How Is the History of Early Traumatic Exposure Associated With the Psychopathological Outcomes of COVID-19 Related Lockdown and Subsequent Re-opening in People With Eating Disorders?

Giammarco Cascino,Patrizia Zeppegno,Sara Bertelli,Francesca Marciello,Caterina Renna,Angela Favaro,Valdo Ricca,Pierandrea Salvo,Alessio Maria Monteleone,Bernardo Carpiniello,Cristina Segura-Garcia,Giulio Corrivetti,Patrizia Todisco,Palmiero Monteleone,Matteo Balestrieri,Umberto Volpe,Giovanni Abbate-Daga

doi:10.3389/fpsyt.2021.789344

Abstract

The negative impact of COVID-19 pandemic on people with Eating Disorders (EDs) has been documented. The aim of this study was to evaluate whether a history of traumatic experiences during childhood or adolescence was associated with a higher degree of psychopathological worsening during COVID-19 related lockdown and in the following re-opening period in this group of people. People with EDs undergoing a specialist ED treatment in different Italian services before the spreading of COVID-19 pandemic (n = 312) filled in an online survey to retrospectively evaluate ED specific and general psychopathology changes after COVID-19 quarantine. Based on the presence of self-reported traumatic experiences, the participants were split into three groups: patients with EDs and no traumatic experiences, patients with EDs and childhood traumatic experiences, patients with EDs and adolescent traumatic experiences. Both people with or without early traumatic experiences reported retrospectively a worsening of general and ED-specific psychopathology during the COVID 19-induced lockdown and in the following re-opening period. Compared to ED participants without early traumatic experiences, those with a self-reported history of early traumatic experiences reported heightened anxious and post-traumatic stress symptoms, ineffectiveness, body dissatisfaction, and purging behaviors. These differences were seen before COVID-19 related restrictions as well as during the lockdown period and after the easing of COVID-19 related restrictions. In line with the “maltreated ecophenotype” theory, these results may suggest a clinical vulnerability of maltreated people with EDs leading to a greater severity in both general and ED-specific symptomatology experienced during the exposure to the COVID-19 pandemic.

Highlights

The outbreak of coronavirus disease 2019 (COVID-19) pandemic has led to a dramatic loss of human life worldwide and presents an unprecedented challenge to public health, food systems and the world of work
Patients previously admitted to specialist ED units located in different regions of Italy and diagnosed with anorexia nervosa (AN), atypical AN, bulimia nervosa (BN), binge-eating disorder (BED), and other specified feeding or eating disorders (OSFED) according to the DSM-5 criteria were asked to fill in an anonymous online survey
The present study investigated changes in general and specific psychopathology during the COVID-19 related restrictions and in the following re-opening period in a large population of Italian patients with EDs with or without a history of early traumatic experiences

Summary

Introduction

The outbreak of coronavirus disease 2019 (COVID-19) pandemic has led to a dramatic loss of human life worldwide and presents an unprecedented challenge to public health, food systems and the world of work. Increased exposition to the Internet and social media messages contributed to the fear of being infected [8,9,10,11,12]. A marked impairment in general psychopathological symptoms has been observed in these patients, which tended to persist after the easing of COVID19 related restrictions [54, 55]. Several factors, such as social isolation, family conflict, disruption in routine activities, and everyday life, heightened exposure to ED-specific media messages and fear of contagion, may have contributed to the vulnerability of people with EDs to the impact of COVID-19 pandemic [50, 56]

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