College-age individuals make up a large proportion of those diagnosed with eating disorders (EDs) with prevalence ranging from 8 to 17%.  This may be due to increased stress associated with life transitions during college years. The median age of onset of binge eating disorder (BED) is 21 years and the median age of onset for both bulimia nervosa (BN) and anorexia nervosa (AN) is 18 years of age. Previous studies have demonstrated the strong relationship between EDs and substance use, however, this relationship is still not well understood. This study examines the relationship between ED diagnosis and substance use disorder (SUD) diagnosis, substance misuse, and illicit drug use among college students.  

The study’s sample consisted of 414,299 college students who completed the National College Health Assessment survey between fall 2015 and spring 2019. Participants were asked to report diagnosis of a SUD in the past 12 months and past 30 days use of cigarettes, e-cigarettes, alcohol, cannabis, cocaine/methamphetamine, sedatives, hallucinogens, opiates, inhalants, MDMA, and other club drugs. Students were also asked about ED diagnosis, treatment, and impact on academic performance. Lastly, respondents’ demographic information was collected including age, gender identity, sexual orientation, race/ethnicity, US geographic location, and institution type. Data was analyzed using unadjusted and adjusted odds ratios to assess for associations between EDs and substance use.  

Results of the data analysis showed 7.15% of the sample experienced an ED or received an ED diagnosis. Students with EDs were 7.43 times more likely to be diagnosed with SUD compared to those with an ED. Both AN and BN were associated with greater odds of SUD diagnosis. Participants with EDs were 1.91 times more likely to misuse cigarettes, 1.81 times more likely to misuse e-cigarettes, 1.16 times more likely to misuse alcohol, 1.69 times more likely to misuse cannabis, and 2.91 times more likely to misuse cocaine/methamphetamine.  Misuse of sedatives, hallucinogens, opiates, inhalants, MDMA, and other club drugs was also significantly associated with EDs.  

Takeaway: Eating disorder diagnosis may increase risk of substance use disorder (SUD) diagnosis, substance misuse, and illicit drug use among college students 

Qeadan, F., English, K., Luke, A., Egbert, J.. Eating disorders and substance use: Examining associations among US college students [published online ahead of print, 2023 Jan 5]. The International Journal of Eating Disorders. 2023;10.1002/eat.23892. doi:10.1002/eat.23892