Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
As Feinmann points out, the impact of the pandemic on disordered eating is striking and appears to be international (1). Reports from North America and Europe accord with our observations in New Zealand of distinct increases in both adult and paediatric patients requiring treatment. Relevant mechanisms, yet to be confirmed, are crucial to identify in order to guide the effective management of these disabling and potentially lethal disorders.
Feinmann’s conference report includes the suggestion that “enforced social avoidance” during lockdowns may occur at a crucial developmental stage and thereby cause increased disordered eating in children. Our experience, by contrast, is that the surge in clinical demand for adults rivals that of children, consistent with the idea that lockdown environments exert a powerful influence regardless of age. This accords with evidence that social disruption and altered home environments are common triggering themes (2,3). We further suggest that it is the uncontrollable disruption of social relationships, rather than isolation per se, that drives the problem. In our experience, and as described in India (1), increased (and unwelcome) social contact during lockdown also appears to have triggered serious exacerbations of disordered eating.
We observed higher numbers of ‘new’ patient presentations in both adults and children following lockdown, suggesting that an increased incidence of eating disorders may be occurring alongside exacerbations of existing disorders (4,5). While children are more likely to be early in their disease trajectory, many adults we saw during this time were experiencing a first inpatient admission, consistent with the idea that what is driving the problem is more linked to social disruption than developmental stage.
Finally, we note that anorexia nervosa is the predominant diagnosis in our inpatient and outpatient lists seen during and following lockdown. This extends the article’s rather limited focus on binge-eating and purging in adults (1). Given the mortality associated with restrictive eating disorders (6), we suggest that an increased pandemic-related prevalence of anorexia nervosa should be an urgent concern for clinicians, service planners, patients, and their families.
1. Feinmann J. Eating disorders during the covid-19 pandemic. BMJ. 2021;374:n1787. doi: 10.1136/bmj.n1787.
2. Rodgers RF, Lombardo C, Cerolini S, Franko DL, Omori M, Fuller-Tyszkiewicz M, Linardon J, Courtet P, Guillaume S. The impact of the COVID-19 pandemic on eating disorder risk and symptoms. Int J Eat Disord. 2020;53:1166-1170. doi: 10.1002/eat.23318.
3. Vuillier L, May L, Greville-Harris M, Surman R, Moseley RL. The impact of the COVID-19 pandemic on individuals with eating disorders: the role of emotion regulation and exploration of online treatment experiences. J Eat Disord. 2021;9:10. doi: 10.1186/s40337-020-00362-9.
4. Machado PPP, Pinto-Bastos A, Ramos R, Rodrigues TF, Louro E, Gonçalves S, Brandão I, Vaz A. Impact of COVID-19 lockdown measures on a cohort of eating disorders patients. J Eat Disord. 2020;8:57. doi: 10.1186/s40337-020-00340-1
5. Phillipou A, Meyer D, Neill E, Tan EJ, Toh WL, Van Rheenen TE, Rossell SL. Eating and exercise behaviors in eating disorders and the general population during the COVID-19 pandemic in Australia: Initial results from the COLLATE project. Int J Eat Disord. 2020;53:1158-1165. doi: 10.1002/eat.23317
6. Papadopoulos F, Ekbom A, Brandt L, Ekselius L. Excess mortality, causes of death and prognostic factors in anorexia nervosa. British Journal of Psychiatry. 2009;194:10-17. doi:10.1192/bjp.bp.108.054742
What drives the pandemic-related surge in disordered eating?
Dear Editor
As Feinmann points out, the impact of the pandemic on disordered eating is striking and appears to be international (1). Reports from North America and Europe accord with our observations in New Zealand of distinct increases in both adult and paediatric patients requiring treatment. Relevant mechanisms, yet to be confirmed, are crucial to identify in order to guide the effective management of these disabling and potentially lethal disorders.
Feinmann’s conference report includes the suggestion that “enforced social avoidance” during lockdowns may occur at a crucial developmental stage and thereby cause increased disordered eating in children. Our experience, by contrast, is that the surge in clinical demand for adults rivals that of children, consistent with the idea that lockdown environments exert a powerful influence regardless of age. This accords with evidence that social disruption and altered home environments are common triggering themes (2,3). We further suggest that it is the uncontrollable disruption of social relationships, rather than isolation per se, that drives the problem. In our experience, and as described in India (1), increased (and unwelcome) social contact during lockdown also appears to have triggered serious exacerbations of disordered eating.
We observed higher numbers of ‘new’ patient presentations in both adults and children following lockdown, suggesting that an increased incidence of eating disorders may be occurring alongside exacerbations of existing disorders (4,5). While children are more likely to be early in their disease trajectory, many adults we saw during this time were experiencing a first inpatient admission, consistent with the idea that what is driving the problem is more linked to social disruption than developmental stage.
Finally, we note that anorexia nervosa is the predominant diagnosis in our inpatient and outpatient lists seen during and following lockdown. This extends the article’s rather limited focus on binge-eating and purging in adults (1). Given the mortality associated with restrictive eating disorders (6), we suggest that an increased pandemic-related prevalence of anorexia nervosa should be an urgent concern for clinicians, service planners, patients, and their families.
1. Feinmann J. Eating disorders during the covid-19 pandemic. BMJ. 2021;374:n1787. doi: 10.1136/bmj.n1787.
2. Rodgers RF, Lombardo C, Cerolini S, Franko DL, Omori M, Fuller-Tyszkiewicz M, Linardon J, Courtet P, Guillaume S. The impact of the COVID-19 pandemic on eating disorder risk and symptoms. Int J Eat Disord. 2020;53:1166-1170. doi: 10.1002/eat.23318.
3. Vuillier L, May L, Greville-Harris M, Surman R, Moseley RL. The impact of the COVID-19 pandemic on individuals with eating disorders: the role of emotion regulation and exploration of online treatment experiences. J Eat Disord. 2021;9:10. doi: 10.1186/s40337-020-00362-9.
4. Machado PPP, Pinto-Bastos A, Ramos R, Rodrigues TF, Louro E, Gonçalves S, Brandão I, Vaz A. Impact of COVID-19 lockdown measures on a cohort of eating disorders patients. J Eat Disord. 2020;8:57. doi: 10.1186/s40337-020-00340-1
5. Phillipou A, Meyer D, Neill E, Tan EJ, Toh WL, Van Rheenen TE, Rossell SL. Eating and exercise behaviors in eating disorders and the general population during the COVID-19 pandemic in Australia: Initial results from the COLLATE project. Int J Eat Disord. 2020;53:1158-1165. doi: 10.1002/eat.23317
6. Papadopoulos F, Ekbom A, Brandt L, Ekselius L. Excess mortality, causes of death and prognostic factors in anorexia nervosa. British Journal of Psychiatry. 2009;194:10-17. doi:10.1192/bjp.bp.108.054742
Competing interests: No competing interests