Changes in eating disorder symptoms and influential factors among Chinese college students: a four-wave longitudinal study

Eating disorder symptoms (EDS) have become increasingly prevalent worldwide, especially among college students. This study examines the change patterns and influential factors of EDS among college students in China.

A total of 5608 students participated in assessments conducted at four time points with 6-month intervals. The Short Form of the Eating Disorder Examination Questionnaire (EDE-QS) was used to evaluate EDS across four waves. Participants’ sample characteristics, clinical variables [i.e., insomnia, depression, anxiety, and body dysmorphic disorder (BDD)], individual psychological factors (i.e., self-control) and environmental factors (i.e., family functioning, school connectedness, and cyber-victimization) were assessed. Latent growth mixture modeling was used to explore trajectories of EDS. Multivariate logistic regressions were used to examine influential factors for trajectory membership.

Three distinct patterns of change in EDS were observed: low-decreasing (79.1%), moderate-stable (17.5%), and high-increasing (3.4%). Participants residing in urban or town areas were more likely to belong to the moderate-stable and high-increasing groups. Meanwhile, compared with the low-decreasing group, individuals in the moderate-stable group reported higher insomnia symptoms, anxiety symptoms, BDD symptoms, and cyber-victimization, as well as lower levels of family functioning, school connectedness, and self-control. Individuals in the high-increasing group scored higher on anxiety symptoms, BDD symptoms, and cyber-victimization, and lower on family functioning, school connectedness, and self-control, compared with the low-decreasing group.

College students exhibited heterogeneous trajectories of EDS, underscoring the necessity for dynamic monitoring. Furthermore, individualized interventions targeting high-risk individuals based on identified influential factors represent a promising approach.