Disordered eating behavior and adolescent social health: evidence of interpersonal disruption across time and relationships.

Abstract

Background: Disordered eating during adolescence is common and can interrupt daily participation in family, peer, and school life. However, prior studies typically treat social relationships as precursors to disordered eating rather than as health outcomes that may deteriorate once symptoms appear.

Purpose: To test whether adolescents with disordered eating symptoms show poorer social health across multiple relational settings, and whether impairment is stronger for multi-symptom and more persistent symptoms and changes over time.

Methods: Data came from 11 868 adolescents in the Adolescent Brain Cognitive Development Study, followed annually across 5 years. Parents reported 5 eating disorder-related symptoms each year; variables were created for any symptom, ≥2 symptoms, and the proportion of study years with symptoms (chronicity). Social health was measured with parent-reported social withdrawal and adolescent-reported prosocial behavior, peer victimization, family conflict, and school functioning (school disengagement, school environment, and school involvement). Generalized estimating equations with year fixed effects estimated population-averaged associations.

Results: Across adolescence, 39.7% of adolescents were ever symptomatic (eg, binge eating, fear of gaining weight, or vomiting for weight control) and 7.0% had ≥2 symptoms. Any eating disorder symptom was associated with higher social withdrawal (β = 0.26, q < .001), more peer victimization (βs = 0.09-0.12, qs < .001), and greater family conflict (β = 0.12, q < .001); school environment and involvement were modestly lower. Associations were substantially stronger for multi-symptom and more persistent symptoms, such that adolescents symptomatic across multiple years showed the largest deficits across all layers of social health. Symptom-by-year tests indicated the social withdrawal gap widened modestly over time.

Conclusions: Adolescent disordered eating symptoms were associated with poorer social health across family, peer, and school settings, particularly when symptoms are recurrent or multifaceted. These findings suggest that social participation warrants assessment alongside eating disorder screening in pediatric and school contexts.