The impact of COVID-19 lockdown and of the following "re-opening" period on specific and general psychopathology in people with Eating Disorders: the emergent role of internalizing symptoms

BACKGROUND: We assessed the impact of the coronavirus disease 2019 (COVID-19) pandemic on specific Eating Disorder (ED) and general psychopathology in people with an ED diagnosis during the lockdown period and after the end of the related containment measures.METHODS: People with clinically defined diagnosis and undergoing treatment for an ED completed an online survey, which included adapted questions from standardized psychometric scales. Data relative to three different time periods (before, during and after the end of lockdown) were collected. Psychopathological changes over these periods were investigated and compared through one-way analysis of variance or covariance with repeated measures.RESULTS: Three hundred twelve people completed the survey (57.4% diagnosed with Anorexia Nervosa (AN) or atypical AN, 20.2% with Bulimia Nervosa, 15.4% with Binge Eating Disorder, 7.05% with Other Specified Feeding or Eating Disorders). The severity of both specific and general psychopathology increased during the lockdown and the rise of general symptoms persisted in the following re-opening phase, except for suicide ideation. Almost all of these findings were not affected by ED diagnosis, participants' age and illness duration.LIMITATIONS: The retrospective nature of data collection is the main limitation of the study.CONCLUSIONS: People with EDs showed a COVID-19 emergency-induced worsening of both general and specific psychopathology. The effect on general psychopathology persisted in the re-opening period. These findings suggest a high stress vulnerability of ED individuals with important effects on internalizing symptoms, which are worth of attention by clinicians

Microbiota in anorexia nervosa: The triangle between bacterial species, metabolites and psychological tests

<div><p>Anorexia nervosa (AN) is a psychiatric disease with devastating physical consequences, with a pathophysiological mechanism still to be elucidated. Metagenomic studies on anorexia nervosa have revealed profound gut microbiome perturbations as a possible environmental factor involved in the disease. In this study we performed a comprehensive analysis integrating data on gut microbiota with clinical, anthropometric and psychological traits to gain new insight in the pathophysiology of AN. Fifteen AN women were compared with fifteen age-, sex- and ethnicity-matched healthy controls. AN diet was characterized by a significant lower energy intake, but macronutrient analysis highlighted a restriction only in fats and carbohydrates consumption. Next generation sequencing showed that AN intestinal microbiota was significantly affected at every taxonomic level, showing a significant increase of <i>Enterobacteriaceae</i>, and of the archeon <i>Methanobrevibacter smithii</i> compared with healthy controls. On the contrary, the genera <i>Roseburia</i>, <i>Ruminococcus</i> and <i>Clostridium</i>, were depleted, in line with the observed reduction in AN of total short chain fatty acids, butyrate, and propionate. Butyrate concentrations inversely correlated with anxiety levels, whereas propionate directly correlated with insulin levels and with the relative abundance of <i>Roseburia inulinivorans</i>, a known propionate producer. BMI represented the best predictive value for gut dysbiosis and metabolic alterations, showing a negative correlation with <i>Bacteroides uniformis</i> (microbiota), with alanine aminotransferase (liver function), and with psychopathological scores (obsession-compulsion, anxiety, and depression), and a positive correlation with white blood cells count. In conclusion, our findings corroborate the hypothesis that the gut dysbiosis could take part in the AN neurobiology, in particular in sustaining the persistence of alterations that eventually result in relapses after renourishment and psychological therapy, but causality still needs to be proven.</p></div

Raw scores for psychopathological assessment.

<p>Raw scores for psychopathological assessment.</p

Distance-based redundancy analysis (db-RDA).

<p>Db-RDA plot shows correlations between gut microbiota composition and body mass index (BMI), insulin, propionate and butyrate. Only significant variables are represented (p>0.05, Permanova analysis). Arrows in the db-RDA biplot denote the magnitudes and directions of the variable effects. Controls are represented by blue dots and anorexic subjects by red dots.</p

Fecal SCFA concentrations in anorexia nervosa subjects and healthy control group.

<p>Fecal SCFA concentrations in anorexia nervosa subjects and healthy control group.</p

Taxa significantly increased (+) or decreased (-) in abundance in anorexia nervosa subjects.

<p>Taxa significantly increased (+) or decreased (-) in abundance in anorexia nervosa subjects.</p

Characteristics of the study population.

<p>Characteristics of the study population.</p

Redundancy analysis (RDA) of gut microbiota.

<p>RDA shows a separation between anorexia nervosa (AN, red dots) and control (CTR, blue dots) subjects.</p

Relative abundance of common microbial taxa.

<p>Bar charts showing the relative abundance of the most represented microbial taxa, defined as having a mean relative abundance of >1%, in stool samples of anorexia nervosa (AN, n = 15) and control (CTR, n = 15) groups. Phylum-level (<b>a</b>) and family-level (<b>b</b>) taxon profiles are shown.</p