When PCOS Meets Eating Disorders: An Explainable AI Approach to Detecting the Hidden Triple Burden

Polycystic Ovarian Syndrome (PCOS) is a widespread hormone problem for women of childbearing age. Women with PCOS may not ovulate; they might have high levels of androgens and have many small cysts on the ovaries. It can cause missed or irregular menstrual periods, excess hair growth, acne, infertility, and weight gain. Machine Learning (ML) can effectively diagnose this disease at an earlier stage as tons of medical data are available now. Traditional approaches to detect PCOS encompass a combination of clinical evaluation, medical history assessment, physical examination, and laboratory tests. These approaches aim to identify the characteristic symptoms and hormonal imbalances associated with PCOS. Physical examination requires good resources and costs time and money. In recent times, data-driven techniques have substantially advanced disease prediction within the medical field. We aim to utilize ML approaches, incorporating unique feature selection algorithms, to predict PCOS. This paper introduces a data-driven approach to PCOS diagnosis, combining Feature Engineering and ML. Several feature selection approaches have been considered to select sets of features for training the ML model, including CatBoost, Extreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine (LGBM), AdaBoost, Random Forest (RF). Results demonstrate that AdaBoost, with ten features selected by RF Feature Importance and Highest Correlation (HC), provides the highest test accuracy.

Large language model (LLM)-based simulations of clinical patients are increasingly used for research and training, yet their validity requires persona stability: coherent maintenance of an assigned psychological profile across and within conversations. We evaluate this prerequisite using eating disorder personas grounded in five published case vignettes, a dual-assessment framework (self-report + independent observer ratings), and validated psychometric instruments (EDE-Q) with known ground-truth scores. Across six LLMs and two experiments (between-conversation stability (Exp. I) and within-conversation stability (Exp. II)), we find that LLMs are paradoxically too stable and too inaccurate: variability is negligible, yet all models systematically overshoot ground-truth severity by 12-30% of the scale range (0.7-1.8 points on a 0-6 scale). The mechanism is selective stereotyping: models differentiate cases on behavioural items (dietary restraint) but maximise cognitive-affective items (body dissatisfaction, weight preoccupation) at ceiling regardless of case severity. Additional conversational context does not improve accuracy; it compounds the overshoot. LLMs can portray severe eating pathology but lack a representation of moderate clinical presentations, a "missing middle".

Recent evidence shows that people with eating disorders (EDs) are increasingly seeking guidance, advice, and emotional support from Large Language Model (LLM)-based chat systems. Although these systems are not designed to provide clinical advice, their perceived expertise, neutrality and accessibility make them a frequent, albeit risky, source of support. This paper investigates potential patterns of interaction between users with EDs and LLMs, focusing on the potential harms arising from models that uncritically adapt to, and facilitate unsafe or self-harming user requests. We find, in consultation with clinical ED experts, that specific linguistic cues in prompts increase the likelihood of unsafe responses and, through systematically varying the degree of potential risk present in the user prompt, report the extent to which LLMs uncritically adapt to problematic, and potentially dangerous user inputs.