Impulsive and Compulsive Traits and BED Among Students

Binge eating disorder (BED) is the most common eating disorder, affecting all age groups, and is linked to significant comorbidity and development of physical problems such as diabetes and obesity. The mean age of onset of BED is later than that for AN or BN, and usually occurs in early adulthood. One group at increased risk of BED includes university students, who have high levels of life stresses from academic pressures and major life changes.

Jeremy E. Solly, PhD, from the Department of Psychiatry at the University of Cambridge, and a team of collaborators recently used the internet to evaluate the vulnerability to develop BED in a large group of college students (CNS Spectr.2023. 28:61). Two areas of particular interest to the researchers were compulsivity and impulsivity. Impulsivity is the tendency to take on behaviors or actions that are inappropriate, premature, or risky, while compulsivity refers to repetitive acts performed according to rigid rules or as a habit.

Earlier studies reported an incidence of BED of 13% in this age group, and noted that binge eating behavior affects as many as 50% of female students (J Eat Disord. 2019. 7:33). To follow their theory that BED was linked to a wide range of comorbidities, including impulsivity and compulsivity, the authors sent an internet-based questionnaire to 10,000 randomly selected students at a large midwestern university. To encourage participation, the authors devised a prize draw, where 10 participants would be randomly selected to receive computers and gift certificates; one $1000 certificate was also rewarded 449 responses.

The authors asked participants about consumption of caffeinated soft drinks during the past week, along with use of e-cigarettes and consumption of alcohol. In other areas, the students were asked if they had used a variety of products such as nonprescription amphetamines, cocaine, opiates, inhalants, marijuana and prescription pain medications. All participants also completed the Alcohol Use Disorders Identification Test (AUDIT). (A score ≥8 indicated potentially harmful alcohol use.)

Impulsive and compulsive behaviors

The students were asked about how many caffeinated soft drinks they had consumed over the past week, whether they had been treated for psychological/emotional problems, and if they were currently taking prescribed mental health medications. Other questionnaires screened for a number of comorbidities, including possible post-traumatic stress disorder, as well as generalized and severe anxiety. Impulsivity was assessed by the Barratt Impulsiveness Scale, Version 11 (BIS11). Another addition was the Rosenberg Self-Esteem Scale, where a score <15 indicated low self-esteem.

In the final evaluation, 3415 college students completed the survey, and 83 (2.4%) had a positive screening outcome of BED; 77.1% of those were female.

Other factors, such as year in college or racial/ethnic group and grade point average, didn’t differ significantly between those with a diagnosis of BED and those without.

The largest effect came with examination of BED with trait impulsivity and compulsivity. The authors also found that BED was associated with higher AUDIT scores, consistent with earlier studies of links between BED and alcohol use disorder.

To the authors’ knowledge, theirs is the first study to investigate trait compulsivity in BED—and finding compulsivity and impulsivity in this group adds to the understanding of the neurobiological basis of BED. The wide association of mental disorders in this group, even with small effects, may point to the need for screening for disordered eating in a range of psychiatric presentations. The authors pointed out that earlier studies used scales unsuitable for measuring compulsivity, such as relying on measurement of obsessive-compulsive symptoms. They suggest that future studies test a range of populations with self-report measures such as they used, including cognitive tasks with self-report questionnaires.

The authors concluded that the largest effect came from associations with trait impulsivity and compulsivity.