Understanding the comorbidity of disordered eating behaviour and alcohol use disorder: a scoping review

Abstract Background Individuals with Alcohol Use Disorder (AUD) are susceptible to binge eating behaviours, and this comorbidity increases physiological and psychological complications while acting as a barrier to recovery. Both conditions share common psychological mechanisms, including emotional dysregulation, impulsivity and low self-esteem, yet this overlap remains underexplored in clinical AUD settings. Current research predominantly focuses on college students or eating disordered populations, whose experiences differ significantly from those of individuals receiving treatment for AUD. There is a need to understand the current evidence base and identify gaps in the literature specific to clinical populations with AUD. Methods The databases EBSCO, PubMed, Scopus, Cochrane and Web of Science were systematically searched to identify eligible articles. Screening was conducted independently by two reviewers, with any disagreement resolved through discussion. All published, peer-reviewed articles examining clinical populations with AUD were eligible for inclusion, regardless of study design or country of origin, including observational and intervention studies. Results Forty-four studies were included, from which four key themes were identified: prevalence of eating disorder symptomology, psychological underpinnings, treatment engagement and outcomes, and cultural, ethnic and gender differences. There was a high prevalence of disordered eating symptomology in clinical populations with AUD, with Bulimia Nervosa most frequently reported. High levels of negative urgency, emotional dysregulation and low self-esteem were identified across studies. Individuals with comorbid eating disorders were more likely to be Caucasian, less likely to be employed, and more likely to leave treatment services early or against medical advice, with associated increases in severity, mortality risk and recovery time. Disordered eating symptomology and its functional role were broadly similar in men and women, though gender-specific screening tools and research remain underdeveloped. Discussion This review highlighted the potential impact of routine screening and monitoring for eating disorder behaviours within clinical populations with AUD. It also discusses the value of a transdiagnostic model of diagnosis and intervention, given the shared psychological mechanisms underpinning both behaviours. Abstinence-focused treatment models may inadvertently reinforce restrictive eating in this population, underscoring the need for further research into holistic, integrated approaches. There is a clear research need for adequately powered, longitudinal studies that include both men and women equitably.