From Renee Engeln Ph.D. @ Psychology Today: Imagine a 21 year-old college student. We’ll call her E. E. has plans to go out drinking with her friends on Saturday night. She knows she’ll probably drink a lot, and she knows that alcohol can be highly caloric. The last thing E. wants is to gain a bunch of beer weight, so she eats nothing all day Saturday except for some celery sticks. E. figures that in addition to offsetting any possible weight gain from the alcohol she’s going to drink, fasting all day will also let her get drunk even faster.
Does E. have an alcohol use disorder? An eating disorder? Neither? Both?
A little over ten years ago, the term “drunkorexia” entered pop culture parlance, possibly via this New York Times article, or possibly through stories of fashion models who starve themselves yet don’t seem to regulate their alcohol intake. Though drunkorexia is far from being an official medical diagnosis, health professionals and researchers are starting to take the idea seriously.
Definitions of drunkorexia vary slightly from one research study to another, but all include engaging in unhealthy compensatory behaviors (e.g., extreme caloric restriction, over-exercise, or purging) to offset the calories ingested through alcoholic beverages or to increase how quickly one becomes intoxicated. Some researchers also include drinking excessively in order to make oneself vomit (and thus purge food one consumed earlier, along with some of the alcohol) as a component of drunkorexia.
Drunkorexia appears to be relatively common among young people in several cultures. A study of Italian adolescents (ages 16-21) found that 12% indicated they had “restricted food or calories before drinking an alcoholic beverage” in the past 30 days. Those who reported this behavior were also more likely to engage in fasting, binge eating, and use of laxatives. A similar survey of female Australian college students found that over half reported engaging in drunkorexia-type behaviors. A recent cross-cultural study found that over half of both French and American college students show signs of drunkorexia.
In addition to the prevalence of drunkorexia, there are other reasons to take this new “diagnosis” seriously. To begin, some researchers have argued that drunkorexia can help explain a long-standing pattern of somewhat counterintuitive research findings. Scientists regularly find evidence of what some have called the “incongruous alcohol-activity association.” Though we might stereotype binge drinkers as being all-around unhealthy, a number of studies have shown that drinkers exercise more than age-matched peers who don’t drink alcohol. This pattern might be explained by people trying to “undo” the negative health effects of problematic alcohol use with physical activity. In other words, you know that night of boozing was bad for your health, but you think you might be able to make up for it with spin class the next day. One recent study of over 25,000 students across 40 U.S. campuses found that binge drinkers were more likely to engage in regular, vigorous exercise. They were also more likely to engage in a wide variety of eating disordered behaviors. (College students are a population of interest when it comes to this topic because, on average, they drink more, work out more, and have higher rates of some eating disorders compared to others in their age group.)
Binge drinking can be dangerous no matter what. It’s associated with depression, suicidality, legal troubles, and violence. Among college students, it’s further linked with missed classes and poor grades. But all of these negative outcomes risk being intensified when people restrict their food intake prior to drinking. A 2009 study found that college students who restricted calories before drinking were much more likely to get drunk. Women who restricted prior to drinking reported more drinking-related memory loss, were more likely to engage in unprotected sex, and were at greater risk for being injured or sexually assaulted. Men who restricted engaged in more physical aggression.
In a 2018 article out of the University of South Florida, researchers argued that we should take the concept of drunkorexia seriously, and that one way to do that is to give it a more appropriate name: Food and Alcohol Disturbance (FAD). This new name would indicate that drunkorexia is more than just the co-occurrence of an Alcohol use disorder and an eating disorder, because the motivations for both sets of problematic behaviors can’t be easily disentangled. Whether you want to call it FAD or drunkorexia, evidence is piling up that researchers and health practitioners can no longer ignore this particularly toxic mix of disordered eating and dangerous drinking.