Eating disorder severity and functional impairment: moderating effects of illness duration in a clinical sample

  • Annika Helgadóttir DavidsenEmail author
  • William T. Hoyt
  • Stig Poulsen
  • Mette Waaddegaard
  • Marianne Lau
Original Article



The aim was to examine duration of illness and body mass index as possible moderators of the relationship between eating disorder severity and functional impairment, as well as psychological distress as a possible mediator of this relationship.


The study included 159 patients diagnosed with bulimia nervosa, binge eating disorder or eating disorder not otherwise specified. Regression analysis was applied to assess the effect of the hypothesized moderators and mediators. Eating disorder severity was measured with the Eating Disorder Examination Questionnaire, functional impairment was measured with the Sheehan Disability Scale, and psychological distress was measured with the Symptom Check List-90-R. Duration of illness and body mass index were assessed clinically.


Duration of illness significantly moderated the relationship between eating disorder severity and functional impairment; the relationship was strongest for patients with a shorter duration of illness. Psychological distress partly mediated the relationship between eating disorder severity and functional impairment. Duration of illness significantly moderated the relationship between psychological distress and functional impairment; the strongest relationship was seen for patients with a shorter duration of illness. Body mass index was not a significant moderator of the relationship between ED severity and functional impairment.


Overall, this study established a link between ED severity, psychological distress and functional impairment indicating that both eating disorder severity and psychological distress are more strongly related to impaired role functioning for patients with more recent onset of an eating disorder. More research in the complex relationship between ED severity and functional impairment is needed.


Functional impairment Eating disorder severity Psychological distress Duration of illness Body weight 



We acknowledge the participation of the patients at a difficult time in their lives, and we are grateful to our clinical and research colleagues at Stolpegaard Psychotherapy Centre for their contribution.

Compliance with ethical standards

The research was carried out at Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark. It was funded by Innovation Fund Denmark (Grant Number 10-084080); the Mental Health Services in the Capital Region of Denmark (no Grant Number), and by the Royal Danish Academy of Sciences and Letters [Inge Lehman’s scholarship (no Grant Number)].

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Annika Helgadóttir Davidsen
    • 1
    • 2
    Email author
  • William T. Hoyt
    • 3
  • Stig Poulsen
    • 4
  • Mette Waaddegaard
    • 1
  • Marianne Lau
    • 1
  1. 1.Stolpegaard Psychotherapy Centre, Mental Health ServicesGentofteDenmark
  2. 2.Department of PsychologyUniversity of CopenhagenCopenhagen K.Denmark
  3. 3.Department of Counseling Psychology, School of EducationUW-MadisonMadisonUSA
  4. 4.Department of PsychologyUniversity of CopenhagenCopenhagenDenmark

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