Eating Disorders among UK University Students: Associations with mental health, wellbeing and behavioural characteristics

Abstract Background Despite growing concern regarding student mental health, large-scale UK studies examining eating disorder (ED) risk and its correlates in university populations remain limited. This study investigated the prevalence of ED disorder screens and their associations with demographic and clinical characteristics in a multi-site sample of UK University students. Methods Data were drawn from the Nurture-U survey of student mental health and wellbeing, conducted across five UK universities. Students completed self-report ED screening items for anorexia nervosa (AN) and bulimia nervosa/binge eating disorder (BN/BED) derived from the Structured Clinical Interview for DSM-5 (SCID-5). Students who did not screen positive on either SCID5 item formed the negative ED screen group (ED-; n = 7674). Students screening positive on one or both SCID-5 items completed the SCOFF questionnaire; those scoring two or more were classified as screening positive for elevated ED risk (ED+; n = 1710). Associations between ED status and demographic and clinical characteristics were examined using univariate and multivariate analyses. Within the ED+ group, comparisons were conducted between students who screened positive for AN only (n = 286) versus BN/BED only (n = 1075). Results Overall, 14.6% of students screened positive for elevated eating disorder risk, with only 20% of these reporting a lifetime ED diagnosis. ED+ screening status was associated with younger age, female sex, Asian ethnicity (excluding Chinese), international status, and overweight BMI. Compared with students screening negative, those screening positive were more likely to report a lifetime ED diagnosis, learning difficulty, non-suicidal self-injury, and suicide attempts, but less likely to report a neurodevelopmental disorder. Students screening positive also reported greater depressive symptoms, lower wellbeing, loneliness, perceived stress, poorer sleep quality, harmful alcohol use, smoking, and poorer physical health. Within the ED+ group, students screening positive for AN-related symptoms were more likely than those screening positive for BN/BED-related symptoms to report underweight BMI, smoking, moderate-severe anxiety, and lifetime ED diagnosis. Conclusions Positive ED screens were common among UK University students and are associated with broad ranging psychological, behavioural and physical health concerns. Distinct profiles were observed across screening subgroups, highlighting the need for early identification, integrated support pathways and tailored interventions across education and healthcare settings.