Differences in eating disorder pathology among college students who engage in food and alcohol disturbance for specific motives and those who only drink alcohol.

Food and alcohol disturbance (FAD) is the use of compensatory behaviors within a drinking episode to enhance alcohol's effects (FAD-AE) and/or alcohol-related caloric compensation (FAD-CC). Prior work has found that FAD-AE and FAD-CC are positively associated with eating disorder (ED) outcomes; however, it is unclear whether ED outcomes differ by the type and number of FAD motives endorsed. This study examined whether domains of ED pathology differed between those who use alcohol only and those engaging in FAD for specific motives. Participants were 2801 (Mage = 19.48; 77.6% female; 68.8% White) undergraduates from six universities who reported past-month alcohol use. Participants were categorized into four groups: Alcohol-Only, FAD-CC, FAD-AE, or FAD-Both (i.e., FAD-AE and FAD-CC). A multivariate analysis of covariance examined group differences across eight ED pathology domains (purging, restricting, excessive exercise, binge eating, muscle building, body dissatisfaction, cognitive restraint, and negative attitudes toward obesity), controlling for biological sex, age, and past-month drinking quantity. The FAD-Both group reported greater ED pathology across most domains compared to all other groups. The Alcohol-Only group reported lower binge eating and body dissatisfaction than all FAD groups. Among those reporting FAD for a single motive, the FAD-CC group reported elevated body dissatisfaction, cognitive restraint, and excessive exercise compared to the FAD-AE group, whereas the FAD-AE group reported greater restriction than the FAD-CC group. Findings underscore the heterogeneity of ED pathology among undergraduates engaging in FAD for specific motives and suggest that those endorsing FAD-Both may represent a high-risk subgroup, highlighting the need for tailored interventions.