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

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.