(PS8-A9) Examining Eating Disorder Severity and Symptoms Before and During the COVID-19 Pandemic Among Patients Presenting to an Outpatient Eating Disorder Clinic in Boston, MA, USA

Increased isolation and media messaging highlighting weight-gain during the COVID-19 pandemic may have exacerbated eating disorder (ED) behaviors. We examined overall ED severity and excessive exercise (EE) among those who presented for an intake evaluation at a Boston, MA, USA outpatient ED clinic before and during the pandemic. We completed exploratory analyses regarding age of onset and illness duration and hypothesized: 1) ED severity would increase during COVID; 2) EE would show the greatest increase during mandatory quarantines compared to the pre-COVID time period and the observed increases in EE would no longer be significant once quarantine mandates were lifted; 3) Anxiety would be higher during COVID and more strongly correlated with ED severity and impairment. All patients presenting to the clinic completed presentation-specific measures of ED severity (Eating Disorder Examination Questionnaire (EDE-Q); Excessive Exercise (EE) Subscale of the Eating Pathology Symptoms Inventory; Nine-Item ARFID Screen (NIAS)), an anxiety measure (State-Trait Anxiety Inventory (STAI)), and the Clinical Impairment Assessment questionnaire (CIA). We created three timelines to reflect patient groups who were referred for treatment during different phases of the pandemic: Pre-COVID (n=85): April 2018 - January 2020; COVID (n=84): April 2020 - January 2022; peak-COVID (n=43) April 2020 - May 2021. Group-comparisons between defined time periods and outcome measures were computed with ANOVA/ANCOVA, and within time-period correlations were run to compare relationships between anxiety and ED severity/impairment scores with between-group Fisher Z tests. Models were corrected for multiple comparisons (corrected p = 0.016). Scores on the EE subscale in peak-COVID compared to pre-COVID were higher (F=6.152, p=.015, η2= .078), and were driven by peak-COVID as pre-COVID and COVID EE were not significantly different (F=1.696, p=.196, η2= .017). We did not find significant group differences between pre-COVID and COVID on EDE-Q, NIAS, STAI, and CIA scores. Associations between STAI and CIA scores and STAI and EDE-Q scores were stronger after pandemic onset, but were not significantly different from pre-COVID (z=-2.097, p=0.018; z=-1.165, p=0.122, respectively). Our exploratory aims demonstrated that the COVID group was younger (F=3.941, p=.049) with a shorter duration of illness (controlling for age) (F=3.891, p=.05) compared to the pre-COVID group. Findings suggest quarantine guidelines exacerbated EE, possibly due to increased isolation and media messaging surrounding quarantine-induced weight gain. Anxiety during COVID was more strongly associated with ED-related impairment, suggesting that due to higher trait anxiety during COVID, ED pathology became more disabling. Further, those evaluated during COVID were younger and had a short illness duration, which may imply that increased time at home contributed to quicker ED identification by family members. Due to the ongoing nature of the COVID-19 pandemic, additional research is needed to further elucidate the long-term impact of the pandemic on individuals with EDs.


Figure 1.