Baseline cortisol predicts drunkorexia in female but not male college students

[Chapters from alcohology]

Az ezredfordulót követő első évtizedben vált divatossá, döntően egyetemi hallgatók körében, egy nagy kockázatú viselkedés, a drunkorexia, amely a szándékos éhezés vagy falás és hánytatás alkoholabúzussal történő kombinációja. A drunkorexia a fiatal felnőtt lakosság körében növekvő gyakoriságú, de nem kellően ismert prevalenciájú tünetegyüttes, amely jelentős fizikai, pszichológiai és szociális-egészségügyi következményekkel jár. Az éhezés és az excesszív alkoholfogyasztás kiváltotta anyagcsere-változások közötti interferencia életveszélyes állapot kialakulását okozhatja. A diagnosztikai kritériumok finomítása lehetővé teszi a pontos diagnózis felállítását. A terápia során a pszichoedukáció és a pszichoterápiás módszerek mellett a gyógyszeres kezelésnek is helye van. Orv Hetil. 2024; 165(48): 1888–1893.

Comprehensive Management of Drunkorexia: A Scoping Review of Influencing Factors and Opportunities for Intervention

BACKGROUND AND OBJECTIVES

Drunkorexia is a novel alcohol-related disorder prevalent among adolescents and young adults. Extensive research on the causes and their relationship is lacking. Identifying these aspects could improve early detection and management by healthcare professionals. The aim of this review was to identify the influencing factors of drunkorexia in adolescents and young adults, as well as the main opportunities for action by health professionals.

METHODS

A scoping review was conducted in June and July 2024 using three databases (Pubmed, Scopus, and Web of Science). A search and review protocol were established and registered in PROSPERO. The research questions were formulated in Patient, Concept, Context (PCC) formats for an adequate literature review. Original articles from January 2008 to July 2024 were included. Reviews, meta-analyses, and doctoral theses or academic texts were excluded. In the screening phase, a methodological assessment was conducted using the Joanna Briggs Institute's (JBI) critical appraisal tools to support study eligibility. Depending on the study design, different checklists were used, and cross-sectional studies that received scores of 4/8 or higher, quasi-experimental designs that obtained 5/9 or higher, and qualitative research that obtained 5/10 or higher were accepted.

RESULTS

A total of 1502 studies were initially found. After applying the inclusion/exclusion criteria, 20 studies were selected. Complications of emotion regulation, both positive and negative metacognitive beliefs, inability to effectively manage stress and anxiety, symptoms of post-traumatic stress disorder, self-discipline and self-control, or differences in social expectations are predisposing factors for drunkorexia. The management of malnutrition and dehydration is an opportunity for clinical professionals to address this problem. In addition, mental health issues can provide another opportunity to manage heavy alcohol consumption.

CONCLUSIONS

Drunkorexia must be recognized as a new disease to be addressed from a multidisciplinary perspective. In this way, increasing research on this trend would support prevention and intervention strategies. The use of digital platforms is essential for raising social awareness of this negative habit.

Unification of the food and alcohol disturbance literature: A systematic review

Food and alcohol disturbance (FAD) reflects the functional relationship between disordered eating and alcohol use. There are two motivations underlying FAD - to enhance the effects of alcohol and/or to compensate for alcohol-related calories. Yet, most FAD studies have failed to adequately measure the motives underlying these behaviors, leading to inconsistent and imprecise findings. The aim of the current systematic review was to thematically consolidate FAD research findings by motive, identify limitations of the existing literature, and highlight next steps for FAD researchers. Eighty-one publications, presenting data from 38,536 participants, were included in the current review. Prevalence rates for the caloric compensation and alcohol enhancement motives range from 5.6% - 88.7% and 4.7% - 81.7%, respectively. Alcohol use and disordered eating were the primary correlates of FAD for both motives, and alcohol-related consequences were positively associated with both FAD motives cross-sectionally. Major limitations of the literature include inconsistent operationalization and imprecise measurement of FAD. Primary recommendations include adopting the terminology of and operationalization of FAD presented here, ensuring attention to FAD motive in developing and testing research questions, and moving beyond cross-sectional studies. Findings from this review can be used to contribute to more rigorous and unified FAD research.

Differences between preemptive and non-preemptive physical activity among 'drunkorexia'-positive college students

Objective: 'Drunkorexia' is characterized by compensating for alcohol-related calories using physical activity (PA). Drunkorexia is common on college campuses but little is known about the PA behaviors within the drunkorexia paradigm. Methods: First-year college students living on campus completed an online survey collecting drunkorexia, PA, and alcohol consumption data. A total of 127 participants reported engaging in drunkorexia behaviors. Results: Fifty-three participants were classified as preemptively physically active (e.g., PA and drink on Tuesday) compared to 74 as non-preemptively physically active. Preemptively physically active participants consumed more alcohol on Fridays and Saturdays than those non-preemptively physically active. Preemptively physically active participants engaged in significantly greater amounts PA. Females accounted for all significant differences between groups. Discussion: Among drunkorexia-positive participants, many made preemptive efforts to control their calories before consuming alcohol, which may predispose them to higher incidences of adverse outcomes such as alcohol poisoning, unwanted sexual advances, and death.

Food and alcohol disturbance among US college students: a mixed methods scoping review

OBJECTIVE

Conduct a scoping review of food and alcohol disturbance (FAD) in US college students to overview the literature within this population and identify research opportunities.

METHODS

Studies (n = 39) were selected using systematic searches of databases and references. Search terms included: drunkorexia, "food and alcohol disturbance," and "compensatory behavior" AND alcohol AND eating.

RESULTS

Issues with methodological quality were noted. Most studies used quantitative methods and cross-sectional designs with small, biased samples. Terminologies, conceptualizations, and measures varied; however, 30% of studies neglected enhanced intoxication effects. Prevalence ranged from approximately 10-55%, with greater risk for women. Alcohol use and disordered eating were primary predictors. Personality, affective, and social factors are potential correlates. Alcohol-related consequences were higher for those with FAD.

CONCLUSIONS

While the literature is inconsistent and unclear, FAD appears to be common among college students and associated with negative consequences. Suggestions and considerations for future research are provided.

Sexual minority status and food and alcohol disturbance among college students: The moderating role of body esteem

Food and alcohol disturbance (FAD; restricting caloric intake before, during, or after drinking to either offset calories or to increase intoxication) is common among college students and poses a threat to students' health. In conjunction, sexual minority (SM; i.e., not exclusively heterosexual) college students may be at increased risk of engaging in alcohol misuse and disordered eating compared to their heterosexual peers due to exposure to minority stress. However, little research has examined whether engagement in FAD differs by SM status. Body esteem (BE) is an important resilience factor among SMs that may influence SM students' risk of participating in FAD. Therefore, the aim of the present study was to understand the association between SM status and FAD with additional interest in BE as a moderating factor. Participants were 459 college students who engaged in past 30-day binge drinking. Most participants identified as White (66.7 %), female (78.4 %), heterosexual (69.3 %), with a mean age of 19.60 (SD = 1.54) years. Participants completed two surveys (3 weeks apart) over the course of an academic semester. Analyses revealed a significant interaction between SM status and BE, such that SMs with lower BE (T1) reported more engagement in FAD-intoxication (T2), whereas SMs with higher BE (T1) reported less engagement in FAD-calories (T2) and FAD-intoxication (T2) than their heterosexual peers. Stressors associated with body esteem may contribute to increased FAD engagement among SM students. Consequently, BE may be an especially important target for interventions aimed at reducing FAD among SM college students.

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 in a broad age-range adult sample

Food and alcohol disturbance involves restricting, purging, or excessively exercising to compensate for the calories consumed from drinking alcohol, or to enhance intoxication levels. But these compensatory behaviors, colloquially termed "drunkorexia," have only been investigated in young adult samples-primarily college students-who are presumed to be at risk due to their high episodic drinking rates. Therefore, this study sought preliminary evidence that food and alcohol disturbance occurs in a broader age-range sample of adult drinkers. We recruited 253 participants aged 18 to 76 (M_age = 38.71) from Mechanical Turk. Rates of food and alcohol disturbance (measured by the Compensatory Eating Behaviors in Response to Alcohol Consumption) were high: 64% of the sample endorsed performing at least one compensatory behavior in the past three months. There were no gender differences in overall prevalence, though men were more likely than women to engage in food and alcohol disturbance to enhance intoxication levels. Drinking habits, drinking motivated by conformity, and abnormal eating attitudes were the strongest predictors of food and alcohol disturbance. However, eating attitudes were a stronger predictor of these behaviors in men than women, whilst drinking habits were a stronger predictor of these behaviors in women than men. The high prevalence of food and alcohol disturbance in our broad age-range sample, alongside the far-reaching health consequences of these behaviors, highlights the need for increased awareness in younger, middle, and older adults alike.

Examining eating disorder-related social comparison orientation and body dissatisfaction in the relationship between fit ideal internalization and drunkorexia engagement

The aim of the present study was to examine the relationship between fit ideal internalization and drunkorexia engagement in women. Specifically, in line with the Tripartite Influence Model, we examined the indirect effect of fit ideal internalization on drunkorexia through eating disorder-related social comparison orientation and body dissatisfaction. Data were collected from two samples of women-college undergraduate students (n = 198) and women recruited through Amazon Mechanical Turk (n = 324)-in order to test the model across the two groups. All participants completed the consent forms and then questionnaires via Qualtrics between March and June 2020. The results suggest that fit ideal internalization, body dissatisfaction, and eating disorder-related social comparison orientation are linked to drunkorexia. More specifically, multigroup path analyses indicated that there was an indirect effect of fit ideal internalization on drunkorexia via eating disorder-related social comparison orientation but not through body dissatisfaction. In examining the role of different types of eating disorder-related social comparison orientation (body, eating, exercise) in the model, more nuanced patterns emerged across the samples. Future research examining potential mediators and moderators of the relationship between eating disorder-related social comparison orientation and drunkorexia would be beneficial in expanding this area of study.