A comparative neuropsychological assessment of anorexia nervosa, bulimia nervosa, binge eating disorder and healthy control: a cross-sectional study in female university students

Eating disorder (ED) symptoms are particularly prevalent among young adults. This study aimed to examine the distinct roles of memory function, mental health, and sleep disturbances in university students with different ED diagnostic categories. In this cross-sectional study, 403 female students were allocated to anorexia nervosa (AN, n = 90), bulimia nervosa (BN, n = 53), binge-eating disorder (BED, n = 116), or healthy controls (HCG, n = 144) based on self-reported physician diagnoses consistent with DSM-5 categories. Participants completed the Eating Disorder Examination-Questionnaire (EDE-Q), Memory Functioning Questionnaire (MFQ), Bergen Insomnia Scale (BIS), and Depression Anxiety Stress Scales – 21 (DASS-21) in a single time-point assessment (January and May 2025). Participants in the AN and BN groups showed significantly higher levels of depression, anxiety, stress, insomnia, and ED pathology, along with memory dysfunction, compared to the BED and HCG groups (p < 0.001). Depression scores were markedly elevated in AN (mean = 13.8, 95% CI [6.5–8.8]) and BN (mean = 19.2, 95% CI [12.1–14.1]) relative to HCG (mean = 6.1) and BED (mean = 9.7). Similarly, insomnia scores were higher in BN (mean = 35.2, 95% CI [25.1–27.7]) and AN (mean = 26.6, 95% CI [15.5–19.9]) compared to BED (mean = 11.3) and HCG (mean = 8.9). Within-group analyses further revealed that in AN, anxiety, stress, forgetfulness, and weight/appearance concerns were strongly interrelated (p < 0.05), while in BN, insomnia, affective symptoms, and memory dysfunction were tightly linked with overall ED severity (p < 0.05). In the BED group, binge eating behaviors showed significant associations with insomnia, affective symptoms, and cognitive difficulties (p < 0.05). ED groups—particularly BN and AN—are characterized by co-occurring insomnia, affective symptoms, and poorer perceived memory functioning. Findings support integrated assessments that include sleep and cognition alongside ED psychopathology and may inform individualized interventions. Results should be interpreted cautiously given reliance on self-reported diagnoses and a single-site, female-only sample.