Symposia
Eating Disorders
Kara A. Christensen, Ph.D.
Postdoctoral Researcher
University of Kansas
Lawrence, Kansas
Nicole Short, Ph.D.
Assistant Professor
University of North Carolina Chapel Hill School of Medicine
Chapel Hill, North Carolina
Victoria Perko, M.A.
Graduate Student
University of Kansas
Lawrence, Kansas
Kelsie Forbush, Ph.D.
Associate Professor
University of Kansas
Lawrence, Kansas
Background: Emerging research suggests that insomnia disorder is associated with increased rates of eating disorders (EDs). However, it is unclear whether insomnia symptoms are associated with higher levels of various ED behaviors, including among those at risk of EDs. Specifically, university students may be “doubly vulnerable” to experiencing insomnia symptoms (e.g., Gellis et al., 2014) and eating pathology (e.g., Lipson & Sonneville, 2017). The current study cross-sectionally tested hypotheses that university students with insomnia disorder would have higher levels of binge eating, fasting, excessive exercise, and laxative/diuretic use.
Methods: Graduate and undergraduate students (n = 1817; M = 23.44 years, SD = 6.94, range = 18-76) from a large Midwestern American university completed questionnaires assessing DSM-5 ED symptoms (Eating Disorder Symptom Scale 5 [EDDS]; Stice et al., 2001), ED-related impairment (Clinical Impairment Inventory [CIA]; Bohn & Fairburn, 2008), and insomnia symptoms (Insomnia Severity Index [ISI]; Bastien et al., 2001). Students were classified with probable insomnia disorder based on established cutoffs for the ISI (Morin et al., 2011) and with a probable ED based on EDDS and CIA responses (e.g., Christensen et al., 2021). ED prevalence between students with and without insomnia disorder was compared using a Chi-square test. We used MANOVA to evaluate differences between students with and without insomnia disorder in frequency of episodes of objective binge eating, subjective binge eating, fasting, excessive exercise, and laxative/diuretic use, as well as level of clinical impairment.
Results: Of the students with complete ISI data (n = 1474), 48.0% met the cutoff for probable insomnia disorder. 51.3% of students with insomnia disorder met criteria for an ED, whereas only 24.4% of students without insomnia disorder met ED criteria (OR = 3.26, 95% CI = 2.61, 4.06). Students with insomnia disorder reported higher BMIs (p < .001, partial eta squared = .01), greater frequency of all ED behaviors (all p < .001, partial eta squared = .01-.05), and greater ED-related impairment (p < .001; partial eta squared = .11).
Conclusion: Students with insomnia disorder report higher ED prevalence, more ED behaviors, and greater impairment than their peers. Consequently, providers should consider screening for EDs when students report with insomnia disorder. Overall, results are consistent with emerging evidence suggesting high rates of co-occurrence between insomnia disorder and other forms of psychopathology.