Impact of COVID‐19 Lockdown on Psychopathology at the Onset of Eating Disorders

Objective: Previous research has shown that the COVID-19 pandemic worsened eating-disorder (ED) symptoms, but most studies have focused on inpatients and compared only two periods: pre-COVID and the period following the pandemic's onset. Outpatient populations, particularly those with binge eating disorder (BED) and other specified feeding or eating disorders (OSFED), have been underrepresented. It remains unclear whether the pandemic influenced the clinical presentation at ED onset. This study aimed to examine differences in general and eating-disorder–related psychopathology at first presentation among outpatients with all ED diagnoses before, during, and after the COVID-19 lockdown in Italy. Methods: We retrospectively reviewed clinical records and assessment data from 400 patients seeking treatment for the first time at a specialised outpatient ED service. Patients were grouped into three periods: pre-lockdown (01.01.2019–10.06.2020), lockdown (11.06.2020–30.09.2021), and post-lockdown (01.10.2021–31.12.2022). These periods were defined to capture the effects of the lockdown while considering the DSM-5 requirement that symptoms persist for at least 3 months to establish a diagnosis. Multivariate analyzes of variance were used to evaluate the effects of period, diagnosis, and their interaction on sociodemographic characteristics, eating-disorder specific symptoms, and general psychopathology. Results: Significant differences were observed across diagnoses, including BED and OSFED. During the lockdown, patients exhibited greater concerns regarding dietary restriction, binge eating, and body, weight and shape across diagnostic groups compared with pre-lockdown. The post-lockdown period was associated with a younger age at ED onset and earlier initiation of dieting behaviours. Conclusions: By distinguishing pre-lockdown, lockdown, and post-lockdown phases and accounting for the DSM-5 diagnostic timeline, this study extends prior research beyond the conventional pre/post pandemic comparison. The COVID-19 lockdown was linked to more severe eating-disorder specific and anxiety-related symptoms at illness onset in outpatients across diagnoses, while the post-lockdown period was marked by earlier onset and increased disorder-specific concerns.