examine the impact on stress-associated gene expression and behavior. Results: We found that H3K4me3Q5ser plays important roles in stress-mediated transcriptional plasticity. Chronically stressed mice displayed dysregulated H3K4me3Q5ser dynamics in DRN, with both AD- and viral-mediated disruption of these dynamics proving sufficient to rescue stress-mediated gene expression and behavior. Conclusions: These findings establish a neurotransmission-independent role for serotonin in stress-/AD-associated transcriptional and behavioral plasticity in DRN.

Early life stress in male mice blunts responsiveness in a translationally-relevant reward task.

Early-life stress (ELS) leaves signatures upon the brain that persist throughout the lifespan and increase the risk of psychiatric illnesses including mood and anxiety disorders. In humans, myriad forms of ELS-including childhood abuse, bullying, poverty, and trauma-are increasingly prevalent. Understanding the signs of ELS, including those associated with psychiatric illness, will enable improved treatment and prevention. Here, we developed a novel procedure to model human ELS in mice and identify translationally-relevant biomarkers of mood and anxiety disorders. We exposed male mice (C57BL/6 J) to an early-life (juvenile) chronic social defeat stress (jCSDS) and examined social interaction and responsivity to reward during adulthood. As expected, jCSDS-exposed mice showed a socially avoidant phenotype in open-field social interaction tests. However, sucrose preference tests failed to demonstrate ELS-induced reductions in choice for the sweetened solution, suggesting no effect on reward function. To explore whether other tasks might be more sensitive to changes in motivation, we tested the mice in the Probabilistic Reward Task (PRT), a procedure often used in humans to study reward learning deficits associated with depressive illness. In a touchscreen PRT variant that was reverse-translated to maximize alignment with the version used in human subjects, mice exposed to jCSDS displayed significant reductions in the tendency to develop response biases for the more richly-rewarded stimulus, a hallmark sign of anhedonia when observed in humans. Our findings suggest that translationally-relevant procedures that utilize the same endpoints across species may enable the development of improved model systems that more accurately predict outcomes in humans.

Self Perceptions and Cognitions of Child Sexual Exploitation Material Offenders.

Identifying the self-perceptions of child sexual exploitation material (CSEM) consumers compared to a reference population of non-consumers is critical in establishing distorted cognitions that may not be elucidated when comparison is made with groups who have committed other offenses. This exploratory work utilizes a quantitative approach toward identifying how individuals previously convicted of child pornography offenses view CSEM and CSEM offending, using a group of non-offenders as a baseline. The target group was selected based on their inclusion in two sex offender registries for child pornography offenses (n = 78). A reference group of non-offenders (n = 254) was gender-matched from a subset of a prior study evaluating the public perceptions of CSEM. Both groups were adults located within the United States and were asked questions using an online survey about their general perceptions of CSEM, their endorsement of CSEM beliefs, and their opinions related to the legality of various forms of CSEM and associated laws and sentencing guidelines. The study found that CSEM consumers more accurately assessed risks associated with CSEM offending, but that they exhibited potential minimization-based cognitive distortions related to severity and victimization and more strongly endorsed child erotica and virtual child pornography being legal. Additionally, they endorsed treatment over prison, and were strongly opposed to sex offender registration for child pornography offenses. The results provide potential treatment targets, including behavioral areas that may be pathways to CSEM offending.

Genome-wide transcriptomics of the amygdala reveals similar oligodendrocyte-related responses to acute and chronic alcohol drinking in female mice.

Repeated excessive alcohol consumption is a risk factor for alcohol use disorder (AUD). Although AUD has been more common in men than women, women develop more severe behavioral and physical impairments. However, relatively few new therapeutics targeting development of AUD, particularly in women, have been validated. To gain a better understanding of molecular mechanisms underlying alcohol intake, we conducted a genome-wide RNA-sequencing analysis in female mice exposed to different modes (acute vs chronic) of ethanol drinking. We focused on transcriptional profiles in the amygdala including the central and basolateral subnuclei, brain areas previously implicated in alcohol drinking and seeking. Surprisingly, we found that both drinking modes triggered similar changes in gene expression and canonical pathways, including upregulation of ribosome-related/translational pathways and myelination pathways, and downregulation of chromatin binding and histone modification. In addition, analyses of hub genes and upstream regulatory pathways revealed that voluntary ethanol consumption affects epigenetic changes via histone deacetylation pathways, oligodendrocyte and myelin function, and the oligodendrocyte-related transcription factor, Sox17. Furthermore, a viral vector-assisted knockdown of Sox17 gene expression in the amygdala prevented a gradual increase in alcohol consumption during repeated accesses. Overall, these results suggest that the expression of oligodendrocyte-related genes in the amygdala is sensitive to voluntary alcohol drinking in female mice. These findings suggest potential molecular targets for future therapeutic approaches to prevent the development of AUD, due to repeated excessive alcohol consumption, particularly in women.

Blood levels of T-Cell Receptor Excision Circles (TRECs) provide an index of exposure to traumatic stress in mice and humans.

Exposure to stress triggers biological changes throughout the body. Accumulating evidence indicates that alterations in immune system function are associated with the development of stress-associated illnesses such as major depressive disorder and post-traumatic stress disorder, increasing interest in identifying immune markers that provide insight into mental health. Recombination events during T-cell receptor rearrangement and T-cell maturation in the thymus produce circular DNA fragments called T-cell receptor excision circles (TRECs) that can be utilized as indicators of thymic function and numbers of newly emigrating T-cells. Given data suggesting that stress affects thymus function, we examined whether blood levels of TRECs might serve as a quantitative peripheral index of cumulative stress exposure and its physiological correlates. We hypothesized that chronic stress exposure would compromise thymus function and produce corresponding decreases in levels of TRECs. In male mice, exposure to chronic social defeat stress (CSDS) produced thymic involution, adrenal hypertrophy, and decreased levels of TRECs in blood. Extending these studies to humans revealed robust inverse correlations between levels of circulating TRECs and childhood emotional and physical abuse. Cell-type specific analyses also revealed associations between TREC levels and blood cell composition, as well as cell-type specific methylation changes in CD4T + and CD8T + cells. Additionally, TREC levels correlated with epigenetic age acceleration, a common biomarker of stress exposure. Our findings demonstrate alignment between findings in mice and humans and suggest that blood-borne TRECs are a translationally-relevant biomarker that correlates with, and provides insight into, the cumulative physiological and immune-related impacts of stress exposure in mammals.

An 8-month longitudinal exploration of body image and disordered eating in the UK during the COVID-19 pandemic.

Research suggests that the COVID-19 pandemic is negatively impacting mental health, with rates of eating disorder referrals in particular rising steeply during the pandemic. This study aimed to examine 8-month changes in body image and disordered eating during the COVID-19 pandemic, and explore whether any changes were moderated by gender, age, or eating disorder history. This study used a longitudinal survey design in which 587 adults living in the UK (85 % women; mean age = 32.87 years) completed assessments every two months over five timepoints from May/June 2020 to January/February 2021. Measures included body esteem, disordered eating, and psychological distress. Mixed effect models showed small but significant improvements in body esteem and disordered eating symptoms from May/June 2020 to January/February 2021. These improvements were independent of changes in psychological distress, and did not vary by gender, age or eating disorder history. Whilst poor body image and disordered eating may have been elevated in the early period of the pandemic, this study suggests improvements, rather than worsening, of these outcomes over time. This may reflect adaptation to this changing context.

A Longitudinal and Comparative Content Analysis of Instagram Fitness Posts.

Body dissatisfaction is among the most common mental health challenges experienced by women and has been identified as a risk factor for disordered eating. Research has found that exposure to social media images depicting thin, muscular bodies, often dubbed 'fitspiration', may contribute to body dissatisfaction. Image-centred social media platforms, such as Instagram, have rising popularity among adolescents and young adults. However, little is known about the content of images produced by different fitness-related sources, such as those from fitness brands compared with individual users, and how fitness content on social media is evolving over time. This study sought to determine whether Instagram content varied between female fitness influencers and brands and how this content changed between 2019 and 2021. A longitudinal content analysis was conducted on a sample of 400 Instagram images using a coding scheme developed specifically for this project. The scheme coded images for fit ideal body depiction, fitness focus, objectification, and sexualisation. Chi-square tests indicated that female fitness influencer content was more sexualised and portrayed more of the fit ideal, while fitness brands produced more Instagram content with a fitness focus. There were no significant overall longitudinal changes for any of the four key variables. However, when looking at longitudinal changes by account type, fitness-focused influencer content increased while fitness-focused brand content decreased over time. These findings highlight discernible differences in content produced by different Instagram account types. It points future research towards the consideration of potential moderating factors, such as account type, when exploring the impact of social media images on body image and mental health.

Suicidal ideation in offenders convicted of child sexual exploitation material offences.

Understanding the prevalence of suicidal ideation in Child Sexual Exploitation Material (CSEM) offenders and their psychological concerns provides the basis for early treatment and intervention. This research solicited responses (n = 78) via an anonymous, web-based survey from adults in the United States previously convicted of CSEM offences. Significant suicidal ideation was present in 73% of respondents (n = 57), and 19% (n = 15) reported attempting suicide after they were made aware of an investigation, with 41% (n = 32) stating they would have been likely to seek counselling if provided a contact. Most of the respondents felt they were not treated with fairness, understanding, and compassion by investigators, and that their primary psychological strains were going to jail and their families finding out. This research highlights the need for more empathetic investigative approaches, as well as the need for more rapid assessment and treatment of proximal suicide risk in this population.

Public Perceptions of Child Pornography and Child Pornography Consumers.

Understanding the public's perceptions of child pornography helps identify gaps in awareness and knowledge, impacts legislative decision making, quantifies stigmatization, and provides a baseline for identifying differences between lay and offender populations for clinical purposes. This research provides a comprehensive public survey assessing these issues. An Internet-based sample of 524 adults (mean age = 47 years, 51% female) within the USA were asked about their understanding and beliefs related to child pornography and individuals who view child pornography. The questions covered three topic areas-general perceptions of child pornography, endorsement of child pornography beliefs, and opinions related to the legality of various forms of child pornography as well as the decision making related to sentencing and sex offender registration for child pornography consumers. The research found that the public viewed these offenses as more severe than most other crimes and that there was an overestimation by the public of risks related to recidivism and contact offending. Additionally, the research found that there was support for most of the current sentencing guidelines in the USA, including sex offender registration, and that there was limited support for treatment over incarceration.

Neurobiological Bases of Alcohol Consumption After Social Stress.

The urge to seek and consume excessive alcohol is intensified by prior experiences with social stress, and this cascade can be modeled under systematically controlled laboratory conditions in rodents and non-human primates. Adaptive coping with intermittent episodes of social defeat stress often transitions to maladaptive responses to traumatic continuous stress, and alcohol consumption may become part of coping responses. At the circuit level, the neural pathways subserving stress coping intersect with those for alcohol consumption. Increasingly discrete regions and connections within the prefrontal cortex, the ventral and dorsal striatum, thalamic and hypothalamic nuclei, tegmental areas as well as brain stem structures begin to be identified as critical for reacting to and coping with social stress while seeking and consuming alcohol. Several candidate molecules that modulate signals within these neural connections have been targeted in order to reduce excessive drinking and relapse. In spite of some early clinical failures, neuropeptides such as CRF, opioids, or oxytocin continue to be examined for their role in attenuating stress-escalated drinking. Recent work has focused on neural sites of action for peptides and steroids, most likely in neuroinflammatory processes as a result of interactive effects of episodic social stress and excessive alcohol seeking and drinking.

Hypoactive Thalamic Crh+ Cells in a Female Mouse Model of Alcohol Drinking After Social Trauma.

BACKGROUND: Comorbid stress-induced mood and alcohol use disorders are increasingly prevalent among female patients. Stress exposure can disrupt salience processing and goal-directed decision making, contributing to persistent maladaptive behavioral patterns; these and other stress-sensitive cognitive and behavioral processes rely on dynamic and coordinated signaling by midline and intralaminar thalamic nuclei. Considering the role of social trauma in the trajectory of these debilitating psychopathologies, identifying vulnerable thalamic cells may provide guidance for targeting persistent stress-induced symptoms. METHODS: A novel behavioral protocol traced the progression from social trauma to the development of social defensiveness and chronically escalated alcohol consumption in female mice. Recent cell activation-measured as cFos-was quantified in thalamic cells after safe social interactions, revealing stress-sensitive corticotropin-releasing hormone-expressing (Crh+) anterior central medial thalamic (aCMT) cells. These cells were optogenetically stimulated during stress-induced social defensiveness and abstinence-escalated binge drinking. RESULTS: Crh+ aCMT neurons exhibited substantial activation after social interactions in stress-naïve but not in stressed female mice. Photoactivating Crh+ aCMT cells dampened stress-induced social deficits, whereas inhibiting these cells increased social defensiveness in stress-naïve mice. Optogenetically activating Crh+ aCMT cells diminished abstinence-escalated binge alcohol drinking in female mice, regardless of stress history. CONCLUSIONS: This work uncovers a role for Crh+ aCMT neurons in maladaptive stress-induced social interactions and in binge drinking after forced abstinence in female mice. This molecularly defined thalamic cell population may serve as a critical stress-sensitive hub for social deficits caused by exposure to social trauma and for patterns of excessive alcohol drinking in female populations.

Collecting and viewing behaviors of child sexual exploitation material offenders.

BACKGROUND: The collecting behaviors of child sexual exploitation material (CSEM) offenders provide insight into their cognitions and motivations that have clinical applications. OBJECTIVE: This study analyzed the CSEM collecting and viewing behaviors of previously convicted offenders. PARTICIPANTS AND SETTINGS: A postal letter soliciting participation in an online survey was sent to adults previously convicted of CSEM offenses in the United States. Comparison information from a non-offending population of adults within the United States (N = 524) was collected and compared to the CSEM respondents (N = 78). METHOD: A mixed-methods approach was utilized. The CSEM group was compared to a gender-matched sample from the non-offending group for general adult sexual exploitation material (SEM) viewing. Exploratory analyses of CSEM offender behaviors related to collecting, collection diversity, and recidivism were conducted. RESULTS: The majority (78%) of the offenders did not organize their content and 74% deleted their entire collection on at least one occasion. Offenders viewed more diverse categories of adult SEM than non-offenders, including more bestiality, hentai, teen, and nudist/naturist material. None of the offenders viewed CSEM exclusively, and 74% viewed more adult SEM than CSEM. The age range of CSEM content viewed did not support highly preferential viewing but did support general novelty seeking. The self-reported recidivism rate was 10%, with infrequent post-conviction CSEM activity. CONCLUSION: Treatment professionals should not assume that pedophilic interests are the sole or even primary motivator for CSEM behavior. Problematic Internet usage, general pornography consumption, coping issues, or novelty seeking may be more appropriate targets for some offenders.

Development and Application of an Interdisciplinary Rapid Message Testing Model for COVID-19 in North Carolina.

INTRODUCTION: From the onset of the COVID-19 pandemic, public health officials have sought to develop evidence-based messages to reduce COVID-19 transmission by communicating key information to media outlets and the public. We describe the development of an interdisciplinary rapid message testing model to quickly create, test, and share messages with public health officials for use in health campaigns and policy briefings. METHODS: An interdisciplinary research team from the University of North Carolina at Chapel Hill assembled in March 2020 to assist the state health department in developing evidence-based messages to influence social distancing behaviors in the state. We developed and iteratively executed a rapid message testing model; the components of the 4-step model were message creation, survey development, survey administration, and analysis and presentation to health department officials. The model was executed 4 times, each during a 7-day period in April and May, and each subsequent survey included new phrasing and/or messaging informed by the previous week's survey. A total of 917 adults from North Carolina participated in the 4 surveys. RESULTS: Survey participants rated messages focused on protecting oneself and others higher than messages focused on norms and fear-based approaches. Pairing behaviors with motivations increased participants' desire to social distance across all themes and subgroups. For example, adding "Protect your grandmother, your neighbor with cancer, and your best friend with asthma," to messaging received a 0.9-point higher score than the base message, "Stay 6 feet apart from others when out in public." PRACTICE IMPLICATIONS: Our model to promote social distancing in North Carolina during the COVID-19 pandemic can be used for rapid, iterative message testing during public health emergencies.

Exploring changes in body image, eating and exercise during the COVID-19 lockdown: A UK survey.

Early reports suggest that lockdown measures associated with the COVID-19 pandemic (e.g., social distancing) are having adverse consequences for people's mental health, including increases in maladaptive eating habits and body dissatisfaction. Certain groups, such as those with pre-existing mental health difficulties, may be especially at risk. The current study explored perceived changes in eating, exercise, and body image during lockdown within the United Kingdom, using an online survey (n = 264). There were large individual differences in perceived changes in eating, exercise, and body image in this period. Women were more likely than men to report increasing struggles with regulating eating, preoccupation with food and worsening body image. Those with a current/past diagnosis of eating disorders reported significantly greater difficulties in regulating eating, increased preoccupation with food, exercise thoughts and behaviours and concern about appearance, even when compared to those with other mental health and developmental disorders. Ongoing research to explore individual differences in the trajectories of change in eating, exercise and body image as lockdown measures ease will be important for understanding the full psychological impact of this pandemic and improve service and public health planning going forward.

A qualitative exploration of the impact of COVID-19 on individuals with eating disorders in the UK.

COVID-19 may have substantial impact on the mental health at a population level, but also has the potential to significantly affect those with pre-existing mental health difficulties such as eating disorders. This qualitative study explores the impact of COVID-19 and associated public health measures on adults with eating disorders within the UK. We conducted 10 in depth interviews with adults (24-38 years) with a self-reported eating disorder during lockdown. Data were analysed using an inductive thematic analysis approach. We identified core themes related to social restrictions (social isolation, changes in accountability to others, and increased responsibility for self and others), functional restrictions (lack of routine and structure, a need to intentionally plan activity, a desire for secrecy particularly around food shopping) and restrictions in access to mental health services. Overall, the impact of the lockdown was experienced as a catalyst for either increased disordered eating behaviours or for a drive for recovery, depending on individual circumstances going into these restrictions. This study is the first in depth interview approach with adults with mixed eating disorder presentations in the UK during COVID-19. Findings have important implications for post lockdown intervention care and practice.