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. 2025 Jun;58(6):1155-1164.
doi: 10.1002/eat.24431. Epub 2025 Mar 26.

Impact of the COVID-19 Pandemic on the Incidence of Anorexia and Bulimia Nervosa in Dutch Primary Care

K Meier  1   2 , D van Hoeken  1 , C C M Kager  3 , A E van Eeden  1   2 , A J Oldehinkel  2 , H W Hoek  1   2   4
Affiliations

Impact of the COVID-19 Pandemic on the Incidence of Anorexia and Bulimia Nervosa in Dutch Primary Care

K Meier et al. Int J Eat Disord. 2025 Jun.

Abstract

Objective: This study examined the impact of the COVID-19 pandemic on incidence rates of anorexia nervosa (AN) and bulimia nervosa (BN) in Dutch primary care by comparing pre-pandemic (2015-2019) and in-pandemic (2020-2022) periods. We hypothesized that the incidence of AN and BN would increase during the pandemic.

Method: This retrospective cohort study used data from general practitioners' electronic health records from the Nivel Primary Care Database, representing ~0.8% of the Dutch population. Incident AN and BN cases were identified using DSM-5 criteria. Incidence rates (IR) per 100,000 person-years were calculated and compared using incidence rate ratios (IRRs).

Results: Overall incidence rates of AN and BN did not increase significantly during the pandemic (AN: IRR = 1.2, 95% CI = 0.8-1.8; BN: IRR = 0.9, 95% CI = 0.5-1.8). Non-significant increases in AN were observed among females overall (+29%, IRR = 1.3, 95% CI = 0.9-2.0) and among 10- to 14-year-old females (+28%, IRR = 1.3, 95% CI = 0.4-3.7). The BN incidence decreased significantly among females aged 20-24 years from 53.8 to 10.7 per 100,000 person-years (IRR = 0.2, 95% CI = 0.0-0.9).

Discussion: Contrary to our hypothesis, we did not find increased incidence rates during the pandemic. The overall incidence of AN among females increased non-significantly by 29%. The previously observed rising trend in AN among 10- to 14-year-old females in 1985-2019 did not have a significant sequel into the pandemic era, although it increased by 28%. The BN incidence remained stable overall and decreased significantly among young adult females.

Keywords: anorexia nervosa; bulimia nervosa; covid‐19; eating disorders; epidemiology; incidence; primary care.

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Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Anderson, K. N. , Radhakrishnan L., Lane R. I., et al. 2022. “Changes and Inequities in Adult Mental Health‐Related Emergency Department Visits During the COVID‐19 Pandemic in the US.” JAMA Psychiatry 79, no. 5: 475–485. 10.1001/jamapsychiatry.2022.0164. - DOI - PMC - PubMed
    1. Anderson, M. , and Jiang J.. 2018. Teens, Social Media & Technology 2018. Pew Research Center. https://www.pewresearch.org/internet/2018/05/31/teens‐social‐media‐techn....
    1. Bittner Gould, J. , Walter H. J., Bromberg J., Correa E. T., Hatoun J., and Vernacchio L.. 2022. “Impact of the Coronavirus Disease 2019 Pandemic on Mental Health Visits in Pediatric Primary Care.” Pediatrics 150, no. 6: e2022057176. 10.1542/peds.2022-057176. - DOI - PubMed
    1. Branley‐Bell, D. , and Talbot C. V.. 2020. “Exploring the Impact of the COVID‐19 Pandemic and UK Lockdown on Individuals With Experience of Eating Disorders.” Journal of Eating Disorders 8, no. 44: 1–12. 10.1186/s40337-020-00319-y. - DOI - PMC - PubMed
    1. Breton, É. , Dufour R., Côté S. M., et al. 2022. “Developmental Trajectories of Eating Disorder Symptoms: A Longitudinal Study From Early Adolescence to Young Adulthood.” Journal of Eating Disorders 10, no. 1: 84. 10.1186/s40337-022-00603-z. - DOI - PMC - PubMed