By Melissa Munn-Chernoff, PhD, FAED

College students are at risk for having adverse mental health outcomes.¹ For example, the prevalence of eating disorder diagnoses in college is 11%-17% in women and 4% in men,² compared with 1-3.5% in the general population,³ and up to 50% of college students report eating disorder symptoms.⁴ Illicit substance use and abuse is also common in college students, with 22% reporting illicit drug use in the past month.⁵ Although numerous studies have examined associations between disordered eating and use of specific substances among college students, few have investigated associations between specific illicit substances, including the non-medical use of stimulants, and disordered eating, particularly in college.

In a study published last year, Nutley and colleagues⁶ included data from over 87,000 college students from the Healthy Minds Study, a study of college student mental health and well-being from across the United States. Students participated in the study from the fall of 2015 to the spring of 2018 and were enrolled at public and private colleges and universities and community colleges. Specifically, the authors assessed associations between disordered eating and non-medical and medical use of prescription stimulants. Disordered eating was assessed with the SCOFF questionnaire, which included five items pertaining to purging, loss of control over eating, losing more than 15 pounds within three months, believing yourself to be fat when others say you are too thin, and stating that food dominates your life. Stimulant use was assessed via a series of questions about the past 12 months, where stimulant use without a prescription or using more than prescribed was categorized as non-medical stimulant use. Individuals who were prescribed stimulants via a healthcare professional and only took them as prescribed were classified as taking stimulants for medical purposes only.

Overall, 2,435 (2.8%) participants reported using stimulants for non-medical purposes, whereas 3,545 (4.1%) students reported prescription stimulant use for medical purposes only and the remaining 81,316 (93.1%) students did not use prescription stimulants. Individuals who reported non-medical stimulant use had the highest prevalence of all five disordered eating characteristics, followed by students who endorsed medical use of stimulants and then students who did not report stimulant use. After adjusting for relevant demographic, substance use, and psychological features, the risk for each disordered eating characteristic, as well as endorsing at least two SCOFF items, was associated with a 20%-46% increased risk of non-medical stimulant use. Furthermore, risk for non-medical use of stimulants increased with the number of disordered eating characteristics endorsed. Finally, students who reported losing more than 15 pounds in three months reported a 25% increase in risk of medical use of stimulants.

This study is the largest study of its kind and highlights an important issue around disordered eating and substance misuse during a key developmental period. Physicians and mental health providers who prescribe stimulants to young adults (and ideally other age groups) should monitor for the presence of a range of disordered eating characteristics. Identifying and treating the comorbidity of disordered eating and stimulant misuse early can reduce the negative consequences associated with comorbid eating disorders and substance use disorders.

References

1.         Auerbach RP, Alonso J, Axinn WG, et al. Mental disorders among college students in the World Health Organization World Mental Health Surveys. Psychological Medicine 2016;46:2955-70.

2.         Eisenberg D, Nicklett EJ, Roeder K, Kirz NE. Eating disorder symptoms among college students: Prevalence, persistence, correlates, and treatment-seeking. Journal of American College Health 2011;59:700-7.

3.         Hudson JI, Hiripi E, Pope HG, Jr., Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry 2007;61:348-58.

4.         Lipson SK, Sonneville KR. Eating disorder symptoms among undergraduate and graduate students at 12 U.S. colleges and universities. Eating Behaviors 2017;24:81-8.

5.         Lipari RN, Jean-Francois B. A day in the life of college students aged 18 to 22: Substance use facts. The CBHSQ Report. Rockville (MD)2013:1-7.

6.         Nutley SK, Mathews CA, Striley CW. Disordered eating is associated with non-medical use of prescription stimulants among college students. Drug and Alcohol Dependence 2020;209:107907.