Academic examination stress increases disordered eating symptomatology in female university students
Abstract
Background It is well documented that stress and anxiety can affect eating behaviour and food intake in humans. The purpose of the current study was to explore the possible effect of academic examination stress on disordered eating attitudes, emotional eating, restraint eating, body image, anxiety levels and self-esteem in a group of female university students. The interrelationships of the above parameters were also examined.Methods Sixty Greek female university students, 18-25 years old, have been recruited and completed, on two separate occasions: a) during an examination stress period, and b) during a control period, the following questionnaires: the Eating Attitudes Test (EAT-26), the Dutch Eating Behavior Questionnaire (DEBQ), the State-Trait Anxiety Inventory (STAI), the Rosenberg Self- Esteem Scale, the Body Image Pictorial Instrument Scale (COLLINS) and a specially designed General Background Questionnaire.Results Subjects reported significantly higher levels of disordered eating attitudes (EAT-26, p=0.01), higher levels of anxiety (p=0.000) and lower levels of self-esteem (p=0.016) during the examination stress period compared to the control period. Disordered eating attitudes (EAT-26) were significantly positively correlated with emotional eating (p=0.04) and restrained eating (p=0.010) and negatively correlated with levels of self-esteem (p=0.05) and perceived desired body image (p=0.008) during the exam stress period. Finally, EAT-26 was significantly positively correlated with levels of anxiety in both study periods.Conclusion Academic examination stress seems to increase disordered eating symptomatology in female university students and is associated with lower levels of self-esteem, an important finding which warrants further investigation.
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Food consumption and weight increased during the COVID-19 pandemic while physical activity decreased, particularly among those with higher BMI.
“Evidence suggests that food consumption and weight increased during the pandemic while physical activity decreased, particularly among those with higher BMI [2, 3, 4, 5, 6].”
From Supporting Weight Management during COVID-19: A Randomized Controlled Trial of a Web-Based, ACT-Based, Guided Self-Help Intervention (2022) · cites this paper as [2]
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“This might explain the peak stress among university students and ED visits during this period.(28)”
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“Studies examining the relationship between eating attitudes, perceived stress, and burnout have reported significant correlations, with stress and burnout exacerbating unhealthy eating patterns [55,56].”
Kim, J. Y., Kang, H. L., Kim, D.-K., Kang, S. W., & Park, Y. K. (2017) · Journal of the American College of Nutrition · doi:10.1080/07315724.2017.1281774 · Cited by 12 · see citing works
The silent pandemic of stress: impact on menstrual cycle and ovulation
Saadedine, M., Berga, S. L., Faubion, S. S., & SHUFELT, C. L. (2025) · Stress · doi:10.1080/10253890.2025.2457767 · Cited by 11 · see citing works
“Studies have demonstrated a correlation between increased stress levels, disordered eating patterns, and unhealthy exercise habits (Barnhart et al., 2021; Chen et al., 2012; Costarelli & Patsai, 2012; Flett & Hewitt, 2005; Wågan et al., 2021).”
Șerban, D. M., Ursoniu, S., Moleriu, R. D., Banu, A., & Șerban, C. L. (2024) · Nutrients · doi:10.3390/nu16121894 · Cited by 10 · see citing works
Laskowski, N. M., Brandt, G., Reque, C. B., Sabel, L., Pahlenkemper, M., Zaiser, C., & Paslakis, G. (2024) · European Eating Disorders Review · doi:10.1002/erv.3141 · Cited by 12 · see citing works
Mandiola, M. I., Marcelo Arancibia, M., Elton, V., Eva Madrid, A., Meza, N., Stojanova, J., Mariane Lutz, R., & Leyton, F. (2022) · Revista médica de Chile · doi:10.4067/s0034-98872022000801046 · Cited by 9 · see citing works
de la Fuente, J., & Romera, J. A. (2019) · Anales de Psicología · doi:10.6018/analesps.35.3.323101 · Cited by 9 · see citing works
“Academic stress as a product variable: cognitive and physiological correlates Unlike in the clinical sphere (Costarelli & Patsai, 2012), educational research has not given proper attention to the stress response, although more articles are appearing in recent years (Mehmet & Watson, 2017).”
BackgroundGritty Goal Pursuit and Perceived Chronic Stress: Exploring Implications for Academic Problems
Kalia, V. (2021) · Springer eBooks · doi:10.1007/978-3-030-57389-8_6 · Cited by 9 · see citing works
Pérez, V. R., Alcázar-Olán, R. J., Saldaña, A. D. K. C., & la Roca-Chiapas, J. M. D. (2020) · psicogente · doi:10.17081/psico.23.44.3659 · Cited by 8 · see citing works
Scutt, E., Langdon-Daly, J., & Smithson, J. (2022) · Journal of Eating Disorders · doi:10.1186/s40337-022-00646-2 · Cited by 9 · see citing works
Frappier, I., Jacob, R., Panahi, S., Larose, D., Bryant, E. J., Chaput, J.-P., Thivel, D., & Drapeau, V. (2021) · Public Health Nutrition · doi:10.1017/s136898002100392x · Cited by 7 · see citing works
Sarang, S., Karnam, A., & Shitole, R. (2019) · The Indian Journal of Occupational Therapy · doi:10.4103/ijoth.ijoth_8_19 · Cited by 7 · see citing works
Ünal, G., & Uçar, A. (2023) · Topics in Clinical Nutrition · doi:10.1097/tin.0000000000000347 · Cited by 6 · see citing works
Radillo, B. E. P., Serrano, M. D. L. P., Campos, A. R. P., & Rayas-Servín, K. (2015) · Advances in Applied Sociology · doi:10.4236/aasoci.2015.512029 · Cited by 6 · see citing works
“Some of the manifestations are identified in physiological reactions (or physiological unrelated to organic diseases), psychological (cognitive or emotional) and behavioral (attitude or behavior towards society) considered non-adaptive (Berrio & Mazo, 2011; Costarelli & Patsai, 2012; Diaz 2010).”
BackgroundThe Relationship Between Sexual Violence and Disordered Eating
Bulgin, D., & Amar, A. F. (2016) · Issues in Mental Health Nursing · doi:10.3109/01612840.2016.1172685 · Cited by 6 · see citing works
“DE symptomology has even been shown to increase during times of academic stress (Costarelli & Patsai, 2012).”
BackgroundOkamoto, Y., Miyake, Y., Nagasawa, I., & Yoshihara, M. (2018) · BioPsychoSocial Medicine · doi:10.1186/s13030-018-0127-y · Cited by 6 · see citing works
Psychological Constructs and Dysfunctional Eating in Pakistani University Students
Hussain, M. (2021) · Journal of Muslim Mental Health · doi:10.3998/jmmh.238 · Cited by 5 · see citing works
Nemati, S., Pourtaleb, N., Badrigargari, R., Hashemi, T., Deetjen-Ruiz, R., & Shojaeian, N. (2022) · Advances in Neurodevelopmental Disorders · doi:10.1007/s41252-022-00307-0 · Cited by 5 · see citing works
“Academic stress among girls is more prevalent than among boys (Costarelli & Patsai, 2012; Maeri-Goff, 2011; Pozos-Radillo et al., 2014; Shadi et al., 2017), and it can be found in different groups of students, especially students with SLD (Panicker & Chelliah, 2016).”
DENTAL STUDENTS' PSYCHOLOGICAL WELL-BEING DURING EXAMINATION PERIOD AND HOLIDAY.
Preoteasa, C. T., Imre, M. M., & Preoteasa, E. S. (2015) · The Medical-Surgical Journal · Cited by 5 · see citing works
Costarelli, V., & Michou, M. (2023) · Nutrition & Food Science · doi:10.1108/nfs-12-2022-0403 · Cited by 5 · see citing works
Self-citationHealthy Lifestyle Habits Among Students at the University of Seville, Spain
Llorent-Bedmar, V., Torres-Zaragoza, L., Navarro-Granados, M., & Moscosio, M. Á. B. (2022) · Journal of Education and Community Health · doi:10.34172/jech.2022.2016 · Cited by 4 · see citing works
“A large proportion of university students have unhealthy eating habits (14), which are further exacerbated during exam periods (15) since stress accounts for the negative effect on eating habits in students (16).”
de la Fuente, J., López, M., Zapata, L., Vicente, J. M. M., Vera, M. M., Solinas, G., & Fadda, S. (2017) · Electronic Journal of Research in Educational Psychology · doi:10.25115/ejrep.34.14034 · Cited by 4 · see citing works
“…learning and academic performance The stress response in humans has been amply studied in different contexts, especially in the clinical and health spheres (Costarelli & Patsai, 2012; Hamdan-Mansour, Puskar, & Bandak, 2009; Gulewitsch et al., 2013; O'Donovan & Hughes, 2007; Pettit & De Barr, 2011).”
BackgroundHayakawa, N., Tanaka, S., Hirata, N., Ogino, S., & Ozaki, N. (2019) · BMC Research Notes · doi:10.1186/s13104-019-4672-7 · Cited by 4 · see citing works
Shidhani, A. S. A., Samani, A. A., Malki, T. A., Shukaili, B. A., Toubi, A. A., Chan, M. F., Al-Harthi, L., Al‐Sibani, N., Saadoon, M. A., Cucchi, A., et al. (2023) · Taiwanese Journal of Psychiatry · doi:10.4103/tpsy.tpsy_3_23 · Cited by 3 · see citing works
Maștaleru, A., Abdulan, I. M., Oancea, A., Costache, A. D., Jigoranu, A. R., Zota, I. M., Roca, M., Ioniuc, I. K., Rusu, C., Trandafir, L. M., et al. (2023) · Nutrients · doi:10.3390/nu15163666 · Cited by 3 · see citing works
Sınav Stresi Ölçeğinin Türkçeye Uyarlanması ve Ölçme Değişmezliğinin İncelenmesi
KARADUMAN, B., & Kilmen, S. (2018) · Eğitimde ve Psikolojide Ölçme ve Değerlendirme Dergisi · doi:10.21031/epod.330426 · Cited by 3 · see citing works
Stress and Disordered Eating Patterns
Tsofliou, F., Casey, C., & Hughes, C. (2022) · Springer eBooks · doi:10.1007/978-3-030-67929-3_3-1 · Cited by 2 · see citing works
Peer victimization and eating behaviors in college students: the mediating role of perceived stress
Rosén, L., Scott, S. D., & Paulman, B. E. (2023) · Journal of Aggression Conflict and Peace Research · doi:10.1108/jacpr-05-2022-0719 · Cited by 2 · see citing works
The optimal cut-off score of the Eating Attitude Test-26 for screening eating disorders in Japan
Nohara, N., Hiraide, M., Horie, T., Takakura, S., Hata, T., Sudo, N., & Yoshiuchi, K. (2024) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-024-01669-1 · Cited by 2 · see citing works
“Therefore, some previous studies evaluated the Beck Depression Inventory second edition (BDI-II) or state trait anxiety inventory (STAI) concurrently with the EAT-26 to assess the impact of those psychological states on EAT-26 scores [11, 67, 76].”
MethodFalzon, R. V. (2020) · IntechOpen eBooks · doi:10.5772/intechopen.94577 · Cited by 2 · see citing works
Stress and Disordered Eating Patterns
Tsofliou, F., Casey, C., & Hughes, C. (2023) · Springer eBooks · doi:10.1007/978-3-031-16691-4_3 · Cited by 1 · see citing works
Validation of the Greek version of the Salzburg Stress Eating Scale in adults
Pediaditakis, N., Michou, M., Tigani, X., Kanaka-Gantenbein, C., & Costarelli, V. (2023) · Mediterranean Journal of Nutrition and Metabolism · doi:10.3233/mnm-230017 · Cited by 1 · see citing works
Self-citationEmotional Eating in Primary Care: Considerations for Assessment and Management
Wozniak, J. D., & Huang, H. Y. (2024) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000405 · Cited by 1 · see citing works
Examining the Correlation Between Stress and Disordered Eating
Liu, W. (2021) · Advances in Social Science, Education and Humanities Research/Advances in social science, education and humanities research · doi:10.2991/assehr.k.211220.245 · Cited by 1 · see citing works
Disordered Eating and Risky Sexual Behaviors in College Women
Terrell, K. R., Satanton, B. R., & Hamadi, H. Y. (2022) · Journal of Counseling Sexology and Sexual Wellness · doi:10.34296/04011060 · Cited by 1 · see citing works
Tuncer, G. Z., & Duman, Z. Ç. (2024) · Journal of Basic and Clinical Health Sciences · doi:10.30621/jbachs.1070068 · Cited by 1 · see citing works
Papadimitriou, A., & Karakasidou, E. (2025) · Future · doi:10.3390/future3030016 · Cited by 1 · see citing works
“Stress, in particular, is often linked to the development of unhealthy eating habits and food addictions as a coping mechanism for emotional distress [48], which can lead to the emergence of disordered eating behaviors [47,49,50].”
Mello, S. A. (2016) · Cited by 1 · see citing works
Romano, K. A., Colgary, C. D., Becker, M. A. S., & Magnuson, A. B. (2018) · Journal of American College Health · doi:10.1080/07448481.2018.1486319 · Cited by 1 · see citing works
Self-Compassion as a Buffer against Eating Pathology in a Greek Community Sample
Karakasidou, E. (2023) · Mental Health & Human Resilience International Journal · doi:10.23880/mhrij-16000211 · Cited by 1 · see citing works
Does Social Support Influence Bulimic Behaviors through Its Impact on Cognitive Appraisal
Kwan, M. Y. (2016) · NDSU Repository (North Dakota State University) · Cited by 1 · see citing works
Stress, Affect Systems and Eating Pathology in Problematic Weight Regulation
Kupeli, N. (2014) · University of Hertfordshire Research Archive (University of Hertfordshire) · doi:10.18745/th.15438 · Cited by 1 · see citing works
“A recent study by Costarelli and Patsai (2012) also demonstrated that DE behaviours are higher during stressful periods.”
BackgroundInfluentialTHE EFFECT OF INTRA-FAMILY COMMUNICATION AND PARENTAL ATTITUDE ON ACADEMIC SUCCESS
Başaslan, Z. (2022) · European Journal of Alternative Education Studies · doi:10.46827/ejae.v7i1.4325
Su, D., & Wong, B. Y. (2025) · SAGE Open · doi:10.1177/21582440251343961
“…suggested that students experiencing academic stress may be more likely to engage in short-sighted or addiction-like behaviours such as alcohol abuse (Metzger et al., 2017), illicit drug use (Ford & Schroeder, 2008), binge eating (Costarelli & Patsai, 2012), and heavy smoking (Jain & Verma, 2016).”
Scutt, E., Langdon-Daly, J., & Smithson, J. (2022) · Figshare · doi:10.6084/m9.figshare.20522630
“Mindful eating: a comparative study between medical and non-medical students of Tanta University”
Mohammad, A. M. A., Kassim, E., El-Sharawy, M., Elsherbini, A. A., & Eldeeb, A. F. (2026) · Journal of Health Population and Nutrition · doi:10.1186/s41043-025-01232-3 · Cited by 1 · see citing works
Zasiekina, L., Dunn, M., Miller, L., Tattersall, I., & Vidaurre, V. (2026) · Journal of Eating Disorders · doi:10.1186/s40337-026-01543-8
“University students, particularly first-year university students, experience disruptions in their eating routines, increased autonomy, and academic stress, which can heighten their vulnerability to maladaptive coping strategies [11, 39, 40, 46].”
Ding, P., & Wang, J. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2026.1826577
“Emotional eating—eating in response to negative emotions rather than physiological hunger (10)—has been linked to stress exposure and impaired emotion regulation (11).”
Yan, X., & Wang, S. (2026) · Journal of Eating Disorders · doi:10.1186/s40337-026-01594-x
“Importantly, even disordered eating has been linked to impaired concentration, increased stress reactivity, sleep disturbance, and reduced academic persistence among college students [11, 62, 66], suggesting that its impact extends beyond physical health to core academic functioning.”
- Authors
- Costarelli, V., & Patsai, A.
- Affiliations
- Harokopio University of Athens (GR)
- Corresponding author
- Costarelli, Vassiliki
- Venue
- Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
- Published
- 2012-09
- Volume
- 17
- Issue
- 3
- Pages
- e164-e169
- ISSN
- 1124-4909 (ISSN-L)
- 1590-1262
- OpenAlex
- W2082613744
- Cited by
- 85
- References
- 54
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 6 · 2023: 8 · 2022: 12 · 2021: 5 · 2020: 7 · 2019: 7 · 2018: 8 · 2017: 6 · 2016: 7 · 2015: 5 · 2014: 5 · 2013: 1
- FWCI
- 3.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Health Professions › General Health Professions › Health and Lifestyle Studies
- Keywords
- disordered eating, female university students, emotional eating, dietary restraint, body image, self-esteem, anxiety, eating attitudes
- MeSH terms
- Adolescent, Adult, Feeding and Eating Disorders, Attitude to Health, Body Image, Feeding Behavior, Female, Greece, Humans, Surveys and Questionnaires, Self Concept, Stress, Psychological, Students, Time Factors, Universities
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