Eating disorders and disordered eating attitudes across recovery stages among a sample of Egyptian males with substance use disorder

Background Eating disorders (EDs) and disordered eating attitudes are increasingly recognized among males with substance use disorder (SUD), particularly during recovery. This study aimed to assess EDs and disordered eating attitudes according to duration of abstinence among Egyptian males with SUD and explore their relationship with psychosocial stress. Methods This observational comparative cross-sectional study included 108 Egyptian males with DSM-5-defined SUD, divided equally into initial abstinence (<3 months), early remission (3 to <12 months), and sustained remission (≥12 months). Participants were assessed using the Mini-International Neuropsychiatric Interview, Alcohol, Smoking and Substance Involvement Screening Test, Eating Attitudes Test-26 (EAT-26), and Social Readjustment Rating Scale (SRRS). Results Age differed significantly among the three abstinence-duration groups, with participants in the sustained remission group being older (35.78 ± 5.81 years) than those in the initial abstinence group (31.25 ± 6.14 years; p = 0.007). Duration of substance use was longer in the sustained remission group than in the initial abstinence group (14.58 ± 6.35 vs. 10.33 ± 5.24 years, p = 0.011). Suicidality score was higher in the initial abstinence group than in the early and sustained remission groups (1.83 ± 2.01 vs. 0.86 ± 1.07 and 0.83 ± 1.25, p = 0.007). Binge-eating disorder was most frequent in the initial abstinence (25.00% vs. 13.89% and 2.78%, p = 0.024). EAT-26 total score was higher in the initial abstinence group than in the sustained remission group (17.67 ± 9.35 vs. 11.25 ± 5.46, p = 0.002). EAT-26 total score was strongly and positively correlated with SRRS total score in the total cohort ( r = 0.837, p < 0.001). Multiple linear regression analysis showed that higher psychosocial stress and abstinence-duration group were significantly associated with EAT-26 total score (β = 0.757, p < 0.001 and β = −0.299, p = 0.001, respectively). Conclusions Disordered eating attitudes and binge-eating disorder were more common among participants in the initial abstinence group, with EAT-26 total scores significantly higher than in the sustained remission group. Psychosocial stress was strongly associated with disordered eating attitudes. In the multiple linear regression analysis, psychosocial stress and abstinence-duration group were significantly associated with EAT-26 total score.