Association Between Family Dysfunction and Risk for Eating Disorders in Adolescents.

Background/Objectives: Risk for eating disorders (ED risk) in adolescents is strongly influenced by psychosocial factors, particularly family dysfunction. The COVID-19 pandemic may have intensified these risks by disrupting family dynamics and increasing stress exposure. This study aimed to examine the association between family dysfunction and ED risk among school adolescents in Lambayeque, Peru, in the post-pandemic context. Methods: An analytical cross-sectional study including 1219 students from five schools (September-December 2022) was conducted. ED risk was screened using the SCOFF questionnaire (≥2), and family functioning was assessed with the Family APGAR (functional, mild, moderate, or severe dysfunction). Additional sociodemographic, behavioral, and mental health variables were analyzed. Adjusted prevalence ratios (PRs) were estimated using Poisson regression with robust variance clustered by school. Results: The ED risk in adolescents was 39.3% (95% CI: 36.5-42.1). Moderate family dysfunction was reported in 10.0% and severe dysfunction in 29.8% of participants. In the multivariable model, moderate family dysfunction was associated with higher ED risk (PR = 1.11). Other factors associated with higher risk included obesity (PR = 1.17), family history of mental illness (PR = 1.18), course failure (PR = 1.18), alcohol consumption ≥4 times per week (PR = 1.75), and having a family member hospitalized due to COVID-19 (PR = 1.14). Protective associations were found for male sex, frequent contact with friends, higher resilience, and living in peri-urban areas. Conclusions: Moderate family dysfunction was associated with an increased at ED risk in adolescents. These findings highlight the importance of school-based screening, family-centered interventions, and resilience promotion in adolescent mental health strategies. Given the cross-sectional design, causal relationships cannot be inferred.