Clinical characteristics associated with persistent and emerging eating disorder risk in young people presenting for mental health care

Eating disorders (EDs) are serious mental health conditions with peak onset during adolescence and young adulthood. While early intervention services frequently encounter young people at-risk of EDs, little is known about the trajectories and factors associated with ED risk among those engaged in services over time. The sample includes 494 young people (aged 12–25 years) who presented to youth mental health services in Australia, primarily for emerging mood disorders. ED risk was assessed at baseline and 12-month follow-up using the SCOFF questionnaire, with scores ≥ 2 (range 0–5) indicating high risk status. Participants were classified into four trajectory groups: persistent (high risk at both timepoints; n = 92, 18.6%), remitting (high to low risk; n = 69, 14.0%), emerging (low to high risk; n = 51, 10.3%), or low risk (low risk at both timepoints; n = 282, 57.1%). Clinical factors included depression, anxiety, deliberate self-harm, functioning, and rumination. Logistic regression analyses were used to identify factors associated with persistent risk (vs remitting risk) and emerging risk (vs low risk). Among those with high ED risk at baseline, the odds of persistent risk were approximately 1.8 times higher than remitting risk ( p  = .014). Greater rumination was associated with worse outcomes in both analyses (i.e., persistence and emergence; all p  < .05). The finding that almost one-fifth of participants had persistently high risk, combined with those who shifted from low to high risk over time, highlights a significant unmet need in youth mental health services. Rumination was linked to worse outcomes, suggesting a potential target for enhanced screening and intervention approaches.