The prospective relationship between anxiety symptoms and eating disorder symptoms among adolescents: a systematic review and meta-analysis of a bi-directional relationship

Anxiety symptoms and eating disorder symptoms commonly co-occur in adolescents. However, there is divergent evidence on the prospective relationship between the two factors. This systematic review and meta-analysis summarises the existing literature on the prospective and bi-directional relationship between anxiety symptoms and eating disorder symptoms in adolescence. A systematic search across six databases was conducted on the 11th June 2024. Studies were included if they assessed the prospective relationship between anxiety symptoms and eating disorder symptoms, or vice versa, in adolescence. 19,591 studies were screened, of which 54 studies met inclusion criteria and were included in the full review. Four meta-analyses were conducted. Anxiety symptoms were associated with subsequent eating disorder symptoms, increases in eating disorder symptoms, and higher odds of eating disorders, including their onset. Conversely, eating disorder symptoms were associated with subsequent anxiety symptoms, increases in anxiety symptoms, and higher odds of subsequent anxiety disorders. Current evidence suggests that anxiety symptoms and eating disorder symptoms do not merely co-occur during adolescence, but are prospectively and bi-directionally linked. Further research is needed to understand the underlying mechanisms of this relationship, as well as individual differences in symptom trajectories.