ORIGINAL RESEARCH article
Front. Psychiatry
Sec. Adolescent and Young Adult Psychiatry
This article is part of the Research TopicExpanding the Evidence Base: The Cultural Continuum of Interventions for Eating Disorders and Related Body Image DifficultiesView all articles
The Psychosis Spectrum and Underlying Factors in Female Youth with Eating Disorders: A Cross-sectional Observational Experience Sampling Methodology Study
Provisionally accepted
- University College Maastricht (UCM), Maastricht, Netherlands
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Objective: Recent reviews indicated that the psychosis spectrum co-occurs with disorders on the eating disorder (ED) spectrum, which might elucidate the low recovery rates. Consequently, the ED field is encouraged to better understand the interplay between these two spectra. This study examined whether female youth with EDs experience higher levels of psychotic phenomena than controls, including associations between different levels of (subclinical) psychosis and the factors negative affect (NA), self-esteem, stress and ED severity. Method: A cross-sectional study using experience sampling methodology (ESM) for 10 days involved 50 young females with EDs and 50 controls. Subclinical psychotic experiences (PE), psychotic symptoms and disorders were assessed using ESM, Community Assessment of Psychic Experiences, Positive And Negative Syndrome Scale, and Mini-International Neuropsychiatric Interview; ED severity was assessed with the Eating Disorder Examination-Questionnaire. Mixed effects, logistic and linear regression models were used for the analyses. Results: The ED group had significantly more momentary PE (B = 1.57, p < .001), lifetime PE (B = 0.50, p < .001), psychotic symptoms (B = 17.21, p < .001), and lifetime psychotic disorders (B = 2.83, p < .001) than controls. In the ED group, momentary PE were associated with momentary NA, self-esteem, stress, and EDE-Q; lifetime PE with momentary NA, stress, and EDE-Q; and psychotic symptoms with momentary NA. Discussion: All levels of psychosis were common in female youth with an ED, and these (subclinical) psychotic phenomena were associated with transdiagnostic factors such as momentary NA, self-esteem, and stress and/or ED severity. The findings have relevance for clinical practice and inform future transdiagnostic studies on mechanism and treatment of individuals with EDs and (comorbid) psychosis.
Keywords: Eating Disorders, Ecological Momentary Assessment, psychosis spectrum, psychotic experiences, Transdiagnostics
Received: 29 Sep 2025; Accepted: 29 Nov 2025.
Copyright: © 2025 Roedelof, Simons, Mulkens and Marcelis. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Anna Roedelof
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