Examining associations between disordered eating and harmful substance use in a nationally representative sample of US veterans.

OBJECTIVE: The association between eating disorders (EDs) and harmful substance use (substance use that causes psychosocial impairment) is well recognized in the literature, and military veterans may be at heightened risk for both issues due to deployment-related stressors. However, little is known about which ED-related symptoms are associated with harmful substance use in veterans, and whether gender plays a differential role in this relationship. Our aims were to: (1) examine gender differences in ED-related symptoms; and (2) examine whether ED-related symptoms differentially predict harmful substance use in US veteran men and women who had recently separated from service. METHOD: This study was based on a nationally representative four-wave longitudinal sample of post-9/11 veterans (N = 835; 61.2% female). Longitudinal mixed modeling was used to test whether specific ED-related behaviors at baseline predicted harmful substance use at follow-ups. RESULTS: We replicated gendered patterns of ED-related symptoms observed in civilian populations, wherein men had higher weight-and-body-related concerns (including excessive exercise and muscle building) and negative attitude toward obesity, and women had higher bulimic and restricting symptoms. For women, alcohol, drug, and marijuana problems were predicted by higher bulimic symptoms, whereas for men, these problems were predicted by higher restricting symptoms. CONCLUSION: Gender played a differential role in the relationship between EDs and harmful substance use. Bulimic symptoms were the most robust predictor for harmful substance use among veteran women, whereas restricting was the most robust predictor for harmful substance use among veteran men. PUBLIC SIGNIFICANCE: The current study found that veteran women had higher bulimic symptoms (characterized by binge eating and purging) and restricting than veteran men. In women, bulimic symptoms predicted future harmful use of alcohol, marijuana, and other drugs. In contrast, veteran men had higher weight-and-body-related concerns (characterized by excessive exercise and muscle building) than veteran women. In men, restricting symptoms predicted future harmful use of alcohol, marijuana, and other drugs.

Social Anxiety and Drunkorexia Behaviors among Adolescents and Young Adults: The Moderating Role of Resilience.

Background: Existing evidence showed that social anxiety represents a significant factor in eating disorders. However, to our knowledge, no prior study has examined the association between social anxiety and drunkorexia behaviors. Objectives: The present study aimed at exploring the relationship between social anxiety and drunkorexia behaviors, and investigating resilience as a moderator of this relationship. Participants were 333 adolescents and young adults aged 15-24 years (Mage=18.26, SDage= 1.55; 66% females) who completed an online survey. Results: The results indicated that drunkorexia behaviors were positively correlated to three dimensions of social anxiety; however, only fear of negative evaluation had a significant predictive effect. In addition, resilience only moderated the relationship between fear of negative evaluation and drunkorexia behaviors, such that youths reporting high fear of negative evaluation and low resilience showed greater drunkorexia behaviors, whereas youths reporting high resilience showed no correlation between fear of negative evaluation and drunkorexia behaviors. Conclusions: The findings highlight the importance of drunkorexia interventions and preventive measures aimed at strengthening youths' resilience and ability to effectively manage stress and social anxiety (i.e., fear of negative evaluation).

Past body shaming experiences and food and alcohol disturbance in young adults: indirect effects via psychological distress.

PURPOSE: This study investigated the associations between retrospective reports of body image victimization (i.e. body shaming) perpetrated by peers and by parents during childhood or adolescence, and food and alcohol disturbance (FAD) in young adulthood, considering the possible mediating role of psychological distress (i.e. subthreshold symptoms of anxiety and depression). METHODS: The study involved 1624 young adults aged between 18 and 30 (69% women), who completed an online survey. RESULTS: Our findings revealed that participants who reported more frequent body image victimization episodes during childhood and adolescence exhibited higher levels of psychological distress and, in turn, higher scores of FAD in young adulthood. CONCLUSIONS: This result represents a novel contribution to understanding the psychological correlates of FAD in youths. Limitations and implications are discussed. Level of evidence Level V, descriptive study.

French validation of the Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale (CEBRACS) in a university student sample.

PURPOSE: Food and Alcohol Disturbance (FAD) is characterized by the combination of problematic alcohol use and eating disorder symptoms to offset caloric intake associated with alcohol drinking and/or to enhance intoxication. The Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale (CEBRACS) is a proven tool for measuring FAD, validated in English and Italian populations but never in the French population. The present study aims at validating a French version of the CEBRACS in a representative sample of university students and to determine its validity and reliability. METHODS: 2267 university students completed the CEBRACS and measures of eating disorders, alcohol consumption and exercise. RESULTS: An exploratory factor analysis revealed a 4-factor structure: enhancement of the effects of alcohol, dietary restraint and exercise, purging and vomiting and extreme fasting. The internal consistency for these subscales ranged from good to excellent. Correlations between the CEBRACS and eating disorders, alcohol and exercise measures revealed a good concurrent validity. No gender differences were found in the CEBRACS scores. Participants with a CEBRACS total score > 21 points were at higher risk for developing eating disorders and alcohol-related problems. CONCLUSIONS: These findings highlight the reliability and validity of the French version of the CEBRACS. The distinct factors identified in the CEBRACS allow to distinguish between participants with different motives for engaging FAD behaviour and thus to prevent future development of eating and/or alcohol use disorders. The CEBRACS seems to be a relevant scale to capture FAD behaviors and thus to prevent negative and deleterious consequences. LEVEL OF EVIDENCE: Level III, evidence obtained from well-designed cohort or case-control analytic studies.

Drunkorexia behaviors and motives, eating attitudes and mental health in Lebanese alcohol drinkers: a path analysis model.

BACKGROUND: Drunkorexia refers to limited intake of high-calorie food to avert gaining weight and the need to increase in alcohol excessive consumption. The present study aimed to check for an association between depression, anxiety, and stress with drunkorexia behaviors/motives among Lebanese adults, while evaluating the mediating role of inappropriate eating attitude in those associations. METHODS: Two hundred and fifty-eight participants enrolled in this cross-sectional study, who filled an online survey (September-December 2020). RESULTS: Drunkorexia behaviors were considered as the dependent variable; the path coefficients from stress to anxiety, from anxiety to eating attitudes, from eating attitudes to drunkorexia behaviors and from anxiety to drunkorexia behaviors were all significant. The indirect relationships showed that eating attitudes mediated the association between anxiety and drunkorexia behaviors. When taking the drunkorexia motives as the dependent variable, the path coefficients from stress to anxiety, from anxiety to eating attitudes, from eating attitudes to drunkorexia motives, and from anxiety to drunkorexia motives were all significant. The indirect relationships showed that eating attitudes mediated the association between anxiety and drunkorexia motives. CONCLUSION: This study highlighted that individuals with more psychological problems (depression, anxiety, and stress) and inappropriate eating habits exhibit more drunkorexic motivations and behaviors. LEVEL OF EVIDENCE: Level V, Cross-sectional study.

Food and alcohol disturbance among young adults during the COVID-19 lockdown in Italy: risk and protective factors.

PURPOSE: The COVID-19 lockdown measures have had a significant impact on risk behaviors as alcohol use and disordered eating. However, little is known about a serious health-risk-behavior named "food and alcohol disturbance" (FAD), characterized by engaging in dysfunctional eating on days of planned alcohol consumption. The aim of the present study was to investigate potential factors that may have put young adults at risk or protected against FAD during the COVID-19 lockdown. METHODS: A sample of 447 young adults (280 females, 167 males; range 18-26) completed an online survey during the country's nationwide lockdown composed of self-reported measures assessing FAD behaviors, alcohol consumption, compensatory behaviors, eating and weight concerns, social support, emotion regulation strategies, and living arrangement. RESULTS: Our findings showed that FAD was significantly and positively correlated to alcohol consumption, use of laxatives, self-induced vomiting, eating and weight concerns, and expressive suppression, and negatively correlated to social support and living with family. Hierarchical regression analysis revealed that alcohol consumption, eating concern, and expression suppression positively predicted FAD, while social support and living with family were negative predictors. CONCLUSIONS: Our results suggest that during the COVID-19 lockdown, preoccupation with eating and the use of expressive suppression may have increased vulnerability to FAD; conversely, perceived social support and living with family may have been a source of protection against this dysfunctional behavior. LEVEL OF EVIDENCE: Level V, descriptive study.

Exploring the association between psychological distress and drunkorexia behaviors in non-clinical adolescents: the moderating role of emotional dysregulation.

PURPOSE: Although drunkorexia seems to represent a new form of eating disorder, it shares several features with traditional eating disorders. However, very little is known about the association between drunkorexia and a widely studied correlate of eating disorders, such as psychological distress and about mechanisms underlying this association. The present study aimed to investigate the relation between symptoms of anxiety and depression and drunkorexia, and to explore the role of emotional dysregulation as moderator of this relationship. METHODS: The sample was composed of 402 adolescents (222 females, 180 males; range 15-21) who completed self-reported measures: Drunkorexia Motives and Behaviors Scale, which assesses different behaviors and motivations associated with drunkorexia, Emotional dysregulation scale from the Eating Disorder Inventory-3, reflecting difficulties regulating emotions, and Anxiety and Depression scales from the Symptom CheckList-90 Revised, assessing general signs of anxious and depressive symptoms. RESULTS: Anxious symptomatology resulted a significant statistical predictor of drunkorexia behaviors (ß = .28, p = .001). Furthermore, emotional dysregulation moderated the relation between anxiety and drunkorexia; specifically, a positive relation was found both at medium levels (ß = .22, p = .007) and at higher levels of emotional dysregulation (ß = .38, p = .000), whereas at lower levels of emotional dysregulation, this association became nonsignificant. CONCLUSIONS: Findings suggest that adolescents who experience both elevated anxiety and emotional dysregulation may be more likely to turn to drunkorexia to reduce their unregulated negative affect in the absence of more adaptive emotion regulation strategies. Implications for intervention and prevention programs are discussed. LEVEL OF EVIDENCE: Level V, descriptive study.

Drunkorexia: is it really "just" a university lifestyle choice?

PURPOSE: The current study investigated the prevalence of compensatory behaviours (caloric restriction, increased exercise and bulimic tendencies) in response to alcohol consumption (also known as Drunkorexia) in students, non-students and previous students, as well as beginning to understand the presence of possible predictors of these behaviours (body esteem, sensation seeking). METHODS: A volunteer sample of students, non-students and previous students (n = 95) completed the Compensatory Eating and Behaviours in Response to Alcohol Consumption Scale, a questionnaire which measures overall Drunkorexia engagement. The participants also completed the Body Esteem Scale for Adolescents and Adults Scale (BESAA) and the Brief Sensation Seeking Scale (BSSS) to investigate predictors of Drunkorexia. RESULTS: The results indicated that there was no significant difference in Drunkorexia engagement and behaviours between students, non-students and previous students. It was also found that both low body esteem and high sensation seeking tendencies were significant predictors of Drunkorexia; specifically, the appearance esteem factor of the BESAA and the disinhibition factor of the BSSS. CONCLUSIONS: Findings suggest that Drunkorexia is also present outside of student populations, and therefore, future interventions and research should include non-students in samples. In addition, findings support the idea that Drunkorexia cannot be classified solely as an eating disorder or a substance abuse disorder. As a result of this, further research should be conducted to fully understand why this complex behaviour exists. EVIDENCE-BASED MEDICINE LEVEL: III (Evidence obtained from case-control analytic study).

Psychological characteristics and eating attitudes in adolescents with drunkorexia behavior: an exploratory study.

PURPOSE: Drunkorexia represents an emerging phenomenon that is still understudied especially among adolescents. The present study aimed to investigate the relation between drunkorexia and psychological characteristics relevant and commonly associated with existing forms of eating disorders. METHODS: The sample was composed of 849 adolescents (513 boys, 334 girls, 2 unknown; range 14-22) who completed a survey composed of Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale and Psychological scales of the Eating Disorders Inventory-3. RESULTS: Our findings highlighted that drunkorexia was associated with low self-esteem, personal alienation, interoceptive deficits, emotional dysregulation, and asceticism. Hierarchical multiple regression analysis indicated that difficulties with emotion regulation and ascetic tendencies were significant predictors of drunkorexia among adolescents. CONCLUSIONS: Our findings suggest the importance for programs preventing drunkorexia to be focused on training adolescents in using more adaptive strategies to manage emotions and accepting both emotional and physical signals without feeling guilty or threatened. LEVEL OF EVIDENCE: Level V, descriptive study.

Examining the role of body esteem and sensation seeking in drunkorexia behaviors.

PURPOSE: The purpose of the present study was to examine the role of body esteem (BE), sensation seeking (SS), and their interaction in drunkorexia, a behavior pattern marked by calorie restriction/compensation in the context of alcohol consumption. While previous research on drunkorexia has focused on a range of variables, the present study examined two novel variables and their potential interaction: body esteem (weight, appearance) and sensation seeking. METHODS: A sample of college students (n =488) completed the Body Esteem Scale for Adolescents and Adults, the Brief Sensation Seeking Scale, and the Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale, which measures overall drunkorexia engagement as well as four dimensions: alcohol effects, bulimia, dietary restraint and exercise, and restriction. RESULTS: Moderated linear regression analyses indicated that SS and BE (weight, appearance) did not interact in predicting drunkorexia. Rather, only main effects were observed; SS, weight esteem (WE), and appearance esteem (AE) were significant in predicting overall drunkorexia engagement. In terms of the drunkorexia dimensions, AE was a significant predictor in the alcohol effects, dietary restraint and exercise, and restriction models. WE was significant in the dietary restraint and exercise model as well as the restriction model. SS was a significant predictor across all drunkorexia dimensions. CONCLUSIONS: Our findings suggest that both elevated SS and lowered BE are associated with drunkorexia engagement. Implications for practice are discussed. Drunkorexia is a complex and multifaceted behavior pattern; therefore, further research is needed in this area of study. LEVEL OF EVIDENCE: Level V (descriptive study).