A total of 7,275 potentially relevant studies were identified from the database search. After duplicates were removed, 6,537 studies were available for screening. After title and abstract screening, 94 studies were progressed to full-text screening. Full-text screening resulted in 18 studies meeting the inclusion criteria and being included in the umbrella review. The PRISMA diagram shown in Fig. 1 reports the reason for exclusion for the remaining 76 studies with full-text review.

Fig. 1

PRISMA flow diagram of included studies

Characteristics of included studies

Out of the 18 systematic reviews, ten included a meta-analysis component. There were six reviews investigating the association between ED or ED risk factors (e.g. body dissatisfaction) and three specific mental health problems: (a) depression and anxiety, (b) obsessive-compulsive symptoms and (c) social anxiety. Another three reviews focused on the relationship between ED and attention deficit hyperactivity disorder (ADHD) while two reviews focused on ED and suicidal-related outcomes. The remaining seven reviews explored the association between ED and bipolar disorders, personality disorders, and non-suicidal self-injury. Further details of the included studies are presented in Table 1. The number of individual studies included within the reviews ranged from five to 122 studies with the majority of included studies being conducted using a cross-sectional study design. All but one review investigated the general population, including males and females, and the sample size ranged from 1,792 to 2,321,441 participants.

Table 1 Summary of included reviewsED, depression and anxiety, obsessive compulsive symptoms and social anxiety

The evidence from two reviews [17,18,19] suggest that individuals afflicted with BED or disordered eating have a higher risk of experiencing negative mood, tension, sadness and emotional instability [19], which can further develop into depressive and anxiety symptoms [17]. However, limited evidence was found to support any link between disordered eating and obsessive-compulsive symptoms [17]. There is evidence to suggest that the relationship between anxiety and AN can be bi-directional. For example, the review by Lloyd et al. [18] demonstrated that the risk of anorexia is predicted to increase in adolescents and young adults diagnosed with an anxiety disorder. Meanwhile, Kerr-Gaffney et al. [11] conducted a systematic review and meta-analysis and found that both BN and AN were associated with social anxiety with a medium effect size of 0.71 [95% CI 0.47, 0.95; p < 0.001] and a large effect size of 1.65 [95% CI 1.03, 2.27; p < 0.001], respectively as estimated using the Cohen’s d statistic. The authors concluded that individuals with AN or BN have high levels of social anxiety compared to healthy controls.

Several reviews have indicated that certain ED risk factors can potentially contribute to depression. The systematic review and meta-analysis conducted by Puccio et al. [20] suggested that eating pathology is one of the risk factors for depression and vice-versa. The effect of eating pathology on depression among 18,641 females aged 6–50 years was shown to be significant with an effect size of 0.13 (95% CI: 0.09 to 0.17, p < 0.001), which was conducted on r values [19]. A systematic review of body image dissatisfaction and depression found that in men the perception of being underweight or dissatisfaction due to low weight was observed by idealizing a larger body, whereas women perceived their body larger than it was by idealizing a lean body [21]. Both of these conditions were associated with the presence of depression or depressive symptoms although the review was unable to conclude whether more severe body image dissatisfaction increased chances of also having depressive symptoms or both conditions co-exist.

ED and attention deficit hyperactivity disorder

A systematic review conducted by Kaisari et al. [22] on disordered eating behaviour and (ADHD) among 115,418 participants (including both male and female populations) suggested that the impulsivity symptoms of ADHD were positively associated with overeating in AN and BN. Similarly, Levin & Rawana [23] explored the association between AN, BN and BED and ADHD among 74,852 participants and showed that childhood ADHD increases the risk of disordered eating or developing ED in later life. The systematic and meta-analysis of ED on ADHD by Nazar et al. [24] showed that the pooled odds ratio of diagnosing any ED in ADHD populations was 3.82 (95% CI 2.34–6.24). BN has the highest odds ratio (5.71, 95% CI 3.56–9.16) followed by AN (4.28, 95% CI 2.24–8.16) and BED (4.13, 95% CI 3.00–5.67). On the other hand, the pooled odds ratio of diagnosing ADHD in people with eating disorders was 2.57 (95% CI 1.30–5.11) [24].

ED and bipolar disorder

The systematic review by Álvarez Ruiz & Gutiérrez-Rojas [25] found that the severity of BN and BED in women was higher among patients with bipolar disorder. The evidence from their review suggested that there is a comorbidity between ED and bipolar disorder, with prevalence rate of EDs in bipolar disorder patients ranging from 5.3 to 31%. In addition, a more recent meta-analytic review of 47 studies reported the lifetime prevalence of AN, BN and BED as 3.8% (95% CI 2–6%), 7.4% (95% CI 6–10%) and 12.5% (95% CI 9.40–16.6%) among individuals with bipolar disorder, respectively [26].

ED and suicidal factors

A systematic review of 12 cross-sectional and 5 longitudinal studies on BED and suicidal factors among adolescents and adults found that BED is associated with a higher risk of suicide, including suicidal behaviours and ideation [8]. Similarly, the systematic review by Goldstein & Gvion [27], which included 36 cross-sectional studies and 2 longitudinal studies, suggested that eating disorders with purging behaviour, impulsivity and specific interpersonal features were associated with greater risk of suicidal behaviours.

ED and non-suicidal self-injury

A systematic review and meta-analysis by Cucchi et al. [28] reported that, among patients with various EDs, the prevalence of a lifetime history of non-suicidal self-injury (NSSI) was 27.3% (95% CI 23.8–31.0%) for ED, 21.8% (95% CI 18.5–25.6%) for AN, and 32.7% (95% CI 26.9–39.1%) for BN. Based on 29 studies and 6,575 participants, the review concluded that NSSI is a significant correlate of ED and prevalent among adolescents and young adults with ED.

ED and personality disorders

The systematic review and meta-analysis conducted by Farstad et al. [29] on ED and personality disorders (PD) included 14 studies and showed that pooled prevalence rates of PD ranged from 0% (95% CI: 0–4%) (for schizoid) to 30% (95% CI 0–56%) (for obsessive-compulsive) in individuals with ED. The authors concluded that increases in perfectionism, neuroticism, low extraversion, sensitivity to social rewards, avoidance motivation, negative urgency and high-self-directedness was found in the people presenting with EDs. This finding is consistent with another review that investigated the association between EDs and symptoms of borderline personality disorder [30]. The authors found that nine symptoms of borderline personality disorder were significantly elevated in patients with EDs compared to controls.

In a meta-analytic review of 59 studies, the lifetime and current prevalence of obsessive-compulsive disorder was reported to be 13.9% [95% CI 10.4–18.1%] and 8.7% [95% CI 5.8–11.8%] respectively across EDs, which included all ED subtypes [31]. Another meta-analysis review reported lifetime comorbidity rates for obsessive-compulsive disorder of 19% in AN patients and 14% in BN patients based on cross-sectional studies [32]. These rates increased to 44% in AN patients and 18.5% in BN patients when longitudinal studies were considered.

Quality of included systematic reviews

The scores achieved by the included reviews ranged from 45% (i.e. 5 out of 11 questions) to 100% (i.e. 11 out of 11 questions). On average, the reviews met 72% of the JBI criteria. The details of the score are presented in Table S3 in the supplementary information file. Overall quality was acceptable and most reviews performed well in the design of review question, inclusion criteria, search strategy and criteria used for study appraisal. The main loss of scores were from the criteria of methods to minimize errors in data extraction and assessment of publication bias.