Which came first? Bulimia and emotional symptoms: A cross-lagged panel analysis.

Purpose: Researchers have found growing evidence for the comorbidity link between bulimia and emotional symptoms among Chinese female youth. However, the prospective effect of one on the other is still unclear. Therefore, a cross-lagged model was used to examine the possible underlying mechanism between bulimia and two typical emotional problems (i.e., anxiety symptoms and depressive symptoms), respectively, in the present study. Methods: A total of 471 female college students participated in the three waves of the present study. Self-reported questionnaires were delivered to assess their bulimia, anxiety symptoms, and depressive symptoms. Results: After controlling for earlier levels of symptoms, our finding indicated that anxiety symptoms triggered more bulimia symptoms from Time 1 to Time 2. In turn, the reciprocal cycles occurred between anxiety symptoms and bulimia symptoms from Time 2 to Time 3. More interestingly, a similar pattern was found between depressive symptoms and bulimia. Conclusions: The persistence and reciprocal cycle between bulimia and emotional symptoms are worthy of attention. Specifically, female youth with higher levels of emotional symptoms appear to be more profound at high risk for eating-related problems afterward. Further eating-related intervention programs may also need to take the level of female youth's emotional symptoms into consideration.