Expanding our understanding of eating disorders through a wellbeing lens

Abstract

Objectives: Mental health encompasses more than the absence of symptoms and includes positive mental health assets. While previous research typically reports averaged inverse associations between mental wellbeing and eating disorder (ED) psychopathology, emerging evidence suggests this relationship operates with greater complexity. This study investigated the relationship between mental wellbeing and ED psychopathology alongside other indicators of positive mental health and mental illness. Method: Young women (N = 554, aged 18-35 years) completed measures of positive mental health and mental illness including ED psychopathology. A dual continua model approach categorised participants based on their joint mental wellbeing and ED psychopathology status, with comparisons among groups on depression, anxiety, body appreciation, intuitive eating, ED-related clinical impairment, and total comorbidity. Results: Among participants with equivalent clinically elevated ED symptoms ('ED-cases'; n = 94), three distinct mental wellbeing levels emerged: high, moderate, and low. Among ED-cases, those with moderate to high mental wellbeing reported better outcomes on all measures compared to those experiencing low wellbeing with an ED, with the low wellbeing group being 15 times more likely to experience severe psychological distress compared to those with an ED and high mental wellbeing. However, all ED groups reported poorer outcomes than their non-ED counterparts with equivalent wellbeing levels. Discussion: Mental wellbeing and ED psychopathology are related but distinct dimensions of overall mental health. The findings suggest that mental wellbeing may explain differences in functioning over and above ED status, potentially offering protective mental health benefits. However, further research is needed to understand this relationship given the complex functions ED symptoms serve. These findings demonstrate that incorporating mental wellbeing assessment into ED research and treatment is essential for understanding individual differences in mental health functioning. The markedly low presence of vulnerable individuals (low wellbeing and absence of mental illness) compared to established rates may reflect developmental influences whereby earlier vulnerability to mental illness may be realised by young adulthood. This finding, and the distinct comorbidity patterns, offer insights for dual continua model development.