Binge eating and purging in first-year college students: Prevalence, psychiatric comorbidity, and academic performance

Eating disorders and psychiatric comorbidity among first-year university students in Sweden: Prevalence and risk factors

BACKGROUND

This study explored eating disorders (ED) prevalences, comorbidity of ED with other mental disorders, and risk factors for ED among university students. ED included binge eating disorder (BED), bulimia nervosa (BN), or other specified feeding and eating disorders (OSFED).

METHODS

A total of 3425 first-year university students in Sweden completed an online survey covering a range of criteria for psychiatric diagnoses, within the World Mental Health International College Student (WMH-ICS) initiative. Pearson's χ2 -tests were used to compare algorithm-based diagnostic prevalences for eating disorders and other comorbid psychiatric disorders between three groups: students with ED with or without other comorbid psychiatric disorders (A), students with psychiatric disorders but no ED comorbidity (B), and students with no psychiatric disorders (C). Multinomial logistic regression was used to calculate between-group comparisons of odds ratios for independent risk factors, where group B served as the reference group for comparisons with groups A and C.

RESULTS

Of the total sample, 75% had at least one psychiatric disorder and 28% had at least one lifetime ED diagnosis. Students with ED (group A) reported higher prevalences for comorbid anxiety disorders, depression, suicidal behavior, and non-suicidal self-injury compared to students with psychiatric disorders but no ED (group B). Group A participants exhibited a higher risk of hazardous drinking, were more likely to have received medical treatment, and to identify as bisexual. Compared to group B, students with no psychiatric disorders (group C) were more likely to report better mental and physical health, but less likely to engage in hazardous drinking, and to have sought mental health treatment.

CONCLUSIONS

A large proportion of students with ED had additional psychiatric disorders, indicating that individuals with ED suffer from multiple mental health problems. It is crucial that student health services acquire competency to offer effective ED assessment and treatment.

The association of binge eating with internet addiction, body shape concerns, and BMI among university students in the United Arab Emirates

BACKGROUND

Binge-eating disorder (BED) is the most common eating disorder with university students being particularly vulnerable. The study aimed to investigate the association between binge eating and Internet addiction (IA), body shape (BS) concerns, and body mass index (BMI) among university students.

METHODS

In this cross-sectional study, 448 university students (221 males and 227 females) aged between 18 and 25 years were recruited. A multicomponent questionnaire included socio-demographic information, and validated scales such as the International Physical Activity Questionnaire (IPAQ), Binge-Eating Disorder Screener-7 (BEDS-7), Internet Addiction Test (IAT), and Body Shape Questionnaire (BSQ). Anthropometric measurements [weight, height, and waist circumference (WC)] were recorded, and BMI was calculated.

RESULTS

The findings reported that approximately 31% of the participants were at risk of BED, 24.3% had moderate/severe IA, 27.8% were moderate/marked concerned about their BS, and 41.1% were overweight/obese. The risk of BED was significantly associated with IA (OR = 1.06, 95%CI: 0.34-0.93; p < 0.005), BS concerns (OR = 1.39, 95%CI:0.90-2.16; p < 0.001), BMI (OR = 1.74, 95%CI:1.16-2.60; p < 0.005), and WC (OR = 1.78, 95%CI: 1.16-2.75; p < 0.006). Regression analysis showed that the risk of BED had a highly significant positive association with WC, BSQ, and IA with the WC identified as the strongest predictor for risk of BED (β = 0.23, p < 0.001).

CONCLUSIONS

This study underscores the need for targeted national initiatives and awareness programs that promote balanced food consumption, healthy internet use, and increased physical activity among young adults of both sexes. By fostering these healthy habits, such interventions can reduce the risk of binge eating disorder and support overall mental and physical well-being in this population.

Substance use and disordered eating risk among college students with obsessive-compulsive conditions

PURPOSE

College students are at higher risk for problematic substance use and disordered eating. Few studies have examined the comorbid risks associated with OCD despite the increased prevalence of OCD among young adults. This study examined substance use and disordered eating risk associated with OCD conditions among college students and how this association may vary by sex/gender.

METHODS

Data were from 92,757 undergraduate students aged 18-24 enrolled in 216 colleges between Fall 2021 and Fall 2022, from the American College Health Association-National College Health Assessment III. Regression models were used to estimate alcohol, cannabis, tobacco, and disordered eating risk among those with OCD related conditions compared to those without conditions, overall and by sex/gender, while adjusting for covariates and school clustering.

RESULTS

Students with OCD conditions displayed a higher prevalence of substance use and disordered eating risks. In adjusted models, OCD conditions were associated with increased odds of moderate/high tobacco (aOR = 1.12, 95% CI 1.05, 1.21), cannabis (aOR = 1.11, 95% CI 1.04, 1.18), alcohol (aOR = 1.14, 95% CI 1.05, 1.24) and disordered eating risk (aOR = 2.28, 95% CI 2.13, 2.43). Analyses stratified by gender revealed cis-female students with OCD conditions were at increased risk for moderate/high risk alcohol (aOR = 1.18, 95% CI 1.08, 1.29), tobacco (aOR = 1.12, 95% CI 1.03, 1.22), cannabis (aOR = 1.13, 95% CI 1.06, 1.23) and disordered eating (aOR = 2.30, 9%% CI 2.14, 2.47). Among TGNC students, OCD conditions were associated with increased risk for moderate/high tobacco risk (aOR = 1.24, 95% CI 1.05, 1.48) and disordered eating (aOR = 2.14, 95% CI 1.85, 2.47). OCD conditions was only associated with disordered eating among male students (aOR = 2.34, 95% CI 1.93, 2.83).

DISCUSSION

Young adult college students with OCD conditions exhibit a higher prevalence of medium/high risk alcohol, tobacco, and cannabis use and disordered eating compared to their counterparts without such conditions, even after adjusting for stress, depression, and anxiety.

Alcohol use disorder, cannabis use disorder, and eating disorder symptoms among male and female college students

BACKGROUND AND OBJECTIVES

Eating disorders (EDs) and substance use disorders are prevalent among college students in the United States, with underlying common mechanisms suggesting co-occurrence of these in the student population. As treatment prognosis of EDs improves when they are identified and treated with early intervention, it is essential to understand which substance use behaviors associate with EDs in students.

METHODS

Using a sample of 471 college students recruited for a study on high risk drinking (i.e., students needed to pregame regularly to be included), we explored the associations between ED symptomatology and two common substances used in this population: alcohol and cannabis. As most research on EDs focuses on female students only or does not separate out males and females, we examined whether sex assigned at birth moderated the association between ED symptomatology and substance use outcomes.

RESULTS

About one-third (32.4%) of the sample screened positive for an ED, with females significantly more likely to screen positive. Males were significantly more likely to screen positive for an alcohol or cannabis use disorder. Screening positive for an ED associated with cannabis use frequency and cannabis use disorder symptoms, but not with alcohol outcomes. Sex moderated the association between ED and cannabis use disorder symptoms, with positive ED screen male students experiencing the highest cannabis use disorder symptoms.

DISCUSSION AND CONCLUSIONS

It is necessary to further assess how sex differences in substance use and ED symptomatology inform each other.

SCIENTIFIC SIGNIFICANCE

Findings underscore the need to assess and screen for cannabis use disorder among students who screen positive for an ED, and, more specifically, with focused attention on male students with ED symptoms.

Binge eating as an emotional response to the COVID-19 pandemic: a sequential mediation model via the impact of events and social anxiety

BACKGROUND

The long-lasting consequences of the COVID-19 pandemic on the psychological well-being of young people have become an emerging research topic, which still raises several questions for post-pandemic interventions at the individual and community levels. This research investigated the relationship between COVID-19 pandemic life events and the occurrence of binge eating behaviors in emerging adults, hypothesizing indirect effects of the emotional impact of pandemic events and social anxiety.

METHODS

Data collection was conducted in November and December 2021 in Italy, involving 286 university students aged 18 to 30 years (Mage = 20.20; SDage = 2.43; 69.6% women) who completed an online anonymous survey. Participants reported the pandemic-related stressors experienced in the last year (i.e., adverse life events; the number of days in quarantine), the long-lasting emotional impact of these experiences in the previous week (i.e., intrusive thoughts; avoidance of thoughts), social anxiety symptoms, and frequency of binge eating episodes. A serial mediation model was tested in line with the research hypotheses.

RESULTS

Both the number of days in quarantine and the pandemic adverse life events in the last year were significantly and positively related to binge eating via the sequential indirect effects of (1) intrusive thoughts and (2) social anxiety.

CONCLUSION

Our findings provide support for the long-lasting effects of pandemic events and quarantine on emerging adults' mental health, with cascade effects on intrusive symptoms, social anxiety, and binge eating. The study has interesting research, practice, and public health policies implications.

Association of Body Image Perception / (Dis)Satisfaction and Symptoms of Eating Disorders in University Students of Health Sciences

We aimed to investigate the association of body image perception / (dis)satisfaction with eating disorders symptoms. We conducted a cross-sectional university-based study with 534 students, aged 18 years or older, from a federal higher education institution specializing in health sciences and located in Southern Brazil in 2023. We evaluated eating disorder symptoms using the Brazilian version of the SCOFF screening tool (≥2 symptoms) and body image using a silhouette scale developed for Brazilian adults. The mean age of the sample (78.3% female) was 23.3 (SD = 6.2) years. The prevalence of eating disorder symptoms was 53.6% (95% CI: 49.3-57.8). In terms of body image, the prevalence of (dis)satisfaction was 64.6% (95% CI: 60.5-68.7) and of body image distortion was 53.4% (95% CI: 49.1-57.6). Students dissatisfied with their body image due to excess weight were 2.16 times more likely to report eating disorder symptoms (PR = 2.16; 95% CI: 1.66-2.80; p < .001). Similarly, students who overestimated their body size were 35% more likely to report eating disorder symptoms (PR = 1.35; 95% CI: 1.12-1.63; p = .002). In conclusion, we found a significant association between body image perception / (dis)satisfaction and symptoms of eating disorders in university students of health sciences.

A 10-year Longitudinal Study: The Relationship between Adverse Childhood Experiences, Mental Health Indicators, and Binge Eating Symptoms among Emerging Adults

Although binge eating symptoms (BE) can contribute to worsened mental and physical health, little is known about factors associated with binge eating across the lifespan, hindering prevention and treatment. To investigate if there is an association between adverse childhood experiences (ACEs), adolescent and adult mental health conditions, and BE symptoms among young adults. One hundred and thirty-one junior high-school students participated in a series of assessments and 10 years later, 100 of these individuals participated in a follow-up assessment. Linear regression models were performed to estimate the association between ACEs, adolescent and emerging adult self-esteem, depression, and anxiety symptoms, and emerging adult BE symptoms. Among the sample, 26% had 1 ACEs, 18% had 2 ACEs, and 41% had ≥ 3ACEs. After adjusting for age, sex, and current mental health, there was a positive association between ACEs and increased levels of BE symptoms (β = 0.37, SE = 0.19, CI=(0.03; 0.7), p =.0485). Higher levels of emerging adult depression and anxiety symptoms (β = 0.02, SE = 0.01, CI=(0.01; 0.04), p =.0020) but not self-esteem (β = 0.04, SE = 0.05, CI=(-0.06; 0.14,) p =.4253), were associated with BE symptoms. Parental mental health, a parent experiencing a mental illness during the participant's childhood, was the only individual ACE associated with BE symptoms (β = 0.84, SE = 0.40, CI = 0.04, 1.64, p =.0409). Cumulative ACEs and emerging adult anxiety and depression symptoms were associated with BE symptoms. Findings indicate that ACEs, anxiety, and depression symptoms contribute to BE symptoms, highlighting the importance of screening for ACEs and mental health conditions. Persons struggling with BE symptoms may have co-occurring conditions, of which a traditional treatment for BE may not suffice.

A cross-sectional evaluation of binge-eating behavior and its correlation with anxiety disorders among adolescents in Northern Saudi Arabia: implications for future generations

Background and aim

Binge-eating behavior and anxiety disorders pose a significant public health issue worldwide, as it has severe implications for both the physical and mental health of the adolescent population. The present study evaluated the prevalence of binge-eating behavior, anxiety disorders, and associated factors among the northern Saudi adolescent population. Furthermore, we assessed the correlation between binge eating and anxiety.

Methods

The present population-based cross-sectional study was carried out among adolescents in the Aljouf region of Saudi Arabia from June 2023 to December 2023. A total of 384 eligible participants were selected using the convenience sampling method. The present study used a pretested Arabic version of the binge eating scale (BES) and Hamilton Anxiety Scale (HAM-A) to assess the binge-eating behavior and anxiety disorders among the target population. The Spearman correlation test determined the strength and direction of the correlation between BES and HAM-A scores. Furthermore, logistic regression analysis was applied to find the associated factors for binge-eating behavior among the study participants.

Results

Of the 384 participants, moderate and severe binge-eating behaviors were found among 11.2% and 8.3% of the respondents, respectively. Regarding the severity of anxiety as assessed by the HAM-A scale, mild, moderate, and severe anxiety were shown among 12.8%, 9.6%, and 7.5% of the participants, respectively. Also, the study found a positive correlation between binge eating and anxiety scores, with a correlation coefficient of 0.26 and a p-value of 0.001. Furthermore, being female (p = 0.001), moderate (p = 0.004), and severe anxiety (P = 0.001) were significantly associated with binge-eating behavior.

Conclusion

The present research findings advocate for the implementation of targeted interventions and support services aimed at decreasing binge-eating behavior and anxiety, thereby promoting the overall well-being of adolescents and building stronger future generations. Moreover, it is recommended that optional courses about binge eating be incorporated into the curricula of schools and universities.

Changes in Emotion Regulation During the Course of Dialectical Behaviour Therapy: Effects on Non-Suicidal Self-Injury and Binge Eating Across Two Samples

Dialectical Behaviour Therapy (DBT) has demonstrated effectiveness in reducing harmful behaviours associated with emotion dysregulation, including non-suicidal self-injury (NSSI) and binge eating. It has been hypothesized that the effects of DBT on NSSI and binge eating are the result of improvements in emotion regulation (ER); however, the extent to which changes in ER account for reductions in these behaviours is unclear. The present study leverages two unique clinical samples to examine the degree to which changes in ER influence changes in the frequency of NSSI and binge eating over the course of DBT. Participants included 189 Veterans receiving outpatient DBT and 117 civilians enrolled in a DBT Intensive Outpatient Program. Analyses examined changes in ER, binge eating and NSSI over the course of treatment, as well as the extent to which NSSI and binge eating frequency were influenced by changes in ER. In the Veteran sample, DBT led to improvements in ER abilities and significant reductions in NSSI and binge eating; however, changes in ER did not account for observed reductions in NSSI or binge eating. In the civilian sample, the effects of DBT on ER, NSSI and binge eating were nonsignificant. Our findings suggest that ER may not be the only mechanism through which DBT exerts its effects on NSSI and binge eating. The effects of DBT on ER and self-damaging behaviours may vary based on factors such as treatment setting, time in treatment and clinical severity of the sample.

Momentary fluctuations in emotional intelligence and stress predict changes in disordered eating

Objective: Low emotional intelligence and symptoms of disordered eating are connected, however, whether daily fluctuations in emotional intelligence predict daily changes in disordered eating symptoms has not been examined, nor has stress been explored as a potential moderator of this relationship. Participants: Participants were undergraduate students (n = 100). Methods: Participants completed baseline questionnaires, then responded to random ecological momentary assessment prompts 3 times daily for 2 weeks. Results: Results indicated that when individuals had higher momentary emotional intelligence, they had lower disordered eating at the same time point (within subjects estimate = -0.30, p < .001) and following time point (within subjects estimate = -0.08, p = 0.03). Momentary stress moderated the relationship between baseline emotional intelligence and momentary disordered eating (b = -0.02, p < .01). Conclusions: Changes in emotional intelligence predict day-to-day changes in disordered eating, and stress moderates the connection between emotional intelligence and disordered eating.

The Clinical and Psychopathological Profile of Inpatients with Eating Disorders: Comparing Vomiting, Laxative Abuse, and Combined Purging Behaviors

BACKGROUND/OBJECTIVES

The previous literature on purging behavior in eating disorders (EDs) suggests an overall more complicated clinical picture for individuals with this symptomatology. So far, no studies have analyzed the possible differences between the specific types of purging among ED inpatients.

METHODS

A clinical sample of 302 inpatients with EDs was classified according to no purging behaviors, vomiting, the abuse of laxatives, and both vomiting and the abuse of laxatives. Participants completed the following questionnaires: the Eating Disorder Examination Questionnaire (EDE-Q), Frost Multidimensional Perfectionism Scale (F-MPS), State-Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI). Clinical information was collected for each individual.

RESULTS

Significant differences in the four groups were evidenced in age (p < 0.001), years of illness (p < 0.001), BMI at discharge (p < 0.001), STAI state anxiety (p < 0.001), STAI trait anxiety (p < 0.001), BDI (p < 0.001), EDE-Q eating concerns (p < 0.001), EDE-Q shape concerns (p < 0.001), EDE-Q weight concerns (p < 0.001), EDE-Q global score (p < 0.001), and F-MPS parental criticism (p < 0.001). ED inpatients with purging behaviors were older, had a longer duration of illness, higher parental criticism, and worse general and eating psychopathology. No differences emerged between the specific types of purging behavior.

CONCLUSIONS

Purging behavior is a marker of severity in EDs independently of the specific type of purging. The appearance of any purging behavior must be regarded as a considerable red flag and be followed by an intensification of the cure.

Comorbidity of binge eating disorder and other psychiatric disorders: a systematic review

OBJECTIVE

Binge eating disorder (BED), although relatively recently recognized as a distinct clinical syndrome, is the most common eating disorder. BED can occur as a separate phenomenon or in combination with other mental disorders, adding to the overall burden of the illness. Due to the relatively short history of recognizing BED as a distinct disorder, this review aimed to summarize the current knowledge on the co-occurrence of BED with other psychiatric disorders.

METHOD

This review adhered to the PRISMA guidelines. Multiple databases, such as MEDLINE, MEDLINE Complete, and Academic Search Ultimate, were used to identify relevant studies. Of the 3766 articles initially identified, 63 articles published within the last 13 years were included in this review. This systematic review has been registered through INPLASY (INPLASY202370075).

RESULTS

The most frequently observed comorbidities associated with BED were mood disorders, anxiety disorders and substance use disorders. They were also related to more severe BED presentations. Other psychiatric conditions frequently associated with BED include reaction to severe stress and adjustment disorders, impulse control disorder, ADHD, personality disorders, behavioral disorders, disorders of bodily distress or bodily experience, and psychotic disorders. Additionally, BED was linked to suicidality and sleep disorders.

DISCUSSION

The findings highlight the interconnected nature of BED with various psychiatric conditions and related factors, shedding light on the complexity and broader impact of BED on mental health and the need for appropriate screening and appropriately targeted clinical interventions.

A longitudinal test of problematic alcohol use and binge eating among college women: The moderating role of shame

Problematic alcohol use and binge eating frequently co-occur. High levels of negative affect, negative urgency, and/or shame may increase the likelihood that problematic alcohol use and binge eating co-occur over time.

OBJECTIVE

Examine 1) the temporal relationship between problematic alcohol use and binge eating among college women, who are at high risk for both, and 2) the additive and moderating effects of shared, emotion-based risk factors in models involving both problematic alcohol use and binge eating.

METHOD

In n = 302 college women assessed at two time points across 8 months, we used hierarchical linear regression to invstigate our objectives.

RESULTS

Baseline problematic alcohol use and baseline shame independently predicted increases in follow-up binge eating, controlling for baseline binge eating. In addition, the interaction between problematic alcohol use and shame accounted for further variance in subsequent binge eating (the influence of baseline problematic alcohol use on follow-up binge eating was stronger at higher levels of baseline shame). The reciprocal relationship was not significant: baseline binge eating did not predict follow-up problematic alcohol use independently or in conjunction with risk factors. Neither negative affect nor negative urgency showed predictive effects beyond prior behavior and shame. Results support 1) problematic alcohol use as a prospective risk factor for binge eating, 2) shame as an additive predictor of binge eating, and 3) shame as a positive moderator of binge eating prediction from problem drinking.

CONCLUSION

Addressing shame and problematic alcohol use may be warranted in binge eating interventions for college women.

Loneliness as a moderator of the association of affective symptoms and binge eating among college women

Affective symptoms (e.g., depression, anxiety, shame) are a potent risk factor for binge eating. However, less is known on the role of loneliness as a moderator of affective symptoms and binge eating. This objective of the current study was to investigate main effects and interactions of affective symptoms and loneliness in relation to binge eating in college women. A sample of 556 undergraduate women completed self-report questionnaires of affective symptoms, loneliness, and binge eating. Results revealed significant interactions between each affective symptom variable and loneliness in relation to binge eating, such that loneliness strengthened the positive association of affective symptoms and greater binge eating. The findings of this study demonstrate an important role of loneliness to binge eating among college women, especially those with underlying affective vulnerabilities. More theoretical and treatment-oriented work on the role of loneliness in binge eating is needed to understand mechanisms and interventions/preventions.

Family pressure and support on young adults' eating behaviors and body image: The role of gender

Families play a key role in establishing eating habits of children, yet whether families continue to influence eating behaviors of young adults remains an open question. It is also not clear whether associations between family variables (i.e., support and pressure) are similar for adult sons and daughters regarding eating pathology. The present cross-sectional study examined family correlates on disordered eating, body satisfaction, and drive for muscularity. The aim was to examine the associations of family support and family pressure with eating pathology, and to determine whether gender moderated the associations. Among 365 undergraduates (Mage = 18.9 years, 62 % Caucasian, 48 % female), neither family pressure nor family support were significantly associated with the drive for muscularity, whereas both were associated with disordered eating, and family pressure was associated with body satisfaction. Gender moderated the relationship of family pressure and body satisfaction (p = 0.03) and, unexpectedly, the relationship of family support and disordered eating (p = 0.02). Contrary to prediction, family pressure had stronger associations with body satisfaction for men (i.e., men had a more robust association (beta = -0.31, p < .001) than women (beta = -0.19, p = 0.004)). For women, the relationship of family support and disordered eating was not significant (beta = 0.07, p = 0.452); but, was significant for men (beta = -0.25, p < .001). These findings suggest that family pressure and support are associated with eating pathology among young adults, and that in some instances the associations were larger for men, thus highlighting the importance of including men in eating pathology research. Pending replication, these results suggest that family attitudes, behaviors, and support may be necessary topics to address when designing prevention programs for young adults.

The relationship between difficulties in the regulation of positive and negative emotions and binge-eating symptoms in young adults

It is well-established that binge-eating (BE) is linked to emotion regulation (ER) difficulties. However, research to date has focused almost exclusively on difficulties regulating negative emotions, with little attention to the relationship between positive emotion dysregulation and BE. Further, research is inconclusive regarding which specific facets of ER difficulties are most strongly associated with BE behaviour. Therefore, the current study examined whether difficulties regulating both negative as well as positive emotions explained unique variance in BE among young adults. The study also aimed to identify which particular dimensions of negative and positive ER difficulties were most strongly related to BE symptoms. Participants (N = 449) ages 18-25 completed self-report measures of difficulties regulating positive and negative emotions, BE symptoms, and psychological distress. Hierarchical regression analyses showed that BE was related to difficulties regulating both positive emotions and negative emotions, after controlling for psychological distress and BMI. Lack of emotional clarity and lack of access to ER strategies when faced with strong negative emotions were the facets of negative ER difficulties most strongly associated with BE. Impulsivity when experiencing strong positive emotions was the facet of positive ER difficulties most strongly associated with BE. These findings support the ER model of BE and suggest that difficulties regulating both positive and negative emotions contribute to BE among young adults.

Associations of positive childhood experiences with binge-eating disorder characteristics and intuitive eating among college students

Childhood experiences encompass both adverse and positive childhood events. Adverse childhood experiences are positively associated with binge-eating disorder characteristics and inversely associated with intuitive eating in adults. However, to what extent positive childhood experiences (PCEs) are associated with binge-eating disorder characteristics and intuitive eating remains unclear. This study examined the associations of cumulative and individual PCEs with binge-eating disorder characteristics and intuitive eating among college students. Data were collected from 828 college students in 2022 (54.5% female, Mage 20.9 ± 2.6 years). PCEs were assessed using the Benevolent Childhood Experiences scale. Binge-eating disorder characteristics were assessed with the Questionnaire on Eating and Weight Patterns-5. Intuitive eating was assessed with the Intuitive Eating Scale-2. Associations of PCEs with binge-eating disorder characteristics and intuitive eating were examined using modified Poisson regressions and linear regressions. PCEs were cumulatively associated with binge-eating disorder characteristics and intuitive eating (p for trend <.05). College students in the low PCEs category (0-4 PCEs) had 1.37-1.92 times the prevalence of binge-eating disorder characteristics and had 3.89 points lower intuitive eating score than those in the high PCEs category (9-10 PCEs). Among the individual PCEs, intrapersonal PCE (i.e., feeling comfortable with oneself during childhood) was associated with both a lower prevalence of binge-eating disorder characteristics (aPR = 0.56-0.76) and a higher score of intuitive eating (adjusted β = 1.87, 95% CI = 1.28-2.46) after adjustment for sociodemographic variables. Findings from this study suggest that PCEs may play a role in eating behaviors of college students. Future studies with nationally representative samples should prospectively examine associations of PCEs with binge-eating disorder characteristics and intuitive eating and explore the underlying mechanisms of the associations between PCEs and eating behaviors.

The association of alcohol use and positive and negative urgency to same day objective binge eating in emerging adults

Introduction

Objective binge eating and problematic alcohol use often co-occur and are common behaviors in emerging adults. Both behaviors are thought to be driven by affect regulation processes. Objective binge eating often occurs in the context of increasing or acute negative affect, and often occurs in solitude. Alcohol use in emerging adults can also be associated with negative affect regulation. However, in contrast to objective binge eating, a large body of research indicates that there are positively valenced pathways to alcohol use in this age group. Emerging adults often drink socially, to enhance enjoyment, and in the context of positive mood. We propose that one pathway to objective binge eating in this developmental period is through alcohol use itself, such that emerging adults who consume alcohol and who are more likely to act impulsively in the context of positive emotion (i.e., have high levels of positive urgency) may be more likely to binge eat following drinking.

Methods

We collected data using ecological momentary assessment in 106 undergraduates on positive and negative affect, motives for drinking and eating, and alcohol use and objective binge eating, in addition to baseline questionnaires of impulsivity.

Results

There were no significant changes in affect prior to drinking in this sample. Alcohol use at one time point significantly increased odds of objective binge eating at a later time point in the same day. Individual differences in positive urgency, the tendency to act rashly while experiencing positive affect, were also associated with increased odds of objective binge eating that occurred after alcohol use. Individual differences in negative urgency, the tendency to act rashly after experiencing negative affect, did not have a main effect on objective binge episodes, but did interact with alcohol use to increase the odds of objective binge eating following drinking. The vast majority of drinking episodes prior to objective binge eating were social drinking episodes, and participants most commonly endorsed "to have fun" as a reason for drinking.

Discussion

Results suggest that alcohol consumption may increase risk for objective binge eating in emerging adults.

A pilot multiple-baseline study of a mobile cognitive behavioral therapy for the treatment of eating disorders in university students

OBJECTIVE

Eating disorders (EDs) are serious psychiatric disorders associated with substantial morbidity and mortality that are prevalent among university students. Because many students do not receive treatment due to lack of access on university campuses, mobile-health (mHealth) adaptations of evidence-based treatments represent an opportunity to increase treatment accessibility and engagement. The purpose of this study was to test the initial efficacy of Building Healthy Eating and Self-Esteem Together for University Students (BEST-U), which is a 10-week mHealth self-guided cognitive-behavioral therapy (CBT-gsh) app that is paired with a brief 25-30-min weekly telehealth coaching, for reducing ED psychopathology in university students.

METHOD

A non-concurrent multiple-baseline design (N = 8) was used to test the efficacy of BEST-U for reducing total ED psychopathology (primary outcome), ED-related behaviors and cognitions (secondary outcomes), and ED-related clinical impairment (secondary outcome). Data were examined using visual analysis and Tau-BC effect-size calculations.

RESULTS

BEST-U significantly reduced total ED psychopathology and binge eating, excessive exercise, and restriction (effect sizes ranged from -0.39 to -0.92). Although body dissatisfaction decreased, it was not significant. There were insufficient numbers of participants engaging in purging to evaluate purging outcomes. Clinical impairment significantly reduced from pre-to-post-treatment.

DISCUSSION

The current study provided initial evidence that BEST-U is a potentially efficacious treatment for reducing ED symptoms and ED-related clinical impairment. Although larger-scale randomized controlled trials are needed, BEST-U may represent an innovative, scalable tool that could reach greater numbers of underserved university students than traditional intervention-delivery models.

PUBLIC SIGNIFICANCE

Using a single-case experimental design, we found evidence for the initial efficacy of a mobile guided-self-help cognitive-behavioral therapy program for university students with non-low weight binge-spectrum eating disorders. Participants reported significant reductions in ED symptoms and impairment after completion of the 10-week program. Guided self-help programs show promise for filling an important need for treatment among university students with an ED.

A Study of the Effects of a Diet with Functional Foods on the Adaptogenicity of First-Year Students to the Student Lifestyle

Background: The period of rapid transition from school to university is associated with a complex of negative stress factors caused by social and professional adaptation, irregular daily routine, sleep, and nutrition. During this period, the inclusion of functional foods in students’ diets has an increasingly beneficial effect on their health. This study aimed to evaluate the impact of diets with functional foods (vegetable and protein–vegetable) on health indicators while minimizing the negative impact of adaptation and acclimatization on the body of first-year university students at the start of their studies. Materials and Methods: A total of 150 first-year students were randomly selected. Biochemical tests, enzyme immunoassays, and analyses of serum immunoglobulin levels and mineral and vitamin content in first-year students’ blood were performed. Results and discussion: Protein–vegetable products are more potent compared to plant-based ones in increasing the body’s natural resistance to all types of stress due to their high protein content. The other functional product had a higher content of carbohydrates. In addition, they differed in the content of minerals and vitamins. Conclusions: The importance of a rational diet increases exponentially during the period of adaptation and acclimatization when the emotional, mental, and physical workload increases.

Binge-eating disorder in university students: high prevalence and strong link to impulsive and compulsive traits

BACKGROUND

Binge eating disorder (BED) is the most common eating disorder, and is associated with significant comorbidity, with university students being particularly vulnerable. We aimed to assess associations of BED with a wide range of comorbidities and measures of impulsivity and compulsivity in university students, to gain better understanding of its prevalence, correlates and pathophysiology.

METHODS

We carried out an internet-based survey, assessing presence of BED using a validated structured self-report diagnostic tool, demographics, substance use, impulsive behaviors, psychiatric history, and measures of impulsivity and compulsivity. Approximately 10 000 students were invited to take part. Group differences between students with current BED and students without BED were investigated.

RESULTS

A total of 3415 students completed the survey, with 83 (2.4%) screening positive for BED. BED was associated with female gender, hazardous/harmful alcohol use, depression and anxiety symptoms, low self-esteem, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, treatment for psychological/emotional problems (including prescribed medication) and trait impulsivity and compulsivity. However, the largest effect sizes were evident for associations with trait impulsivity and compulsivity.

CONCLUSIONS

The associations of BED with trait impulsivity and compulsivity implicate these latent phenotypes in its pathophysiology. The identified links between BED and a wide range of mental disorders highlight the need to screen for disordered eating in student populations, including when students present with other mental health conditions.

Severity of Binge Eating Behavior among Overweight College Students in Taiwan and Associated Factors

BACKGROUND

Binge eating (BE) is considered a marker of obesity and overweight and a significant characteristic of feeding and eating disorders. Despite the high prevalence of obesity on college campuses, the issue of BE among college students in Taiwan has received little attention. The aim of this study was to investigate BE behavior among overweight college students in Taiwan and associated factors.

METHODS

This study utilized a cross-sectional survey. A total of 300 overweight college students were recruited through convenience sampling. Data were collected using a self-administered Binge Eating Scale (BES) and a body weight composition monitor (Model No. OMRON, HBF-126) and analyzed using descriptive statistics, correlation analysis, and regression analysis.

RESULTS

The average BES score was 10.67 (SD = 6.66, 0-34). With a BES score of 17 as the cut-off point, 17.3% (n = 52) of the participants were found to have moderate or severe BE behavior. Analysis of the demographic and psychosocial data using Spearman's rho rank correlation coefficient revealed that sex, body mass index (BMI), uncontrolled eating, weight loss diets, academic stress, peer competition, interpersonal distress, and unpleasant or major life events were significantly correlated with BE behavior and its probability (rs = -0.14-0.15, p < 0.05). Furthermore, logistic regression analysis indicated that the odds ratio of the BES scores of female participants and those who stated to have experienced uncontrolled eating, weight loss diets, peer competition, and interpersonal distress was 1.05-6.04 times those of male participants and those without such experiences (p < 0.05).

CONCLUSION

The study found that nearly one-fifth of participants presented moderate to severe levels of BE behaviors, and these were significantly correlated with sex and external environmental stress. This study suggests early intervention from campus psychological health personnel to provide proper therapy.

The Effects of Appearance-Based Comments and Non-Appearance-Based Evaluations on Body Dissatisfaction and Disordered Eating Urges: An Ecological Momentary Assessment Study

The current study used ecological momentary assessment (EMA) to investigate whether appearance-based comments, social and performance-based evaluations affected levels of body dissatisfaction (BD) and urges to engage in disordered eating behaviors (DE) throughout daily life. A total of 620 participants completed a baseline questionnaire assessing sociodemographic variables. Participants then downloaded a mobile app which alerted them to complete short surveys assessing their levels of BD, DE urges, and experiences of receiving comments and evaluations six times per day for 7 days. Negative appearance-based comments predicted greater levels of state BD, while positive appearance comments predicted lower levels of state BD. Negative social and performance-based evaluations predicted an increase in state BD, while positive evaluations predicted a decrease in this outcome variable. No significant predictor was found for the DE urge outcomes. The present findings suggest that receiving negative and positive feedback in various domains of one's life may predict opposite outcomes for body image. However, these effects do not necessarily associate with urges to engage in DE in a nonclinical population.

Increases in shame following binge eating among women: Laboratory and longitudinal findings

This multi-method, two-study investigation tested the hypothesis that, controlling for guilt and negative affect, shame increases following binge eating. Support for this hypothesis constitutes the first step in testing the theory that shame mediates the link between binge eating and comorbid psychopathology. Study 1 employed a laboratory binge-eating paradigm in n = 51 women [21 with bulimia nervosa, 30 controls]. Study 2 employed a naturalistic test of prospective relationships among binge eating, shame, guilt, and negative affect in n = 302 college women over three months. In Study 1, women with bulimia nervosa reported increases in shame that were not explained by changes in guilt or negative affect, following laboratory binge eating, compared with controls. In Study 2, baseline binge eating predicted increased shame at follow-up independently of guilt and negative affect. Should shame prove to mediate the link between binge eating and comorbid disorders, interventions to reduce shame may be useful for those who binge.

Developmental trajectories of eating disorder symptoms: A longitudinal study from early adolescence to young adulthood

BACKGROUND

Adolescence is a critical period for the development of eating disorders, but data is lacking on the heterogeneity of their evolution during that time-period. Group-based trajectories can be used to understand how eating disorders emerge and evolve over time. The aim of this study was to identify groups of individuals with distinct levels of eating disorder symptoms between 12 and 20 years and the onset of different types of symptoms. We also studied sex differences in the evolution and course of eating disorder symptoms from early adolescence to adulthood.

METHODS

Using archival data from the QLSCD cohort, trajectories of eating disorder symptomatology were estimated from ages 12 to 20 years using semiparametric models. These trajectories included overall eating disorder symptomatology as measured by the SCOFF (Sick, Control, One Stone, Fat, Food), sex, and symptom-specific trajectories.

RESULTS

Two groups of adolescents following distinct trajectories of eating disorder symptoms were identified. The first trajectory group included 30.9% of youth with sharply rising levels between 12 and 15 years, followed by high levels of symptoms between 15 and 20 years. The second trajectory group included 69.1% of youth with low and stable levels of symptoms between 12 and 20 years. Sex-specific models indicated that the proportion of girls in the high trajectory group was 1.3 times higher than the proportion of boys (42.8% girls vs. 32.3% boys). Trajectories of SCOFF items were similar for loss-of-control eating, feeling overweight, and attributing importance to food. The weight loss item had a different developmental pattern, increasing between 12 and 15 years and then decreasing between 17 and 20 years.

CONCLUSIONS

The largest increase in eating disorder symptoms in adolescence is between the ages of 12 and 15 . Yet, most prevention programs start after 15 years of age. Our findings suggest that, unlike common practices, eating disorder prevention programs should aim to start before puberty.

Reinforcement sensitivity and bulimia symptoms: the role of emotion regulation

OBJECTIVE

Reinforcement Sensitivity Theory (RST) provides a theoretical foundation associated with various approach and avoidance behaviors and individual personality differences. Sensitivity to reward and punishment, two neural systems within the RST have been significantly associated with bingeing and purging behaviors. However, inconsistent findings are observed and specific factors mediating these relationships are not well understood. Deficits in emotion regulation may account for these relationships, as both negative urgency and distress tolerance have been independently associated with bulimia behaviors. Thus, this is an area that requires further investigation.

METHOD

The current study utilized various self-report inventories, including the Eating Disorder Inventory-3rd Edition to measure bulimia symptoms, as well as measures of negative affect, sensitivity to reward and punishment, distress tolerance, and negative urgency. These measures were used to assess whether distress tolerance and negative urgency mediated associations between sensitivity to reward and punishment and bulimia symptoms in a community sample of 394 young adults ranging from the ages of 18 to 25.

RESULTS

As expected, sensitivity to reward and punishment were significantly associated with decreased distress tolerance. Distress tolerance was also directly associated with greater negative urgency, which was significantly associated with increased bulimia symptoms. Consistent with hypotheses, indirect associations between sensitivity to reward and sensitivity to punishment to bulimia symptoms via distress tolerance and negative urgency were observed, controlling for gender and negative affect.

DISCUSSION

Results contribute to understanding specific contributions of risk factors within the relationship of sensitivity to reward and punishment and bulimia symptoms, measured by the EDI-3. Novel to existing literature, results indicate that reinforcement sensitivity significantly contributes to emotion regulation deficits. Thus, these findings may have important implications for understanding the development and treatment of bulimia symptoms.

LEVEL OF EVIDENCE

Level V, based on descriptive, cross-sectional data.

Student achievement prediction using deep neural network from multi-source campus data

Finding students at high risk of poor academic performance as early as possible plays an important role in improving education quality. To do so, most existing studies have used the traditional machine learning algorithms to predict students’ achievement based on their behavior data, from which behavior features are extracted manually thanks to expert experience and knowledge. However, owing to an increase in the varieties and overall volume of behavioral data, it has become more and more challenging to identify high-quality handcrafted features. In this paper, we propose an end-to-end deep learning model that automatically extracts features from students’ multi-source heterogeneous behavior data to predict academic performance. The key innovation of this model is that it uses long short-term memory networks to capture inherent time-series features for each type of behavior, and it takes two-dimensional convolutional networks to extract correlation features among different behaviors. We conducted experiments with four types of daily behavior data from students of the university in Beijing. The experimental results demonstrate that the proposed deep model method outperforms several machine learning algorithms.

Longitudinal Association of Depressive Symptoms, Binge Eating, and Quality of Life With Cardiovascular Risk Factors in Young Adults With Youth-Onset Type 2 Diabetes: The TODAY2 Study

OBJECTIVE

To report the prevalence of depression, eating disorder symptoms, and impaired health-related quality of life (HRQOL) and examine their longitudinal associations with glycemia and diabetes complications in young adults with youth-onset type 2 diabetes.

RESEARCH DESIGN AND METHODS

Participants recruited over a 4-year period were enrolled at 15 clinical diabetes centers in the follow-up observational Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) study. From 2014-2020, prevalence of symptoms of depression, eating disorders, and HRQOL by sex, race/ethnicity, and baseline family income were assessed annually. Longitudinal relationships between assessments of glycemia and complications with psychiatric symptoms and HRQOL were evaluated in adjusted models.

RESULTS

Participants (n = 514) were 21.7 ± 2.5 years old with a diabetes duration of 8.6 ± 1.5 years in year 1 of TODAY 2 (2014). Symptoms of depression and impaired HRQOL were common and increased significantly over 6 years (14.0% to 19.2%, P = 0.003; and 13.1% to 16.7%, P = 0.009, respectively). Depression and impaired HRQOL were more common in women and those with lower baseline family income but did not differ by race/ethnicity. Rates of binge eating were stable over time; self-reported purging increased. Over time, symptoms of depression were associated with higher HbA1c, hypertension, and retinopathy progression; impaired HRQOL was associated with higher BMI, systolic blood pressure, hypertension, and retinopathy progression; and symptoms of eating disorders were associated with higher BMI.

CONCLUSIONS

Significant psychiatric symptoms and impaired HRQOL are common among emerging adults with youth-onset type 2 diabetes and are positively associated with glycemia, hypertension, and retinopathy progression in this group that is at ongoing risk for medical morbidity.

Loss of control over eating: A systematic review of task based research into impulsive and compulsive processes in binge eating

Recurring episodes of excessive food intake in binge eating disorder can be understood through the lens of behavioral control systems: patients repeat maladaptive behaviors against their explicit intent. Self-report measures show enhanced impulsivity and compulsivity in binge eating (BE) but are agnostic as to the processes that might lead to impulsive and compulsive behavior in the moment. Task-based neurocognitive investigations can tap into those processes. In this systematic review, we synthesize neurocognitive research on behavioral impulsivity and compulsivity in BE in humans and animals, published between 2010-2020. Findings on impulsivity are heterogeneous. Findings on compulsivity are sparse but comparatively consistent, indicating an imbalance of goal-directed and habitual control as well as deficits in reversal learning. We urge researchers to address heterogeneity related to mood states and the temporal dynamics of symptoms, to systematically differentiate contributions of body weight and BE, and to ascertain the validity and reliability of tasks. Moreover, we propose to further scrutinize the compulsivity findings to unravel the computational mechanisms of a potential reinforcement learning deficit.

Descriptive analysis of binge eating in adult and adolescent females

PURPOSE

Provide qualitative descriptions of context and characteristics of binge eating in adults and adolescents to explore consistency in precipitating factors.

METHOD

Open-ended, qualitative interviews were administered to an adult sample (n = 24) and an adolescent sample (n = 20) to collect details about the context in which two binge episodes occurred.

RESULTS

Factors and context of the binge episodes were similar between adults and adolescents. In contrast, the two binge episodes described by each individual were not consistent. Binge episodes were not strongly affect-driven or food cue-driven.

CONCLUSIONS

Binge eating appears similar between adults and adolescents, which may have treatment implications. Similar treatment approaches may be used with both age groups and would benefit from covering a broad range of binge triggers rather than attempting to match individuals into an approach focused on particular triggers.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Effect of Ethnic Identity on the Relationship Between Acculturation Stress and Abnormal Food Behaviors in Colombian Migrants in Chile

BACKGROUND

Acculturation stress may influence the development of abnormal eating behaviors. However, some mental health indicators, such as ethnic identity, may have a protective effect on this relationship. This study's main objective is to analyze the mediating effect of ethnic identity on the relationship between acculturation stress and abnormal eating behaviors in Colombian migrants living in Chile.

METHODS

We obtained data on 976 Colombian migrants who were recruited with the help of the Department of Foreign Affairs, the Colombian Consulate in Chile, and self-managed groups of migrants residing in Chile. The mediation model was analyzed using Mplus 8.2 software, using the robust weighted least squares (WLSMV) estimation method.

RESULTS

The most common abnormal eating behaviors were eating until you feel full and eating large amounts of food. The mediation model was adapted to the data. The effects indicate that ethnic identity only had an indirect effect on the problems of social relations with other migrants (indirect effect = .17, p = .01) and on the distance from the origin (indirect effect = -. 06, p = .01) on the abnormal eating behaviors. On the other hand, the ethnic identity presented a direct and indirect effect on the relationship between citizenship and legality problems, and abnormal behaviors (indirect effect = -.06, p = .04; direct effect = -.35, p = .01).

DISCUSSION

Ethnic identity could be fundamental in the relationship between acculturation stress and abnormal eating behaviors, considering that post-migration eating practices are associated with unhealthy eating habits.

Influential Factors of Non-suicidal Self-Injury in an Eastern Cultural Context: A Qualitative Study From the Perspective of School Mental Health Professionals

Background: Adolescent non-suicidal self-injury (NSSI) is becoming a serious public health concern worldwide. In recent years, there has seen a significant increase in both the growth rate and cases of NSSI in Eastern countries, such as Japan, India, and China. In China, most schools have a mental health office that comprises mental health professionals (MHPs), who are the first to respond to student mental health problems, which include NSSI. MHPs possess comprehensive knowledge as well as unique insight into adolescent NSSI. However, very few studies on NSSI have incorporated their perspectives. In this work, we seek to add novel insight by conducting a study focusing on adolescent NSSI from the perspective of MHPs. Methods: We recruited a total of 24 MHPs from different schools using purposive sampling and conducted a semi-structured interview on NSSI-related issues. Each interview was voice recorded and lasted ~30 min. A thematic analysis was performed for the responses to study the most common and concerning issues underlying NSSI. Results: We extracted three major themes and eight sub-themes from the interview records, which included (1) the impact of Chinese culture on NSSI (sex-bias discrimination, overly high expectations, and inappropriate parenting style); (2) life events in school (internet use, academic pressure, and romantic relationships); and (3) opinions on the status quo of NSSI in China (ignorance and stigma). Conclusion: Results showed that culturally sensitive influential factors, such as sex-bias discrimination, the imposing of unrealistic expectations for personal achievement, and inappropriate parenting style, should be given more attention to prevent, assess, and intervene in NSSI. Emerging factors of modern society and adolescent lifestyles, such as academic pressure, internet use, and romantic relationships, should also be considered for treatments.

Binge Eating and Binge Drinking: A Two-Way Road? An Integrative Review

Unhealthy diet and alcohol are serious health problems, especially in adolescents and young adults. "Binge" is defined as the excessive and uncontrolled consumption of food (binge eating) and alcohol (binge drinking). Both behaviors are frequent among young people and have a highly negative impact on health and quality of life. Several studies have explored the causes and risk factors of both behaviors, and the evidence concludes that there is a relationship between the two behaviors. In addition, some research postulates that binge eating is a precipitating factor in the onset and escalation of excessive alcohol consumption, while other studies suggest that alcohol consumption leads to excessive and uncontrollable food consumption. Given that no review has yet been published regarding the directionality between the two behaviors, we have set out to provide an upto- date overview of binge eating and binge drinking problems, analyzing their commonalities and differences, and their uni- and bidirectional associations. In addition, we explore the reasons why young people tend to engage in both behaviors and consider directions for future research and clinical implications.

Eating Disorders among College Students in France: Characteristics, Help-and Care-Seeking

The aim of this paper was to identify the characteristics of broader categories of eating disorders (ED) and help- and care-seeking among college students. An online cross-sectional study was conducted among students of the University of Rouen-Normandy, France. The Expali-validated algorithmic tool, combining SCOFF test (Sick, Control, One stone, Fat, Food) and body mass index, was used to screen eating disorders into three diagnostic categories: restrictive eating disorders, bulimic eating disorders, and hyperphagic eating disorders. A total of 1493 college students were included; mean age was 20.1 years (SD = 1.9). The prevalence of likely cases of eating disorder was 24.8% (95% CI, 22.6-27.0). Percentage distributions of bulimic eating disorders, hyperphagic eating disorders, and restrictive eating disorders were 13.3%, 8.6%, and 2.9%, respectively. The two main resources for help-seeking in emotional stress situations were friends and family, whatever the ED. Students with eating disorders consulted their general practitioner more often for stress or anxiety than students without eating disorders: hyperphagic eating disorders (44.9%), restrictive eating disorders (35.1%), bulimic eating disorders (30.2%), and no eating disorder (20.4%) (p < 0.0001). The prevalence of healthcare renunciation was 21.9%, with a higher risk among students with bulimic eating disorders (AOR CI 95% 1.91 (1.34-2.72). The findings show one quarter of students screened positive for an eating disorder. Stress management was not necessarily different between students with eating disorders and students without eating disorders, but the former had a greater risk of renouncing treatment, especially related to a fear of seeing a general practitioner.

Non-Suicidal Self-Injury and Eating Disordered Behaviors: An Update on What We Do and Do Not Know

PURPOSE OF REVIEW

The current report aims to summarize recent advances about the relationship between non-suicidal self-injury (NSSI) and eating disordered (ED) behaviors and highlights meaningful directions for future research.

RECENT FINDINGS

While there is solid evidence indicating a robust cross-sectional association between NSSI and ED behaviors, emerging evidence suggests that the temporal relationship between these behaviors may be bidirectional. Shared functions and risk factors may explain why these behaviors often co-develop. At the same time, little is still known about the psychosocial consequences of comorbid NSSI and ED engagement, and there is a lack of intervention studies that target these behaviors simultaneously. It is well-established that NSSI and ED behaviors frequently co-occur. The field should now turn to longitudinal designs to advance our understanding of the longer-term developmental and the shorter-term momentary relationship of these behaviors in daily life. Providing insight into these areas will help guide the deployment of evidence-based interventions that match the needs of clients who report comorbid NSSI and ED behaviors.