(PS8-A23) Food and Alcohol Disturbance, Distress, and Impairment: Temporal Relationships Using Ecological Momentary Assessment

Compensatory food and alcohol disturbance, or “FAD,” is characterized by inappropriate compensatory behaviors (i.e., restriction, self-induced vomiting, laxative use, diuretic use, or exercise) that are intended to compensate for calories consumed from alcohol. These behaviors are cross-sectionally linked to alcohol-related consequences, including blackouts and injury, but it is currently unclear whether compensatory FAD is related to impairment secondary to eating pathology, overall quality of life, or general psychological distress. Additionally, the majority of existing literature regarding compensatory FAD is limited by its cross-sectional design and reliance on recall of behaviors. Addressing limitations of recall bias and cross-sectional design is necessary for establishing the clinical significance of these behaviors. The current study used ecological momentary assessment to test prospective associations between compensatory FAD and distress/impairment. It was hypothesized that more frequent compensatory FAD behaviors would longitudinally predict more severe distress and impairment. Twenty-nine undergraduate women who endorsed compensatory FAD completed an ecological momentary assessment protocol for three weeks. Approximately one week after completing the protocol, participants completed assessments of distress (Kessler Psychological Distress Scale), impairment secondary to eating pathology (Clinical Impairment Assessment) and alcohol use (Short Inventory of Problems-Alcohol), and quality of life (The World Health Organization Quality of Life-BREF). Participants endorsed a mean of 11.9 (SD = 12.87) compensatory FAD behaviors (i.e., food restriction, self-induced vomiting, laxative use, diuretic use, or exercise to compensate for alcohol) over the nine-day protocol (Thursday, Friday, and Saturday for three weeks). Contrary to hypotheses, frequency of compensatory FAD behaviors were not significantly related to psychological distress (r(27) = .082, p = .671), impairment secondary to eating pathology (r(27) = .063, p = .746), and global quality of life (r(27) = -.255, p = .182). However, more frequent compensatory FAD behaviors predicted greater impairment secondary to alcohol use at follow-up (r(27) = .428, p = .021). Results highlight the specificity of impairment in compensatory FAD to alcohol-related consequences, including failing to meet expectations, harming physical health, and experiencing social impairment with family or friends due to drinking. Thus, results support the clinical significance of compensatory FAD and suggest that intervening on FAD-related behaviors may be important to reduce these deleterious outcomes. Individuals with co-occurring alcohol use and inappropriate compensatory behaviors should be particularly monitored for dangerous alcohol-related consequences, such as memory deficits and injury. Future research should continue to use designs that can examine temporal relationships among variables to better understand the factors that maintain compensatory FAD, which could ultimately help to prevent the negative consequences associated with these behaviors.