Eating disorders and disordered eating symptoms in individuals at clinical high risk for psychosis: a systematic review and meta-analysis

Eating disorders (EDs) are among the least studied mental disorders in individuals at clinical high risk for psychosis (CHR-P). The primary aim (a) of this systematic review and meta-analysis was to identify factors predicting ED diagnoses in CHR-P individuals. The secondary aim (b) was providing a comprehensive clinical description of individuals with both CHR-P and EDs/ED-related symptoms.

Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020-compliant systematic review and meta-analysis, searching PubMed/(EBSCO)PsycINFO/Web of Science for studies published between 01/01/2018 and 30/05/2023, including individuals with CHR-P and EDs/ED symptoms (PROSPERO CRD42023488792). Quality assessment was performed using the Newcastle–Ottawa Scale (NOS). We performed a meta-regression model on the proportion of EDs in CHR-P individuals (primary aim) and conducted a narrative synthesis (secondary aim).

We included 26 articles, reporting on 2,060 and 589 subjects for study aim (a) and (b), respectively (mean NOS score = 6.38). The prevalence of EDs in CHR-P individuals was 0.05 (95% CI 0.3–0.8). No factor had a significant effect on the proportion of EDs in CHR-P individuals. This result is limited by the inability to include ED-related symptoms and antipsychotic prescriptions in the meta-regression model, due to an insufficient number of studies reporting on these variables. The narrative synthesis offers a characterization of individuals with both CHR-P and ED/ED-related symptoms; however, the limited number of included studies is insufficient to support definitive conclusions.

No significant predictor of EDs was found in CHR-P individuals. Transdiagnostic, prospective cohort studies are warranted to examine long-term outcomes in individuals with both CHR-P and EDs, beyond diagnostic silos.

I. Systematic review and meta-analysis