BACKGROUND: The COVID-19 lockdown has had a significant impact on mental health. Patients with eating disorders (ED) have been particularly vulnerable. AIMS: (1) To explore changes in eating-related symptoms and general psychopathology during lockdown in patients with an ED from various European and Asian countries; and (2) to assess differences related to diagnostic ED subtypes, age, and geography. METHODS: The sample comprised 829 participants, diagnosed with an ED according to DSM-5 criteria from specialized ED units in Europe and Asia. Participants were assessed using the COVID-19 Isolation Scale (CIES). RESULTS: Patients with binge eating disorder (BED) experienced the highest impact on weight and ED symptoms in comparison with other ED subtypes during lockdown, whereas individuals with other specified feeding and eating disorders (OFSED) had greater deterioration in general psychological functioning than subjects with other ED subtypes. Finally, Asian and younger individuals appeared to be more resilient. CONCLUSIONS: The psychopathological changes in ED patients during the COVID-19 lockdown varied by cultural context and individual variation in age and ED diagnosis. Clinical services may need to target preventive measures and adapt therapeutic approaches for the most vulnerable patients.

1st Department of Paediatrics Semmelweis University 1085 Budapest Hungary

Centro de Diagnóstico de Enfermedades Moleculares Universidad Autónoma de Madrid 28049 Madrid Spain

Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas 28029 Madrid Spain

Centro de Investigación Biomédica en Red de Salud Mental ISCIII 28029 Madrid Spain

CESP Université Paris Saclay UVSQ INSERM U 1178 94805 Villejuif France

Child and Adolescent Psychiatry and Psychology Department Hospital Sant Joan de Déu Institut de Recerca Sant Joan de Déu 08950 Esplugues de Llobregat Spain

Child and Adolescent Psychiatry and Psychology Service Child Hospital Niño Jesus 28009 Madrid Spain

CIBER de Enfermedades Infecciosas Instituto de Salud Carlos 3 28029 Madrid Spain

CIBER Fisiopatología Obesidad y Nutrición Instituto de Salud Carlos 3 28029 Barcelona Spain

Clinical Psychology Faculty of Medicine and Health Sciences University Antwerp 2000 Antwerp Belgium

Clinical Psychology Faculty of Psychology and Educational Sciences KU Leuven 3000 Leuven Belgium

D Uznadze Institute of Psychology Ilia State University 0162 Tbilisi Georgia

Department of Biological and Medical Physics UNESCO Tyumen State Medical University 625023 Tyumen Russia

Department of Child and Adolescent Psychiatry and Psychology 2017SGR881 Institute of Neurosciences Hospital Clinic de Barcelona 08036 Barcelona Spain

Department of Clinical Psychology Shanghai Mental Health Center Shanghai Jiao Tong University School of Medicine 280 Shanghai 200030 China

Department of Clinical Sciences Lund Psychiatry Faculty of Medicine Lund University 221 00 Lund Sweden

Department of Clinical Sciences School of Medicine and Health Sciences University of Barcelona 08907 Barcelona Spain

Department of Endocrinology and Nutrition Virgen de la Victoria University Hospital Instituto de Investigación Biomédica de Málaga 29010 Málaga Spain

Department of Medical Sciences School of Medicine University of Girona 17004 Girona Spain

Department of Neuroscience University of Padua and Neuroscience Center 35122 Padua Italy

Department of Physiology CIMUS University of Santiago de Compostela Instituto de Investigación Sanitaria 15782 Santiago de Compostela Spain

Department of Political Science Vytautas Magnus University 44248 Kaunas Lithuania

Department of Psychiatry 1st Medical Faculty of Charles University 11000 Prague Czech Republic

Department of Psychiatry and Legal Medicine Universitat Autònoma de Barcelona 08193 Barcelona Spain

Department of Psychiatry Bellvitge University Hospital IDIBELL 08907 Barcelona Spain

Department of Psychiatry Germans Trias i Pujol University Hospital IGTP 08916 Barcelona Spain

Department of Psychiatry Hospital de la Santa Creu i Sant Pau Institut d'Investigació Biomèdica Sant Pau 08041 Barcelona Spain

Department of Psychiatry Institut Mutualiste Montsouris School of Medicine Université Paris Descartes 75006 Paris France

Department of Psychiatry School of Medicine International University of Health and Welfare Narita 286 8686 Japan

Department of Psychiatry Seoul Paik Hospital Inje University Seoul 01757 Korea

Department of Psychobiology and Methodology School of Psychology Universitat Autònoma de Barcelona 08193 Barcelona Spain

Department of Therapy and Endocrinology Tyumen State Medical University 625023 Tyumen Russia

Dipartimento di Salute Mentale e Fisica e Medicina Preventiva Universitá degli Studi della Campania Luigi Vanvitelli 80138 Naples Italy

Eating Disorders Center Vilnius University Vilnius 01513 Vilnius Lithuania

Eating Disorders Program Department of Psychiatry University of California San Francisco CA 94143 USA

Eating Disorders Unit Department of Child and Adolescent Psychiatry Medical University of Vienna 1090 Vienna Austria

Endocrinology and Nutrition Division Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi Sunyer 08036 Barcelona Spain

Facultad de Ciencias de la Salud Universidad Internacional de La Rioja 26006 La Rioja Spain

Facultad de Psicología Universidad Autónoma de Madrid 28049 Madrid Spain

FITA Foundation 08006 Barcelona Spain

Gambling Disorder Unit Malmö Addiction Center 205 02 Malmö Sweden

Infectious Diseases Department Hospital Universitari Bellvitge Institut de Investigació Biomedica de Bellvitge Institut Català d'Oncologia Hospitalet 08908 Barcelona Spain

Institute of Behavioral Sciences Semmelweis University 1085 Budapest Hungary

Institute of Internal and Preventive Medicine Branch of the Institute of Cytology and Genetics Siberian Branch of Russian Academy of Sciences 630090 Novosibirsk Russia

Institute of Neuroscience Hospital Clínic de Barcelona 08036 Barcelona Spain

Institute of Physiology of Komi Science Centre of the Ural Branch of the Russian Academy of Sciences 167982 Syktyvkar Russia

Institute of Psychiatry of Taras Shevchenko National University of Kyiv 01033 Kyiv Ukraine

Instituto de Investigación Valdecilla 39011 Santander Spain

Laboratory for Chronobiology and Chronomedicine Department of Biology Tyumen State Medical University 625023 Tyumen Russia

Metabolic Research Laboratory Clínica Universidad de Navarra University of Navarra IdiSNA 31008 Pamplona Spain

Parkland Klinik 34537 Bad Wildungen Germany

Psychiatry Service University of Salamanca Healthcare Complex University of Salamanca 37008 Salamanca Spain

Psychoneurobiology of Eating and Addictive Behaviors Group Neurosciences Programme Bellvitge Biomedical Research Institute 08908 Barcelona Spain

Psychotherapy and Psychopathology Research Unit Psychology Research Center School of Psychology University of Minho 4710 057 Braga Portugal

REIPI Instituto de Salud Carlos 3 28029 Madrid Spain

Safra Children's Hospital Chaim Sheba Medical Center Tel Hashomer 52 621 Israel

Schön Klinik Roseneck 83209 Prien am Chiemsee Germany

Section of Eating Disorders Department of Psychological Medicine Institute of Psychiatry Psychology and Neuroscience King's College London London WC2R 2LS UK

Tyumen Cardiology Research Institute Tomsk Research Medical Center 634009 Tyumen Russia

UFR des Sciences de la Santé Simone Veil Praticienne Hospitalière Fondation Santé des Etudiants de France 78180 Paris France

Unidad de Trastornos de la Conducta Alimentaria Hospital Universitario Marqués de Valdecilla Avda Valdecilla s n 39011 Santander Spain

Unit of Diabetes Endocrinology and Nutrition Hospital de Girona Dr Josep Trueta Institut d'Investigació Biomèdica de Girona 17007 Girona Spain

Zobrazit více v PubMed

González-Sanguino C., Ausín B., Castellanos M.Á., Saiz J., López-Gómez A., Ugidos C., Muñoz M. Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain. Brain Behav. Immun. 2020;87:172–176. doi: 10.1016/j.bbi.2020.05.040. PubMed DOI PMC

Wang C., Pan R., Wan X., Tan Y., Xu L., Ho C.S., Ho R.C. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int. J. Environ. Res. Public Health. 2020;17:1729. doi: 10.3390/ijerph17051729. PubMed DOI PMC

Rodgers R.F., Lombardo C., Cerolini S., Franko D.L., Omori M., Fuller-Tyszkiewicz M., Linardon J., Courtet P., Guillaume S. The impact of the COVID-19 pandemic on eating disorder risk and symptoms. Int. J. Eat. Disord. 2020;53:1166–1170. doi: 10.1002/eat.23318. PubMed DOI PMC

Chew Q.H., Wei K.C., Vasoo S., Chua H.C., Sim K. Narrative synthesis of psychological and coping responses towards emerging infectious disease outbreaks in the general population: Practical considerations for the COVID-19 pandemic. Singap. Med. J. 2020;61:350–356. doi: 10.11622/smedj.2020046. PubMed DOI PMC

Cao W., Fang Z., Hou G., Han M., Xu X., Dong J., Zheng J. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res. 2020;287:112934. doi: 10.1016/j.psychres.2020.112934. PubMed DOI PMC

De Girolamo G., Cerveri G., Clerici M., Monzani E., Spinogatti F., Starace F., Tura G., Vita A. Mental Health in the Coronavirus Disease 2019 Emergency—The Italian Response. JAMA Psychiatry. 2020;77:974–976. doi: 10.1001/jamapsychiatry.2020.1276. PubMed DOI

Ozamiz-Etxebarria N., Dosil-Santamaria M., Picaza-Gorrochategui M., Idoiaga-Mondragon N. Stress, Anxiety, and Depression Levels in the Initial Stage of the COVID-19 Outbreak in a Population Sample in the Northern Spain. Cad. Saúde Pública. 2020;36:e00054020. doi: 10.1590/0102-311x00054020. PubMed DOI

Todisco P., Donini L. Eating disorders and obesity (ED&O) in the COVID-19 storm. Eat. Weight. Disord. Stud. Anorex. Bulim. Obes. 2021;26:747–750. doi: 10.1007/s40519-020-00938-z. PubMed DOI PMC

Branley-Bell D., Talbot C.V. Exploring the impact of the COVID-19 pandemic and UK lockdown on individuals with experience of eating disorders. J. Eat. Disord. 2020;8:44. doi: 10.1186/s40337-020-00319-y. PubMed DOI PMC

Nisticò V., Bertelli S., Tedesco R., Anselmetti S., Priori A., Gambini O., Demartini B. The psychological impact of COVID-19-related lockdown measures among a sample of Italian patients with eating disorders: A preliminary longitudinal study. Eat. Weight. Disord. Stud. Anorex. Bulim. Obes. 2021;26:2771–2777. doi: 10.1007/s40519-021-01137-0. PubMed DOI PMC

Castellini G., Cassioli E., Rossi E., Innocenti M., Gironi V., Sanfilippo G., Felciai F., Monteleone A.M., Ricca V. The impact of COVID-19 epidemic on eating disorders: A longitudinal observation of pre versus post psychopathological features in a sample of patients with eating disorders and a group of healthy controls. Int. J. Eat. Disord. 2020;53:1855–1862. doi: 10.1002/eat.23368. PubMed DOI PMC

Msc J.D.T., Watson H.J., Thornton L.M., Borg S., Ma R.E.F., Ba C.M.M., Bs L.E.H., van Furth E., Peat C.M., Bulik C.M. Early impact of COVID-19 on individuals with self-reported eating disorders: A survey of ~1000 individuals in the United States and the Netherlands. Int. J. Eat. Disord. 2020;53:1780–1790. doi: 10.1002/eat.23353. PubMed DOI

Fernández-Aranda F., Casas M., Claes L., Bryan D.C., Favaro A., Granero R., Gudiol C., Jiménez-Murcia S., Karwautz A., Le Grange D., et al. COVID-19 and implications for eating disorders. Eur. Eat. Disord. Rev. 2020;28:239–245. doi: 10.1002/erv.2738. PubMed DOI PMC

Håkansson A., Fernández-Aranda F., Menchón J.M., Potenza M.N., Jiménez-Murcia S. Gambling During the COVID-19 Crisis – A Cause for Concern. J. Addict. Med. 2020;14:e10–e12. doi: 10.1097/ADM.0000000000000690. PubMed DOI PMC

King D.L., Delfabbro P.H., Billieux J., Potenza M.N. Problematic online gaming and the COVID-19 pandemic. J. Behav. Addict. 2020;9:184–186. doi: 10.1556/2006.2020.00016. PubMed DOI PMC

Phillipou A., Meyer D., Neill E., Tan E.J., Toh W.L., Van Rheenen T.E., Rossell S.L. Eating and exercise behaviors in eating disorders and the general population during the COVID -19 pandemic in Australia: Initial results from the COLLATE project. Int. J. Eat. Disord. 2020;53:1158–1165. doi: 10.1002/eat.23317. PubMed DOI PMC

Christensen K.A., Forbush K.T., Richson B.N., Thomeczek M.L., Perko V.L., Bjorlie K., Christian K., Ayres J., Wildes J.E., Chana S.M. Food insecurity associated with elevated eating disorder symptoms, impairment, and eating disorder diagnoses in an American University student sample before and during the beginning of the COVID-19 pandemic. Int. J. Eat. Disord. 2021;54:1213–1223. doi: 10.1002/eat.23517. PubMed DOI PMC

Touyz S., Lacey H., Hay P. Eating disorders in the time of COVID-19. J. Eat. Disord. 2020;8:19. doi: 10.1186/s40337-020-00295-3. PubMed DOI PMC

Weissman R.S., Bauer S., Thomas J.J. Access to evidence-based care for eating disorders during the COVID-19 crisis. Int. J. Eat. Disord. 2020;53:639–646. doi: 10.1002/eat.23279. PubMed DOI PMC

Baenas I., Caravaca-Sanz E., Granero R., Sánchez I., Riesco N., Testa G., Vintró-Alcaraz C., Treasure J., Jiménez-Murcia S., Fernández-Aranda F. COVID -19 and eating disorders during confinement: Analysis of factors associated with resilience and aggravation of symptoms. Eur. Eat. Disord. Rev. 2020;28:855–863. doi: 10.1002/erv.2771. PubMed DOI PMC

Machado P.P.P., Pinto-Bastos A., Ramos R., Rodrigues T.F., Louro E., Gonçalves S., Brandão I., Vaz A. Impact of COVID-19 lockdown measures on a cohort of eating disorders patients. J. Eat. Disord. 2020;8:57. doi: 10.1186/s40337-020-00340-1. PubMed DOI PMC

Vuillier L., May L., Greville-Harris M., Surman R., Moseley R.L. The impact of the COVID-19 pandemic on individuals with eating disorders: The role of emotion regulation and exploration of online treatment experiences. J. Eat. Disord. 2021;9:10. doi: 10.1186/s40337-020-00362-9. PubMed DOI PMC

Monteleone A.M., Cascino G., Marciello F., Abbate-Daga G., Baiano M., Balestrieri M., Barone E., Bertelli S., Carpiniello B., Castellini G., et al. Risk and resilience factors for specific and general psychopathology worsening in people with Eating Disorders during COVID-19 pandemic: A retrospective Italian multicentre study. Eat. Weight. Disord. Stud. Anorex. Bulim. Obes. 2021;26:2443–2452. doi: 10.1007/s40519-020-01097-x. PubMed DOI PMC

Schlegl S., Maier J., Meule A., Voderholzer U. Eating disorders in times of the COVID-19 pandemic—Results from an online survey of patients with anorexia nervosa. Int. J. Eat. Disord. 2020;53:1791–1800. doi: 10.1002/eat.23374. PubMed DOI PMC

Schlegl S., Meule A., Favreau M., Voderholzer U. Bulimia nervosa in times of the COVID -19 pandemic—Results from an online survey of former inpatients. Eur. Eat. Disord. Rev. 2020;28:847–854. doi: 10.1002/erv.2773. PubMed DOI PMC

Fernández-Aranda F., Munguía L., Mestre-Bach G., Steward T., Etxandi M., Baenas I., Granero R., Sánchez I., Ortega E., Andreu A., et al. COVID Isolation Eating Scale (CIES): Analysis of the impact of confinement in eating disorders and obesity—A collaborative international study. Eur Eat Disord Rev. 2020;28:871–883. doi: 10.1002/erv.2784. PubMed DOI PMC

Hamamura T., Heine S.J., Paulhus D.L. Cultural differences in response styles: The role of dialectical thinking. Pers. Individ. Differ. 2008;44:932–942. doi: 10.1016/j.paid.2007.10.034. DOI

English T., Chen S. Culture and self-concept stability: Consistency across and within contexts among Asian Americans and European Americans. J. Pers. Soc. Psychol. 2007;93:478–490. doi: 10.1037/0022-3514.93.3.478. PubMed DOI

American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association; Washington, DC, USA: 2013.

First M.B., Williams J.B.W., Karg R.S., Spitzer R.L. Structured Clinical Interview for DSM-5 Disorders, Clinician Version (SCID-5-CV) American Psychiatric Association; Arlington, TX, USA: 2015.

Stata-Corp Stata Statistical Software: Release 17. Statacorp; College Station, TX, USA: 2021.

Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. L. Erlbaum Associates; Hillsdale, NJ, USA: 1988.

Kelley K., Preacher K.J. On effect size. Psychol. Methods. 2012;17:137–152. doi: 10.1037/a0028086. PubMed DOI

Finner H., Roters M. On the false discovery rate and expecte type I errors. J. Am. Stat. Assoc. 2001;88:920–923. doi: 10.1080/01621459.1993.10476358. DOI

Ammar A., Brach M., Trabelsi K., Chtourou H., Boukhris O., Masmoudi L., Bouaziz B., Bentlage E., How D., Ahmed M., et al. Effects of COVID-19 Home Confinement on Eating Behaviour and Physical Activity: Results of the ECLB-COVID19 International Online Survey. Nutrients. 2020;12:1583. doi: 10.3390/nu12061583. PubMed DOI PMC

Sánchez E., Lecube A., Bellido D., Monereo S., Malagón M.M., Tinahones J.F. Leading Factors for Weight Gain during COVID-19 Lockdown in a Spanish Population: A Cross-Sectional Study. Nutrients. 2021;13:894. doi: 10.3390/nu13030894. PubMed DOI PMC

Bhutani S., Cooper J.A. COVID-19–Related Home Confinement in Adults: Weight Gain Risks and Opportunities. Obesity. 2020;28:1576–1577. doi: 10.1002/oby.22904. PubMed DOI PMC

Stevenson J.L., Krishnan S., A Stoner M., Goktas Z., A Cooper J. Effects of exercise during the holiday season on changes in body weight, body composition and blood pressure. Eur. J. Clin. Nutr. 2013;67:944–949. doi: 10.1038/ejcn.2013.98. PubMed DOI

Agüera Z., Lozano-Madrid M., Mallorquí-Bagué N., Jiménez-Murcia S., Menchón J.M., Fernández-Aranda F. A review of binge eating disorder and obesity. Neuropsychiatrie. 2021;35:57–67. doi: 10.1007/s40211-020-00346-w. PubMed DOI

Villarejo C., Fernández-Aranda F., Jiménez-Murcia S., Peñas-Lledó E., Granero R., Penelo E., Tinahones F.J., Sancho C., Vilarrasa N., Montserrat-Gil de Bernabé M., et al. Lifetime Obesity in Patients with Eating Disorders: Increasing Prevalence, Clinical and Personality Correlates. Eur. Eat. Disord. Rev. 2012;20:250–254. doi: 10.1002/erv.2166. PubMed DOI PMC

Monteleone A.M., Marciello F., Cascino G., Abbate-Daga G., Anselmetti S., Baiano M., Balestrieri M., Barone E., Bertelli S., Carpiniello B., et al. The impact of COVID-19 lockdown and of the following “re-opening” period on specific and general psychopathology in people with Eating Disorders: The emergent role of internalizing symptoms. J. Affect. Disord. 2021;285:77–83. doi: 10.1016/j.jad.2021.02.037. PubMed DOI PMC

Agüera Z., Riesco N., Valenciano-Mendoza E., Granero R., Sánchez I., Andreu A., Jiménez-Murcia S., Fernández-Aranda F. Illness perception in patients with eating disorders: Clinical, personality, and food addiction correlates. Eat. Weight. Disord.—Stud. Anorex. Bulim. Obes. 2021;26:2287–2300. doi: 10.1007/s40519-020-01083-3. PubMed DOI

Bryan D.C., Macdonald P., Ambwani S., Cardi V., Rowlands K., Willmott D., Treasure J. Exploring the ways in which COVID-19 and lockdown has affected the lives of adult patients with anorexia nervosa and their carers. Eur. Eat. Disord. Rev. 2020;28:826–835. doi: 10.1002/erv.2762. PubMed DOI PMC

Claes L., Boekaerts E., Verschueren M., Boukaert W., Luyckx K. Identity statuses in prebariatric patients with obesity: Associations with eating disorder symptoms, psychological complaints, and coping behaviour? Eur. Eat. Disord. Rev. 2019;27:410–420. doi: 10.1002/erv.2681. PubMed DOI

Riesco N., Agüera Z., Granero R., Jiménez-Murcia S., Menchón J.M., Fernández-Aranda F. Other Specified Feeding or Eating Disorders (OSFED): Clinical heterogeneity and cognitive-behavioral therapy outcome. Eur. Psychiatry. 2018;54:109–116. doi: 10.1016/j.eurpsy.2018.08.001. PubMed DOI

He M., Xian Y., Lv X., He J., Ren Y. Changes in Body Weight, Physical Activity, and Lifestyle During the Semi-lockdown Period After the Outbreak of COVID-19 in China: An Online Survey. Disaster Med. Public Heal. Prep. 2021;15:e23–e28. doi: 10.1017/dmp.2020.237. PubMed DOI PMC

Rajkumar R.P. COVID-19 and mental health: A review of the existing literature. Asian J. Psychiatry. 2020;52:102066. doi: 10.1016/j.ajp.2020.102066. PubMed DOI PMC