Eating disorders and substance use: Examining associations among US college students

Abstract

Objective To investigate associations between reported eating disorder (ED) diagnosis and substance use disorder (SUD) diagnosis, substance misuse, and illicit drug use among US college students. Method Data consisting of n = 414,299 students' responses to the National College Health Assessment survey conducted by the American College Health Association between fall 2015 and spring 2019 were utilized for this study. Unadjusted and adjusted odds ratios were used to determine the association of reported ED diagnosis with reported SUD diagnosis, misuse of cigarettes, e‐cigarettes, alcohol, marijuana, cocaine/methamphetamine, sedatives, hallucinogens, opiates, inhalants, MDMA, and other club drugs, as well as illicit use of prescription pain killers, prescription sedatives, and prescription stimulants. A sensitivity analysis investigating associations between reported anorexia nervosa (AN), bulimia nervosa (BN), and each substance use outcome was also conducted. Results Among all in our analytic cohort, 7.15% reported receiving an ED diagnosis or being treated for an ED in the last 12 months. Students with ED indications were significantly more likely to report each of the substance use outcomes investigated in this study, including SUD diagnosis (aOR: 7.43; 95% CI: 6.98, 7.92; p < .0001), opiate misuse (aOR: 8.35; 95% CI: 7.38, 9.45; p < .0001), and misuse of other club drugs (aOR: 10.37; 95% CI: 9.10, 11.81; p < .0001) than peers without reported EDs. Both AN and BN were associated with an increased likelihood of SUD diagnosis. Discussion These findings demonstrate strong associations between EDs and the most extensive list of substance use outcomes explored in the context of college setting ED research to date.

Intersectionality of demographic characteristics in self‐reported anorexia nervosa, bulimia nervosa, and probable eating disorders among college students

“…Our study is unique in that it expands on previous ACHA‐NCHA studies by addressing identity intersectionality, looking at more than one identity at a time. Our findings expand upon the work of previous researchers who also utilized the ACHA‐NCHA data to explore various aspects of eating disorders among college students (Claydon & Zullig, 2020; Duffy et al, 2019; Matthews‐Ewald et al, 2014; Qeadan et al, 2023; Schiros & Antshel, 2023; Van Dyne et al, 2023). Our findings were consistent with Matthews‐Ewald et al (2014) who observed higher odds of EDs and disordered eating behaviors among sexual minorities (i.e., gay, unsure, and bisexual men compared to heterosexual men).…”

“…Our study is unique in that it expands on previous ACHA-NCHA studies by addressing identity intersectionality, looking at more than one identity at a time. Our findings expand upon the work of previous researchers who also utilized the ACHA-NCHA data to explore various aspects of eating disorders among college students (Claydon & Zullig, 2020;Duffy et al, 2019;Matthews-Ewald et al, 2014;Qeadan et al, 2023;Schiros & Antshel, 2023;Van Dyne et al, 2023) (Duffy et al, 2019). Second, students with anorexia nervosa and bulimia nervosa who were treated with medication and psychotherapy reported improved academic performance and grade point averages (Claydon & Zullig, 2020).…”

“…Second, students with anorexia nervosa and bulimia nervosa who were treated with medication and psychotherapy reported improved academic performance and grade point averages (Claydon & Zullig, 2020). Finally, students with ED indications were 7.43 times more likely to report a substance use disorder diagnosis than peers without EDs (Qeadan et al, 2023). Thus, the ACHA‐NCHA samples utilized by previous researchers have contributed to the growing body of knowledge on the various factors influencing eating disorders among college students, and our study contributes to the important conclusions taken from such research.…”

“…Several studies have utilized data from the National College Health Assessment administered by the American College Health Association (ACHA‐NCHA) to explore various aspects of eating disorders among college students (Claydon & Zullig, 2020; Duffy et al, 2019; Matthews‐Ewald et al, 2014; Qeadan et al, 2023; Schiros & Antshel, 2023; Van Dyne et al, 2023). Matthews‐Ewald et al (2014) found that sexual minority students were significantly more likely to report clinical EDs and disordered eating behaviors when compared to heterosexual peers.…”

Associations of childhood maltreatment with binge eating and binge drinking in emerging adult women

“…Emerging adulthood (ages 18 to 25) is a period of several life transitions characterized by increased risk and impulsivity related to addictive health behaviors and is a particularly high-risk period for binge drinking and binge eating in women ( Arnett, 2005 , Grucza et al, 2018 , Qeadan et al, 2023 , Sonneville et al, 2013 , Sussman and Arnett, 2014 ). The term “binge” refers to a pattern of excessive consumptive behavior that occurs in a short, discrete period of time ( Escriva-Martinez et al, 2020 ).…”