COVID-19-Related Stress and Adolescent Anorexia Nervosa: Early Detection, Similar Illness Course

The COVID-19 pandemic was associated with a worldwide increase in hospitalizations among adolescents with anorexia nervosa (AN). The factors contributing to this remain unclear and may include alterations in healthcare systems and/or clinical factors. This study examined the possibility that pandemic-related stress led to more severe illness in adolescents with AN.

Participants included adolescents with AN and healthy controls (HC) enrolled in a longitudinal study between 2017 and 2022. Illness severity and response to treatment were compared between individuals enrolled pre-COVID-19 and mid-COVID-19, with HC providing an additional reference for community levels of mood, anxiety, and eating symptoms. Exposure to COVID-19-related stress was assessed systematically, and the effect on illness severity was evaluated.

There were no significant differences in age, body mass index (BMI), or eating disorder/depression/anxiety severity between individuals who presented for evaluation of AN pre-COVID-19 (n = 60) versus mid-COVID-19 (n = 31). Illness duration was shorter in the mid-COVID-19 group (M_mid-COVID = 0.30 ± 0.35 vs. M_pre-COVID = 0.83 ± 1.07 years, t₈₈ = 2.62, p = 0.01). Duration of restrictive eating was also shorter in the mid-COVID-19 group (M_mid-COVID = 1.4 ± 1.1 years vs. M_pre-COVID = 2.4 ± 2.1 years, t₈₈ = 2.36, p = 0.02). Individuals with AN and HC showed similar levels of COVID-related stress, and there was little association between COVID-19-related stress and symptom severity or response to treatment.

This study suggests that while the pandemic led to increased incidence and hospitalizations for AN, there may have been less impact on overall illness severity and treatment response. For some, pandemic-related circumstances might have influenced hospitalization rates more than the level of pandemic-related stress.