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COVID lockdown associated with PTSD in patients with eating disorders




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COVID-19 and the resulting blockade are linked to Post-traumatic stress disorder Two new studies show (PTSD) symptoms and other adverse consequences of patients with eating disorders (ED).

The results of the first study showed that patients with ED had more stress, anxiety, depression, And PTSD-related symptoms during blockade than mentally healthy companions.

In the second study, improvement of patient treatment-related symptoms Bulimia nervosa (BN) Slowed down after the blockade.In addition, BN or Anorexia nervosa (AN) Experienced significant deterioration of disorder-specific behaviors such as bulimia nervosa and excessive exercise

The strict blockade introduced by the Italian government to contain the COVID-19 pandemic “disrupted the daily lives of all citizens,” said Veronica Nistico, MS, Università Degli Studi of Italy, who led the first study. Di Milano told the delegation. Attended the 2021 Conference of the Virtual European Psychiatric Association (EPA).

In addition to the difficulty of accessing health care, she added, “it has become difficult to go to supermarkets and gyms, and to get the social support we all are accustomed to.”

Out of control

Previous studies have suggested that people with ED experience high levels of anxiety and increased binge eating, exercise, and purging behavior, Nisticò said.

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

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

Participants completed an online survey that included several standardized depression and anxiety measures and an extraordinary survey that was adopted from the Eating Disorders Test Questionnaire. It assessed restricted diet, food management, body image, and psychological well-being changes compared to pre-pandemic levels.

Recent results Published online To Anorexia and Weight Disorders-Anorexia, Bulimia Nervosa and obesity, Patients with ED showed significantly more stress, anxiety, depression, and PTSD-related symptoms compared to controls (P <.05 all).

In addition, people with ED are more afraid to lose control of their dietary behavior than people without ED, spend more time thinking about food and body, and are more uncomfortable looking at their bodies than they were before the blockade. The researchers found that it was (P <.05).

Clinical significance

The second assessment, conducted in June 2020, after the blockade restrictions were lifted, included 40 ED patients who participated in the first assessment. This time, participants were asked to compare their current dietary behavior with the dietary behavior during the blockade.

Lifting the blockade restriction was associated with a significant improvement in PTSD-related symptoms, but the effects on stress, anxiety, and depression persisted.

Nisticó states that these findings support the hypothesis that certain conditions that occurred during the blockade directly affected the symptoms of certain eating disorders.

She added that these findings should be considered when developing ED interventions in the context of individual psychotherapy and when designing large-scale preventive interventions.

In the second study, Eleonora Rossi, MD, Psychiatric Unit, Department of Health Sciences, University of Florence, Florence, Italy, and colleagues investigated the longitudinal effects of pandemics on patients with ED.

They surveyed 74 patients with AN or BN who underwent baseline evaluation and completed several questionnaires in the first few months of 2019, along with enrollment in another study.

Participants were treated with enhanced cognitive behavioral therapy and reassessed between November 2019 and January 2020. It was then compared to 97 healthy individuals.

Binge eating patients are more vulnerable

After the outbreak of the pandemic, most treatments were given online, allowing patients to continue treatment, Rossi said in a presentation.

All participants were reassessed in April 2020, six weeks after the start of the Italian blockade.

Result is, Release In International Journal of Eating Disorders, ED patients have shown to have “significantly improved in general and eating disorder-specific psychopathology” during the initial treatment period, Rossi reported. In addition, among people with AN, the body mass index increased significantly (P <.05 all).

Patients with AN continued to improve during the blockade when treatment was given online. However, Rossi said the improvement that occurred among BN patients slowed down.

In addition, both groups of ED patients experienced morbid deterioration of feeding behavior, especially objective bulimia nervosa and compensatory exercise, during the blockade (P <.05).

“Certainly, the positive trajectory of improvement observed before the blockade was clearly interrupted during the pandemic,” Rossi said. This can “represent a possible hint of an imminent exacerbation of the disease.”

The results also suggest that the outbreak of domestic debate and fear of the safety of loved ones predicted an increase in symptoms during the blockade, she added.

In addition, patients with BN reported more severe COVID-related PTSD symptoms than patients in the AN and control groups. The increased severity of this condition is more common between patients with a history of childhood trauma and those with unstable attachment, suggesting that such patients may be more vulnerable. doing.

Evidence of recovery

Comments on the study of Medscape Medical News, David Spiegel, MD, Vice-Chairman of Stanford University Psychiatry in Palo Alto, California, said ED generally occurs early in life after physical or sexual trauma.

“It is standard for traumatic-related disorders that even other, relatively minor traumatic experiences can exacerbate PTSD symptoms,” said Spiegel, who was not involved in the study. .. In addition, the trauma of the COVID pandemic was “not minor,” he added.

“Relative isolation and lack of contact with the outside world may focus more on many people with eating disorders in the fight against how they care for their bodies.” Spiegel said.

“I noticed that the group with anorexia nervosa is more impervious than the group with bulimia nervosa, but I think that’s the case with this disorder. In a sense, it’s more severe and obviously more life-threatening. It’s a threatening obstacle, “he added.

“The hope is that there seems to be evidence of recovery and improvement, especially with worsening post-traumatic stress, which is good,” Spiegel said.

The study author and Spiegel have not reported any relevant financial relationships.

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

Eat weight mismatch. Published online on February 13, 2021. Full article

J eats discord. Published online on August 28, 2020. Full article

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