Mental Health and Well‐Being Across the Eating Disorder Spectrum—From Milder Symptoms of Disordered Eating Behaviors to Diagnosed Eating Disorders

OBJECTIVE: This study examined differences in mental health and well-being, risk behaviors, suicidality, and social functioning across a proposed eating disorder (ED) spectrum, ranging from no ED symptoms to clinically diagnosed EDs. METHODS: We examined 44,303 participants in the 18-year follow-up in the Danish National Birth Cohort (DNBC-18) with cross-sectional data on self-reported ED symptoms and indicators of mental health and well-being. National register data was linked to identify hospital-diagnosed EDs. The ED spectrum comprised mutually exclusive categories ranging from no symptoms, through disordered eating behaviors (DEBs) and self-reported diagnosis-like subthreshold and threshold ED symptoms to diagnosed EDs. We compared sex-specific weighted proportions and 95% confidence intervals (CIs) of impaired mental health and well-being by spectrum category. RESULTS: Among 25,974 females and 18,329 males, 73.3% and 80.3%, respectively, had no ED symptoms, while 12.7% of females and 1.5% of males had at least subthreshold ED symptoms, with milder DEBs constituting the largest proportion of the ED spectrum, particularly in males. Diagnosed EDs showed the highest co-occurrence of other psychiatric disorders, self-injury, and suicidality, whereas threshold ED symptoms were associated with the poorest mental health across most self-reported measures and, among females, several risk behaviors. Compared with no ED symptoms, females across the ED spectrum showed higher co-occurrence of impaired mental health and well-being. In males, differences were small, but omitting muscle dysmorphia showed substantially poorer mental health among males with other DEBs. CONCLUSIONS: Poor mental health and well-being co-occurred across the full ED spectrum, particularly in females, with substantial difficulties in both diagnosed EDs and those with threshold ED symptoms.