Parallel Increase in Childhood Anorexia Nervosa and Early Puberty During the COVID-19 Pandemic

During the COVID-19 pandemic, an increase in anorexia nervosa (AN), specifically childhood AN, as well as in central precocious puberty (CPP) and early-onset puberty (EOP), was reported. The aim of this study was to explore whether there was a population-level association between increases in both disorders and to discuss possible underlying causes.

Data were retrieved from the largest health insurance institution in Germany comprising approximately 3.5 million children between 0 and 14 years for the years 2019-2023. All female cases with a diagnosis of AN/atypical AN and those with CPP/EOP according to ICD-10 were included. To investigate possible specificity of associations, we also examined associations with depressive disorders (DD) and anxiety disorders (AD).

Decreasing and increasing numbers of cases with EOP, CPP, and childhood AN/atypical AN showed a similar pattern during the COVID-19 pandemic. The number of diagnosed cases of AN/atypical AN combined with either CPP (Spearman's ρ = 0.45; p = 0.02), EOP (Spearman's ρ = 0.60; p = 0.003), or combined CPP/EOP (Spearman's ρ = 0.53; p = 0.008) in this time span was highly and significantly correlated. Associations with CPP/EOP were generally stronger for AN/atypical AN than for DD (Spearman's ρ = 0.45; p = 0.02) or AD (Spearman's ρ = 0.29; p = 0.11).

The highly increasing prevalence of childhood AN, EOP, and CCP may reflect pandemic-associated stress and lifestyle changes and/or their effects on reproductive functioning. Pre- and peripubertal girls seem to be especially vulnerable to these environmental stressors and might react with important physical and mental impairments.