Traumatic stress and alcohol-related disordered eating in a college sample

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.

Weight-control compensatory behaviors patterns and correlates: a scoping review

Objective

Weight-control compensatory behaviors appear to be a commonly utilized strategy for health management. Individuals engaging in such behaviors believe that the negative consequences from unhealthy behaviors will be neutralized by the positive consequences of healthy behaviors. Existing research has not reached a consensus on whether such behaviors are beneficial to health. This review aims to (1) summarize the patterns of weight-control compensatory health behaviors in different populations, (2) highlight correlates, predictors, and consequences of compensatory health behaviors, and (3) identify gaps for future research.

Method

This review identified existing literature using online databases, CINAHL and PubMed. Primary research articles published after 2000 with non-clinical participants of 12 years or older who engaged in compensatory behaviors for weight control purposes were selected. Descriptive statistics were extracted from 35 studies.

Results

Different patterns for weight-control compensatory behaviors emerged between the female and male sexes. Meanwhile, no clear association of such behaviors was found across weight status. Studies reviewed also highlighted three main areas of compensatory behaviors for weight management, namely dietary behaviors, physical activity, and alcohol consumption. Weight-control compensatory behaviors had significant negative correlations with mental health indicators, such as psychosocial functioning, emotional differentiation ability, and body esteem.

Conclusion

Weight-control compensatory behaviors may be a widely used weight management strategy and can be presented in diverse ways. Although believed to be promoting health, such behaviors appear to be associated with poor psychological well-being. This emerging topic warrants more in-depth investigation to establish the direction of causation. Future research may investigate the relationship between weight-control compensatory behaviors and various aspects of health over longer time periods, examine the engagement of multiple weight-control compensatory behaviors, and focus on high-risk populations.

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.

Problematic alcohol use and food and alcohol disturbance in mothers: Examining the role of stress, body dissatisfaction, and wine-mom-consistent drinking

OBJECTIVE

In recent years, women have significantly closed the alcohol use gender gap-and they are drinking more heavily now than in previous decades (Keyes et al., 2019). Furthermore, "wine-mom" culture (which promotes the use of alcohol to cope with the stressors of parenthood) has become increasingly prevalent in society and may be a factor in mothers' alcohol use. In the present study, we examined wine-mom-consistent drinking (whether one's alcohol use corresponds to that promoted by wine-mom culture) as a moderator in the relationship between psychosocial predictors (stress, body dissatisfaction) and alcohol-related outcomes (problematic alcohol use, food and alcohol disturbance-FAD).

METHODS

Participants were mothers (Mage = 40.18, SD = 8.28) recruited through Prolific from both the United States and the United Kingdom (n = 466; 50 % from the US and UK each); they completed the study via a Qualtrics survey.

RESULTS

In the models tested, stress interacted with wine-mom-consistent drinking in predicting FAD (alcohol effects and restriction dimensions), and body dissatisfaction interacted with wine-mom-consistent drinking in predicting the FAD restriction dimension. Compared to those who did not endorse wine-mom-consistent drinking, the relationship between the predictors and the FAD dimensions was stronger among participants who endorsed wine-mom-consistent drinking. Body dissatisfaction and wine-mom-consistent drinking also emerged as significant independent predictors in some of the models.

CONCLUSION

Wine-mom-consistent drinking is associated with problematic alcohol use and FAD among mothers. Further research is needed to better understand wine-mom culture and related psychosocial factors in mothers' drinking motives and behaviors.

The impact of trauma-related symptoms and neuroticism on compensatory behaviors in a sample of adults with eating disorders

INTRODUCTION

Inappropriate compensatory behaviors (ICBs), including purging, restricting, and excessive exercising, are key symptoms of several eating disorders (EDs). Studies have found positive associations between trauma and ICBs, although few studies have explored mechanisms that may explain these relationships. Emotion dysregulation has been posited as a mechanism that explains associations among ICBs and trauma. Given that individuals with high neuroticism may be particularly likely to use ICBs to regulate emotions following a trauma, the purpose of this study was to test whether neuroticism moderated the relationship between trauma-related symptoms and each type of ICB (purging, restricting, and excessive exercise).

METHOD

A community sample of adults with a DSM-5 ED (N = 263; 83.7 % female) completed measures of trauma-related symptoms, ED psychopathology, and personality.

RESULTS

Zero-inflated negative binomial models revealed that trauma-related symptoms alone predicted restricting and purging behavior. In addition, we found that neuroticism alone predicted the presence of excessive exercise. We found no significant interaction between trauma-symptoms and neuroticism.

CONCLUSION

Although past research has documented high rates of co-occurring ED and PTSD, the connections between trauma-related symptoms and ICBs are complex and may be unique to each type of ICB. Given that neuroticism may not influence the relationship between trauma-related symptoms and ICBs, more research should be done to establish an understanding of factors that could explain the relationship between ICBs and trauma-related symptoms. Novel interventions that simultaneously target restricting, purging, and trauma-related symptoms could be beneficial to explore.

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.

The Psychological Impact of the COVID-19 Pandemic on Alcohol Abuse and Drunkorexia Behaviors in Young Adults

The COVID-19 outbreak negatively affected young adults' psychological well-being, increasing their stress levels and symptoms of anxiety and depression, and potentially triggering health-risk behaviors. The present study was aimed at investigating the psychological impact of the COVID-19 pandemic on alcohol abuse and drunkorexia behaviors among young adults living in Italy. Participants were 370 emerging adults (63% women, 37% men; Mage = 21.00, SDage = 2.96, range: 18-30) who were recruited through an online survey between November 2021 and March 2022. Participants completed measures of alcohol abuse, drunkorexia behaviors, negative life experiences, and post-traumatic symptoms related to the COVID-19 outbreak. The results showed that the emotional impact and negative life experiences associated with the pandemic predicted both alcohol abuse and drunkorexia behaviors, albeit in different ways. Specifically, the number of negative life experiences during the pandemic and the tendency to avoid COVID-19-related negative thoughts positively predicted alcohol abuse; and the presence of intrusive thoughts associated with the pandemic significantly predicted the frequency of drunkorexia behaviors. Implications for research and clinical practice are discussed.

Impact of Teachers' Post-Traumatic Stress Due to Violence Victimization: Moderated Mediation Effect of Living a Calling

Based on the Affective Events Theory, Work as a Calling Theory, and related studies, this research examined the moderated mediating effects of Living a Calling and the mediating effect of social interaction anxiety and psychological burnout on the relationships between post-traumatic stress disorder symptoms consequent to violence victimization, self-destructive behaviors, and turnover intention. Data from 420 Korean elementary and secondary school teachers were analyzed using the moderated mediation model. The analysis revealed that post-traumatic stress disorder caused by violence victimization positively affected self-destructive behavior and turnover intention through the sequential mediation of social interaction anxiety and psychological burnout. Further, Living a Calling moderated the indirect effect of violence victimization; the stronger the Living-a-Calling experience, the greater the indirect effect of violence victimization on turnover intention. Additionally, when the sense of Living a Calling was low, post-traumatic stress disorder caused by violence did not significantly affect turnover intention through social interaction anxiety, but contrary to expectations, the stronger the sense of Living a Calling, the more positive the mediating effect of social interaction anxiety. Therapeutic interventions in teachers' work environment, improvements, and suggestions for future research are discussed.

Food-restricted alcohol consumption: relation to psychopathology in college students

Objective: Food-restricted alcohol consumption (FRAC) is a growing concern among college students. We investigated demographic and lifestyle characteristics and psychiatric symptoms associated with FRAC. Participants: College students (n = 561) at a large southeastern university in the United States. Methods: Participants completed online self-reported questionnaires assessing past-year FRAC, demographic and lifestyle characteristics, and psychiatric symptoms. Results: The past-year prevalence of FRAC was 23.89%. In the bivariate analyses, students engaging in FRAC had higher mean scores of multiple psychiatric symptoms, reported more harmful or hazardous drinking and suicidality, and were more likely to report a history of an eating disorder than their peers without FRAC. In a hierarchical regression model, binge eating, cognitive restraint, self-reported history of an eating disorder, and harmful or hazardous drinking were significantly associated with FRAC (ps < 0.05) after other psychiatric symptoms were included in the model. Conclusion: Our findings stress the importance of heightened awareness of FRAC in college.

Characterizing alcohol-related disordered eating behaviors in adults with binge eating

PURPOSE

Alcohol-related disordered eating behaviors (ADEBs; i.e., engagement in dietary restriction or excessive exercise before or after drinking alcohol to avoid weight gain) are associated with negative psychosocial and medical consequences. Previous research has primarily studied ADEBs among community samples. Individuals with clinically significant binge eating may also engage in ADEBs given high rates of alcohol use and inappropriate weight-control behaviors. The current study aimed to characterize the prevalence and psychological correlates (i.e., weight and shape concerns, alcohol consumption, binge eating frequency) of ADEBs among individuals with clinically significant binge eating.

METHODS

Participants were 166 treatment-seeking individuals who engaged in once weekly binge eating over the past three months. Participants completed a clinical interview to assess eating disorder symptoms and self-report measures of alcohol consumption patterns and ADEBs engagement.

RESULTS

Over one-fourth of participants endorsed at least one ADEBs in the past three months. Participants who endorsed ADEBs reported greater alcohol consumption than participants who drank alcohol but did not endorse ADEBs, after controlling for eating disorder diagnosis. Greater frequency of ADEBs was related to higher weight and shape concerns among individuals who endorsed ADEBs in the past three months. Presence of ADEBs and ADEBs frequency were not related to binge eating frequency.

CONCLUSION

Results suggest that clinicians treating individuals with binge eating who drink alcohol should screen for ADEBs and assess how ADEBs may contribute to an individual's eating pathology. Future research should assess the temporal relationship between alcohol use and ADEBs engagement, and study ADEBs in BN-spectrum samples.

LEVEL OF EVIDENCE

Level V, descriptive studies.

Loneliness and Alcohol-Related Problems among College Students Who Report Binge Drinking Behavior: The Moderating Role of Food and Alcohol Disturbance

Loneliness and alcohol misuse are common among college students and pose a threat to public health. To better understand the longitudinal association between these public health concerns we examined food and alcohol disturbance (FAD; i.e., restricting one's caloric intake prior to drinking) as a moderator in the association between loneliness and alcohol-related problems. Participants were 456 college students from a mid-sized university who engaged in past 30-day binge drinking. The majority of participants identified as being White (67.1%), female (78.1%), and reported a mean age of 19.61 (SD = 1.54) years. Participants completed two surveys (3 weeks apart) over the course of an academic semester. Analyses revealed a significant interaction between loneliness and FAD, such that loneliness (T1) significantly and positively predicted alcohol-related problems (T2), but only among individuals who engaged in relatively higher levels of FAD (T1). FAD may be an appropriate target for interventions aimed at reducing alcohol-related problems among college students experiencing loneliness.

Expressive suppression a mediating variable between stress and procrastination in eating behavior disorder

Eating disorders (EDs) are psychiatric illnesses in which emotions play an important role in their development and maintenance. These disorders are associated with expressive suppression, stress, and procrastination. The purpose of this work was to explain eating disorders from stress and procrastination, with expressive suppression as a mediating variable. It was attended by 918 students from three universities in Ecuador. The information was collected through four instruments: inventory of eating disorders, perceived stress scale, Tuckman procrastination scale and emotional regulation questionnaire. The data was analyzed through a mediational analysis in the Jasp program, version 15. The independent variables were: procrastination and stress, the dependent variable was risk of experiencing bulimia (REB) and the mediating variable was expressive suppression. Procrastination and stress, mediated by expressive suppression, were found to have no statistically significant effect on EBR. Procrastination has a direct effect on REB, although stress does not, and the model between expressive suppression and REB explains a good percentage of the variance.