Background: The COVID-19 pandemic, associated with confinement and social isolation, seems to have impacted the course of many mental disorders in children and adolescents. An increase in hospital admission rates for juvenile anorexia nervosa (AN) has been documented in many regions of the world. However, data from Europe are scarce. Methods: We asked clinicians in specialized eating disorder units in hospitals of maximum care in France, Germany, Italy, Spain, Sweden, and the Netherlands to report on (i) overall (inpatient and outpatient) and (ii) inpatient admission rates for adolescents with AN during 2019 and 2020. Additionally, a modified version of the COVID Isolation Eating Scale (CIES) was used to assess the child and adolescent psychiatrists’ estimations of a possible increase in symptom severity in children and adolescents with AN during the COVID-19 pandemic and to (iii) inquire about the contributing factors perceived by the caring professionals. Results: Four out of six representatives of European hospitals described a higher rate of overall admissions during the pandemic. Three hospitals out of six reported an increase in inpatient admissions, and two centres had constant high numbers of admissions of both outpatients and inpatients. The clinicians perceived a higher symptom severity in 2020 than in 2019, especially involving more frequent use of social media, longer duration of exercising, and more restrictive eating. They supposed an increase in social media consumption, a perceived “loss of control”, and a lack of in-person assessments and weight controls as the main contributing factors for the deterioration in AN numbers and symptomatology. Conclusions: The COVID-19 pandemic seems to have had a deep impact on symptom severity in AN, which is mirrored by a large increase in admission rates across Europe. An increase in exercise, social media consumption, a perceived “loss of control”, and a lack of face-to-face health care seem to have contributed to this development. Further investigation is required to identify which factors may lead to the increase in incidence and deterioration of childhood and adolescent AN. Possible preventive means for the future could include educating paediatricians and health care workers about AN, regular weight assessment, and home-based treatments.

Genetic variants within the dopamine D4 receptor gene (DRD4) are among the strongest and most consistently replicated molecular genetic findings in attentional functioning as well as attention deficit hyperactivity disorder (ADHD). Functionally, the 7-repeat allele of the DRD4-48 base pair repeat gene leads to a sub-sensitive postsynaptic D4 receptor, which is expressed at a particularly high density in the frontal lobes. We used fMRI to investigate the influence of the 7-repeat allele on BOLD (Blood Oxygen Level Dependency) responses in 26 healthy children and adolescents while they performed a combined stimulus-response Incompatibility Task (IC) and a Time Discrimination Task (TT). 7-repeat non-carriers exhibited increased neural activation of the left middle and inferior frontal gyrus (IFG) in the IC and greater cerebellar activation in the TT. Furthermore, the 7-repeat non-carriers exhibited a stronger coupling in haemodynamic responses between left IFG and the anterior cingulate cortex (ACC) during the IC and between cerebellar activation and brain regions that have high DRD4 density, including the IFG and the ACC during the TT. Our results indicate that the 7-repeat allele influences both regional brain activation patterns as well as connectivity patterns between neural networks of incompatibility and temporal processing.

(1) Background: the COVID-19 pandemic and subsequent confinements have led to a dramatic increase in anorexia nervosa (AN) in adolescent patients, whereas the effect on symptom severity and the influencing factors are not yet clear, especially not from the adolescents’ perspective. (2) Methods: from February to October 2021, 38 adolescent patients with AN completed an adjusted version of the COVID Isolation Eating Scale (CIES), a self-report questionnaire asking for ED symptomatology before and during the COVID-19 pandemic and for their experiences with remote treatment. (3) Results: patients reported a significant negative impact of confinement on ED symptoms, depression, anxiety, and emotional regulation. During the pandemic, engagement with weight and body image was related to social media, and mirror checking increased. The patients were more preoccupied with cooking recipes and had more eating-related conflicts with their parents. However, the differences in the amount of engagement with social media actively glorifying AN before and during the pandemic did not remain significant after correction for multiple comparisons. The minority of patients who received remote treatment found it to be only limitedly helpful. (4) Conclusions: from the patients’ perspective, the COVID-19 pandemic-associated confinement had a detrimental effect on the symptoms of adolescent patients with AN.

Background: Bulimia nervosa (BN) is a serious mental illness with impulsivity as a cardinal symptom. Impulsivity contributes to various other, often comorbid, mental disorders, such as attention deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD). The aim of this study was to explore comorbidities of BN with ADHD and BPD as well as the contribution of impulsivity as an underlying trait linking these disorders. Methods: Hundred and fifteen females with BN and 98 healthy matched controls (HC) (age range between 16 and 48 years) were assessed regarding adult and childhood-ADHD, personality disorders and impulsivity. Results: Patients with BN were more impulsive (p < 0.001) and more often fulfilled criteria of childhood/adulthood ADHD (p < 0.001) than HC, and criteria of BPD than expected in the general population. Childhood-ADHD (p = 0.009) and BPD (p = 0.017) both were significant positive predictors for impulsivity scores found in patients with BN. Conclusion: Comorbidity with ADHD and BPD often is prevalent in BN and associated with an increase in impulsivity, the latter being a relevant transdiagnostic trait. It might be beneficial to explore impulsivity as well as comorbidities in the clinical care of patients with BN. Level of evidence III: Evidence obtained from well-designed cohort or case–control analytic studies.

Anorexia nervosa (AN) is a severe eating disorder with significant somatic complications, potentially involving an altered intestinal barrier. Prior studies yielded heterogeneous results, ranging from decreased to increased intestinal permeability in AN. This study aimed to assess intestinal permeability in adolescent patients with AN by comparing serum markers Zonulin, Lipopolysaccharide-binding protein (LBP), and intestinal Fatty acid-binding protein (iFABP) with healthy controls (HC) over time. We conducted a longitudinal study on 60 female adolescent patients with AN and 36 age-matched HC. Blood samples were collected at admission to inpatient treatment, at discharge, and at a one-year follow-up. Zonulin, LBP, iFABP and inflammation marker Interleukin 6 levels were measured alongside clinical parameters. Linear mixed models were applied to assess group differences and longitudinal changes. Pearson correlations were used to explore clinical associations. Zonulin levels were significantly decreased in the AN group at admission and again at the follow-up compared to HC. LBP levels were consistently reduced in AN across all three time points. These alterations thus persisted despite weight recovery. No significant differences were observed in iFABP levels between the groups or over time. Zonulin and LBP positively correlated with Interleukin 6, linking gut permeability to inflammatory processes. Decreased Zonulin and LBP levels suggest reduced paracellular intestinal permeability in adolescent AN while transcellular permeability (iFABP) appears to be rather unaffected. The persistence of these alterations despite weight recovery suggests that reduced intestinal permeability may be a trait rather than a state marker in AN. Our findings challenge the concept of a "leaky gut" in adolescent AN.This highlights the need for further research on the intestinal barrier in AN, while also integrating the role of nutritional intake, gut microbiome interaction and immune reactions, to support the development of gut-targeted therapies.