Clinical outcomes of restricting-type anorexia nervosa onset in female adolescents and young adults aged 12–24 years during Japan’s first COVID-19 state of emergency

BACKGROUND: Our previous research indicated that patients with self-reported onset of eating disorders (EDs) during Japan's first state of emergency (declared April 7, 2020) for COVID-19 were significantly Eyounger at presentation and had a shorter illness duration, which potentially facilitated earlier clinical intervention. Since early consultation is often associated with better prognosis in anorexia nervosa (AN), we hypothesized that patients with AN development during the first state of emergency would exhibit more favorable outcomes. METHODS: This age-adjusted comparative study included 36 female adolescent and young adult patients (aged 12-24 years) with restricting-type AN (AN-R) diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria. Both inpatients and outpatients were included and categorized into three groups: those who visited the hospital before (Before group, n = 12) and after (After group, n = 12) the emergency declaration and those with self-reported symptom onset during the first state of emergency (During group, n = 12). Patients were evaluated at their initial visit (T0) and 3 (T1), 6 (T2), and 12 months (T3) thereafter using the Global Clinical Score (GCS) and percent standard weight as outcome measures. Psychological characteristics at T0 were assessed using the Parental Bonding Instrument (PBI) and Eating Disorder Inventory (EDI). RESULTS: The During group demonstrated significantly earlier improvement compared to the other two groups. Specifically, GCS scores at T1 were significantly lower in the During group (Before vs. During: 11 vs. 9, p = 0.006; After vs. During: 11 vs. 9, p = 0.0030), indicating a large effect. Percent standard body weight at T2 was significantly higher in the During group than in the After group (After vs. During: 73 vs. 83.5, p = 0.01), exhibiting a large effect. EDI and PBI scores were comparable among groups. CONCLUSION: Patients whose patient-reported AN-R symptom onset occurred during the first state of emergency showed a faster recovery trajectory than did those who presented before or after the emergency, consistent with our hypothesis. Increased time spent at home with family during the "stay-at-home" period may have contributed to earlier medical consultation and subsequent recovery, although this interpretation remains speculative. These findings highlight the importance of early intervention in AN treatment.