Decoding the impact of the Covid-19 pandemic on anorexia nervosa psychopathology: A network comparison of pre- and post-pandemic onset

The COVID-19 pandemic has profoundly impacted anorexia nervosa (AN), increasing pressure on healthcare services and causing specific psychopathological changes. However, the characterization of changes in presentation patterns across the pandemic remains unclear. This study aimed to address this gap by comparing symptom networks in patients with pre- and post-pandemic AN onset. Data from 189 patients diagnosed with AN from 2016 to 2022 were analyzed. Patients were divided into pre-COVID (n = 101) and post-COVID (n = 88) onset groups. Network analysis was employed to examine interconnections among eating disorder symptoms measured by EDI-1, general psychopathology measured by SCL-90, and perceived social support. Regularized partial correlation networks were estimated and compared. The post-COVID group showed increased centrality of obsessive-compulsive symptoms and body dissatisfaction. Stronger associations were found between interoceptive awareness and obsessive-compulsive symptoms, perfectionism and body dissatisfaction, perceived support by friends and bulimic behaviors. The pre-pandemic group showed a unique connection between drive for thinness and somatization, while the post-pandemic group showed a negative association between family support and drive for thinness. These findings suggest pandemic-related factors have altered AN psychopathology and highlight the peculiar role of social relationships. Understanding these changes can enhance clinical approaches to treating AN amid ongoing and future global challenges.