Bidirectional associations between insomnia symptoms and eating disorders: A two-wave longitudinal study among Chinese college students

Previous literature suggests a link between insomnia symptoms and eating disorders (EDs), yet empirical data on the temporal associations between these two variables are lacking. This study aimed to explore the bidirectional associations between insomnia symptoms and EDs in a population of college students. A total of 11,010 college students were assessed initially from October 17 to 29, 2023, and again 6 months later from April 15 to 24, 2024. EDs were assessed using the Short Form of the Eating Disorder Examination Questionnaire (EDE-QS), while insomnia symptoms were measured through a three-item questionnaire addressing difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening. Our findings indicated that insomnia symptoms at baseline was significantly associated with increased odds of EDs six months later. Moreover, EDs at baseline were significantly predict insomnia symptoms at the six-month follow-up. This study identifies prospective bidirectional relationships between insomnia symptoms and EDs among college students, offering insights that may inform educational and clinical approaches to preventing and treating insomnia symptoms and EDs.