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Updated: Apr 30, 2026
A Computer-Based Platform for Aiding Clinicians in Eating Disorder Analysis and Diagnosis
Published on: May 10, 2022
Impact of COVID-19 Lockdown on Psychopathology at the Onset of Eating Disorders
Elvira Anna Carbone1, Cristiano Dani2, Matteo Geraci1
1Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy.
Insights
The COVID-19 lockdown intensified eating disorder (ED) symptoms like dietary restriction and binge eating in outpatients. Post-lockdown, patients presented with earlier onset of ED and increased concerns regarding body image and weight.
Area of Science:
- Psychiatry
- Clinical Psychology
- Public Health
Background:
- The COVID-19 pandemic exacerbated eating disorder (ED) symptoms, yet research predominantly focused on inpatients, neglecting outpatient populations like those with binge eating disorder (BED) and other specified feeding or eating disorders (OSFED).
- Limited understanding exists regarding the pandemic's influence on the initial clinical presentation of EDs, particularly across different diagnostic groups and temporal phases relative to the lockdown.
Purpose of the Study:
- To investigate variations in general and ED-specific psychopathology at the first presentation among outpatients with diverse ED diagnoses.
- To compare these presentations across three distinct periods: pre-lockdown, during lockdown, and post-lockdown in Italy.
Main Methods:
- Retrospective analysis of clinical records and assessment data from 400 first-time outpatient ED service attendees.
- Categorization of patients into pre-lockdown (Jan 2019–June 2020), lockdown (June 2020–Sept 2021), and post-lockdown (Oct 2021–Dec 2022) periods, aligning with DSM-5 diagnostic criteria duration.
- Multivariate analyses of variance (MANOVAs) to assess the impact of period, diagnosis, and their interaction on sociodemographic, ED-specific, and general psychopathology.
Main Results:
- Significant diagnostic differences were observed, particularly for BED and OSFED.
- During the lockdown, patients across all diagnostic groups reported increased concerns related to dietary restriction, binge eating, and body/weight/shape compared to the pre-lockdown period.
- The post-lockdown phase was characterized by a younger age at ED onset and earlier initiation of dieting behaviors.
Conclusions:
- This study differentiates the pre-lockdown, lockdown, and post-lockdown phases, offering a more nuanced view than simple pre/post pandemic comparisons.
- The COVID-19 lockdown correlated with more severe ED-specific and anxiety-related symptoms at illness onset for outpatients across diagnoses.
- The post-lockdown period showed trends toward earlier ED onset and heightened disorder-specific concerns.
Objective:
Previous research has shown that the COVID-19 pandemic worsened eating-disorder (ED) symptoms, but most studies have focused on inpatients and compared only two periods: pre-COVID and the period following the pandemic's onset. Outpatient populations, particularly those with binge eating disorder (BED) and other specified feeding or eating disorders (OSFED), have been underrepresented. It remains unclear whether the pandemic influenced the clinical presentation at ED onset. This study aimed to examine differences in general and eating-disorder-related psychopathology at first presentation among outpatients with all ED diagnoses before, during, and after the COVID-19 lockdown in Italy.
Methods:
We retrospectively reviewed clinical records and assessment data from 400 patients seeking treatment for the first time at a specialised outpatient ED service. Patients were grouped into three periods: pre-lockdown (01.01.2019-10.06.2020), lockdown (11.06.2020-30.09.2021), and post-lockdown (01.10.2021-31.12.2022). These periods were defined to capture the effects of the lockdown while considering the DSM-5 requirement that symptoms persist for at least 3 months to establish a diagnosis. Multivariate analyzes of variance were used to evaluate the effects of period, diagnosis, and their interaction on sociodemographic characteristics, eating-disorder specific symptoms, and general psychopathology.
Results:
Significant differences were observed across diagnoses, including BED and OSFED. During the lockdown, patients exhibited greater concerns regarding dietary restriction, binge eating, and body, weight and shape across diagnostic groups compared with pre-lockdown. The post-lockdown period was associated with a younger age at ED onset and earlier initiation of dieting behaviours.
Conclusions:
By distinguishing pre-lockdown, lockdown, and post-lockdown phases and accounting for the DSM-5 diagnostic timeline, this study extends prior research beyond the conventional pre/post pandemic comparison. The COVID-19 lockdown was linked to more severe eating-disorder specific and anxiety-related symptoms at illness onset in outpatients across diagnoses, while the post-lockdown period was marked by earlier onset and increased disorder-specific concerns.
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