COVID blocks related to PTSD in patients with eating disorders

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COVID-19 and its resulting blockages are linked to Post traumatic stress disorder Symptoms (PTSD) and other adverse outcomes among patients with eating disorders (ED), according to two new studies.

The results of the first study show that patients with ED had more stress, anxiety, depression, and PTSD-related symptoms during blockages that your mentally healthy peers.

In the second study, the improvement in treatment-related symptoms among patients with bulimia nervosa (BN) slowed down after the blockade. In addition, patients with BN or anorexia nervosa (AN) experienced a significant worsening of specific behaviors of the disorder, including overeating and excessive exercise

Due to the strict blocking measures introduced by the Italian government to contain the COVID-19 pandemic, “the daily lives of all citizens were disrupted,” Veronica Nisticò, MS, Università Degli Studi Di Milano, Italy, told delegates. , who led the first study. attending the European Psychiatric Association (EPA) Virtual Congress 2021.

In addition to the difficulties in accessing health care, “it became difficult to go to the supermarket, the gym and have the social support we were all used to,” all of which had a well-documented impact on mental health, he said. add.

Loss of control

Previous research suggests that people with ED experience high levels of anxiety and an increase in overeating, exercise and purge eating behaviors, Nisticò said.

To investigate further, the researchers conducted a longitudinal study of changes in the prevalence of adverse outcomes. In the study, two evaluations were performed.

In the first evaluation, conducted in April 2020, the researchers evaluated 59 outpatients with ED and 43 unaffected hospital staff and their acquaintances. The second group served as the control group.

Participants completed an online survey that included several standardized scales of depression and anxiety, as well as an adapted ad hoc survey from the Eating Disorder Examination Questionnaire. Changes in restrictive diet, food control, body image, and psychological well-being were assessed compared to prepandemic levels.

The results, which were also recent published online inside Eating and weight disorders: studies on anorexia, bulimia and Obesity, showed that patients with ED had a symptom related to stress, anxiety, depression, and PTSD compared with control persons (Pg <.05 for all).

In addition, the researchers found that those with ED were more afraid of losing control over their eating behavior, spent more time thinking about food and their body, and became more uncomfortable seeing their body than before the blockage. compared to those without ED (Pg <.05).

Clinical implications

A second evaluation, which took place in June 2020, after removing blockade restrictions, included 40 patients with ED who had participated in the first evaluation. This time, participants were asked to compare their current eating behavior with their eating behavior during closure.

Although the lifting of blockade restrictions was associated with a significant improvement in PTSD-related symptoms, the impact on stress, anxiety, and depression persisted.

These findings, according to Nisticó, support the hypothesis that the specific conditions that occurred during the blockade had a direct effect on the specific symptoms of the eating disorder.

These findings, he added, should be taken into account when developing interventions for ED in the context of individual psychotherapy and when designing large preventive interventions.

In the second study, Eleonora Rossi, MD, Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy, and colleagues examined the longitudinal impact of the pandemic on individuals with SD.

They examined 74 patients with AN or BN who had undergone baseline assessments and had completed several questionnaires during the first months of 2019 along with being enrolled in another study.

Participants were treated with improved cognitive-behavioral therapy and re-evaluated between November 2019 and January 2020. They were then compared with 97 healthy individuals.

Most vulnerable patients with bulimia

After the outbreak of the pandemic, most treatments were administered online, so patients were able to continue therapy, Rossi said during his presentation.

All participants were re-evaluated in April 2020, 6 weeks after the start of the Italian closure.

The results, that were published at the International Journal of Eating Disorders, showed that patients with ED “experienced a significant improvement in terms of general and specific eating disorder psychopathology” during the first treatment period, Rossi reported. In addition, among those with AN, the body mass index increased significantly (Pg <.05 for all).

Patients with AN continued to improve during blockade when online therapy was administered. However, the improvements that had occurred among those with BN declined, Rossi noted.

In addition, both groups of patients with ED experienced a worsening of their pathological eating behaviors during blockage, in particular, excessive goal consumption and compensatory exercise (Pg <.05).

“In fact, the positive trajectory of improvement observed before the blockade was clearly interrupted during the pandemic period,” Rossi said. This could “represent a possible indication of an imminent exacerbation of the disease.”

The results also suggest that the emergence of arguments in the home and fear about the safety of loved ones predicted an increase in symptoms during closure, he added.

In addition, patients with BN reported more severe COVID-related PTSD symptoms than those with AN and the control group. This increase in the severity of symptoms was more common among patients who had a history of childhood trauma and among those with an insecure condition, suggesting that these patients may be more vulnerable.

Evidence of recovery

Commenting on the studies for Medscape Medical News, David Spiegel, MD, associate president of psychiatry at Stanford University, Palo Alto, California, noted that cardiovascular disorders usually appear after physical or sexual trauma before life.

“It’s a standard thing with trauma-related disorders that any other traumatic experience, even a relatively minor one, can exacerbate PTSD symptoms,” said Spiegel, who did not participate in the studies. In addition, the trauma of the COVID pandemic “was not minor,” he added.

“Relative isolation and lack of outside contact can further focus people with eating disorders in their struggles with how to care for their bodies,” Spiegel said.

“It struck me that the anorexia nervosa group was more impervious than the bulimia nervosa group, but I think that’s the case with the disorder. Somehow, it’s more serious, obviously it’s a more dangerous disorder. for life, ”he added.

“The hopeful thing is that there seemed to be some evidence of recovery and improvement, especially with the exacerbation of post-traumatic stress, as time went on,” Spiegel said, “and that’s good.”

The study authors and Spiegel do not report relevant financial relationships.

European Psychiatric Association (EPA) Congress 2021: Abstracts O059 and 0071. Presented April 10, 2021.

Eating Disorder. Published online February 13, 2021. Full article

J Eating Disorder. Published online August 28, 2020. Full article

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