Demographic and clinical characteristics of adolescent patients with eating disorders before and during the Covid-19 pandemic

Int J Adolesc Med Health. 2025 Oct 28. doi: 10.1515/ijamh-2025-0046. Online ahead of print.

ABSTRACT

PURPOSE: It is known that the frequency of eating disorders (EDs) increased during the Covid-19 pandemic. This study evaluates the presentation of demographic/clinical characteristics of patients with EDs during the pandemic, and compares them to those that presented during 2014-2015.

METHODS: Our division conducted a study on EDs in adolescent patients presenting from May 2014 to April 2015. That study examined presenting demographic/clinical variables. This current study looked at those same variables for patients presenting from September 2020 to May 2021, during the pandemic. The variables were compared.

RESULTS: 285 patients (23.8/month) presented for an ED evaluation beginning May 2014: Earlier Group (EG); 365 patients (40.6/month) presented during the pandemic: Covid Group (CG). The following differences were found: (1) 81 % of EG and 70 % in CG identified as White (p<0.001). (2) Atypical Anorexia Nervosa (AAN) was diagnosed in 23.2 % of EG and 36.4 % of CG – Avoidant Restrictive Food Intake Disorder (ARFID) was diagnosed in 16.1 % of EG and 21.0 % of CG (p<0.001). The frequency of AAN patients/month nearly tripled and ARFID doubled. (3) 34.0 % of EG had a history of anxiety compared with 41.9 % in CG (p<0.05), and this increase in anxiety was seen primarily in patients with AAN and ARFID. (4) In EG, 60.0 % were scheduled to return in 1 week and 23.9 % in 2 weeks, while in CG 32.1 % were scheduled to return in 1 week and 42.2 % in 2 weeks (p<0.001), and this difference was seen primarily in patients with AN and ARFID. There was no significant difference in age, gender, weight, BMI, illness length, menstrual status, ED behaviors, medications and history of OCD/depression between the groups.

DISCUSSION: The presentation of EDs in adolescents rose dramatically during the pandemic, prompting a question of if and what changed in characteristics about EDs. Although the nature of the disorder remained largely the same pre-pandemic and during the pandemic, there were some noted demographic and clinical differences. Some of these may be pandemic related – worsening adolescent mental health increased ED prevalence, so return visits were spaced farther apart. Other differences reflect societal changes – a wider racial distribution may represent the increased diversity of the NYC area; increased AAN may represent the increase in overweight patients during the pandemic; the rise in co-morbid anxiety correlates with increased prevalence of mental health issues during the pandemic. Further research needs to be done to address the evolving qualities and characteristics of EDs.

PMID:41140004 | DOI:10.1515/ijamh-2025-0046