Work

Pubertal development and eating disorders and muscle dysmorphia symptoms in adolescents: a Danish population-based follow-up study

Year: 2026

Type: article

Abstract: Background Earlier pubertal timing has been associated with eating disorders in girls, but evidence in boys is scarce, and the role of pubertal tempo remains unclear in both sexes. We investigated associations of pubertal timing and tempo with eating disorders in girls and muscle dysmorphia in boys. Methods Tanner stages, age at menarche, first ejaculation, and voice break were self-assessed half-yearly throughout puberty in 13,208 adolescents from the Puberty Cohort within the Danish National Birth Cohort (DNBC). Timing and tempo were derived using non-linear mixed-effect growth models and analyzed categorically as early/fast, average, or late/slow. Self-reported anorexia nervosa, bulimia nervosa, binge eating disorder, and muscle dysmorphia were obtained from the 18-year DNBC follow-up, and clinically diagnosed anorexia nervosa and bulimia nervosa were obtained from the Danish National Patient Register. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using logistic regression models. Results In girls, early (OR: 3.06 (95% CI: 1.07;8.74)) and late (OR: 2.43 (95% CI: 1.02;5.79)) timing of pubic hair development were associated with clinically diagnosed anorexia nervosa compared to average timing. Late timing of breast development (OR: 3.86 (95% CI: 1.84;8.07)), pubic hair development (OR: 2.41 (95% CI: 1.07;5.44)), and menarche (OR: 3.10 (95% CI: 1.45;6.63)) were associated with self-reported anorexia nervosa, whereas early timing of these milestones appeared to be associated with a higher risk of binge eating disorder. In boys, early timing of first ejaculation (OR: 1.96 (95% CI: 1.06;3.63)) and late timing of genital development (OR: 1.88 (95% CI: 1.11;3.20)) were associated with muscle dysmorphia. Fast tempo of pubic hair development was associated with a higher risk of clinically diagnosed anorexia nervosa and self-reported binge eating disorder, but a lower risk of self-reported anorexia nervosa compared to average tempo. Findings for pubertal tempo in boys were inconsistent. Conclusions Pubertal timing, rather than tempo, showed the most consistent associations across clinically diagnosed and self-reported outcomes. Given that both earlier and later pubertal timing increase the risk of eating disorders in girls and muscle dysmorphia in boys, monitoring adolescents with such timing for early signs of disordered eating could enable timely support and intervention.

Source: Journal of Eating Disorders

DOI: 10.1186/s40337-026-01799-0