“Drunkorexia”: It’s so normalized you might not even know you have it
Written by CCTC Staff Writer
If you and all your friends work out to “burn off the calories” from alcohol, or your sorority throws a party and you all eat less so you can drink without gaining weight, is it really disordered? Absolutely. In both these instances, you could potentially be suffering from what’s now known as drunkorexia. Comorbid alcoholism and eating disorders are common, hard to treat, and very serious.
Read on to find out:
The definition of drunkorexia and who is most at risk for it, according to research
Underlying mechanisms behind comorbid alcohol use disorders and eating disorders
How comorbid alcoholism use disorder and eating disorders are treated
What to do if you struggle with substance use and an eating disorder
It is not normal to avoid food or exercise to “account for” or justify alcohol use, even when diet culture has normalized it. Food has necessary nutrients that you can’t get from alcohol alone. Exercise is supposed to be a way of nurturing your body, not punishing yourself for a night out. And vomiting, whether as an eating disorder behavior or because you’ve had too much alcohol, is definitely not normal.
Related: Not all levels of movement are healthy. This is how to tell whether your exercise habit is actually a problematic compulsion.
What is drunkorexia and why is it dangerous?
“Drunkorexia” is a nonmedical term used to describe the restriction of food or purging of calories consumed in order to “save calories” for drinking. The idea is that there are calories in alcoholic drinks, so to keep from gaining weight, one must compensate for those calories.
Drunkorexia may come in the form of:
Restricting caloric intake to “save calories” before consuming alcohol
Excessively exercising as a form of purging calories consumed from alcohol
Drinking in order to purge previously consumed food
Purging food in order to drink more alcohol
Drunkorexia is dangerous for many reasons:
Without food, you get intoxicated much easier and faster. This makes you much more likely to engage in risky behaviors such as drunk driving and other uninhibited behaviors that you would not otherwise engage in (such as unprotected sex or overspending.)
Alcohol does not provide the nutrients that your body needs to survive. By restricting or purging food to continue drinking alcohol, your body will become malnourished.
Alcohol is a diuretic, meaning that it dehydrates you. Purging is also dehydrating. Dehydration can lead to electrolyte imbalances, fainting, blacking out, and more.
Modifying your eating habits to “account for” drinking puts you at risk for developing comorbid alcohol use problems and eating disorders.
And like any other mental health issue, drunkorexia has the ability to negatively impact work, school, your relationships — every aspect of your life.
Note: Individuals struggling with binge eating disorder are also at a very high risk for an alcohol problem. They just do not engage in compensatory behaviors to prevent weight gain.
Who is at risk for drunkorexia?
High School and College Students
Most people are exposed to alcohol for the first time in high school or college. Parties, celebrations, and having older friends all offer access to alcohol within this age group.
This is also a time when body image concerns and social expectations run rampant. This is often why individuals turn to disordered eating, purging, and exercise behaviors to avoid weight gain.
Those in fraternities and sororities are especially at risk for drunkorexia, since there are more opportunities to access alcohol in Greek-affiliated housing.
Related: Exposure to substances and social pressures are two of many reasons college students develop eating disorders.
Individuals with Trait Impulsivity
People with impulsive personalities are more likely to engage in both excessive drinking and eating disorder behaviors.
Research shows that the strongest association between eating disorders and alcoholism is found in individuals with purging behaviors. Bulimia and anorexia (binge/purge subtype) is characterized by the impulsive intake of food, and subsequent purging behaviors to “fix” their impulsive actions.
This same cycle happens with drinking. Impulsive individuals may drink and then react to that impulsive decision with purging behaviors. Or, they may compulsively overeat and purge after. Then, they drink to stop ruminating on the negative thoughts that arise after the binge-purge or binge-restrict cycle.
Finally, the third scenario: An individual impulsively overeats, but then physically cannot purge the contents of their stomach. This leads to so much distress that they use alcohol to induce vomiting.
Related: You are not “weak” for binging. This is how to end the binge-restrict cycle for good.
Individuals with an Inability to Identify and/or Regulate Emotions
Those who cannot identify, or who cannot cope with, their emotions are much more likely to use eating disorder behaviors as a coping mechanism. Individuals may binge eat to numb distressing emotions, restrict food in order to numb themselves, or engage in intense exercise to avoid sitting with their feelings.
People who struggle with emotion identification and regulation are also more likely to binge drink to “numb out” or “loosen up.”
They may first use eating disorder behaviors to cope, and move to drinking when their eating disorder doesn’t work as a coping mechanism, or causes even more emotional issues. Or, it may be the other way around.
Individuals with Negative Body Image
Studies show that individuals with low self-esteem and negative body image are more likely to engage in unhealthy weight management behaviors.
They are also more likely to binge drink in order to feel like they “fit in” and ease social anxiety.
Comorbid Alcoholism and Eating Disorders: Which disorder comes first?
You may have noticed that individuals at risk for comorbid alcoholism and eating disorders often develop one disorder after another. Alcoholism can come first, or the eating disorder, or (more infrequently) they develop at the same time.
This begs the question: Do people develop one disorder as a response to the other, as a replacement for the first one, or do the two disorders develop independently of each other?
Researchers have found that, for most people, the eating disorder occurs first or at the same time as an alcohol use disorder. Specifically, in this large study of individuals with anorexia or bulimia and substance use disorders:
70% of individuals with comorbid bulimia and alcohol use disorder developed their eating disorder first.
15% of people with bulimia and alcohol use disorder developed both at the same time.
67% of individuals with comorbid anorexia and alcohol use disorder developed their eating disorder before their substance use problems.
Researchers suggest that, for some people, alcoholism may occur as a replacement coping mechanism when eating disorder behaviors are no longer a useful or available option.
This means that individuals in recovery from an eating disorder are at a high risk for developing a substance use disorder.
Those who develop an eating disorder after an alcohol use disorder tend to fall more into the “drunkorexia” category, where they use behaviors specifically to counteract any potential weight gain from drinking. Eating disorder behaviors, specifically exercise, are often used to create an illusion of health for someone suffering with substance use problems.
Treating Comorbid Diagnoses: How are comorbid alcoholism and eating disorders treated?
Unfortunately, despite the high prevalence of comorbid alcohol use disorder and eating disorders, it’s hard to identify and treat both problems at once. Many treatment centers report not being well equipped enough to treat both problems at once.
Many individuals in substance abuse treatment centers are not screened for eating disorders, and their eating patterns are not monitored. They are not given proper nutritional information, meal support, or therapy targeting negative body image.
Those in eating disorder treatment may not get to address present or past alcohol use problems. They may not be prepared to face a potential alcohol problem once they start using disordered behaviors.
But things are getting better — more eating disorder treatment centers than ever are recognizing the high prevalence of comorbid diagnoses. Eating disorder clinicians are getting more informed about the signs and treatment implications of alcohol use disorder.
Since eating disorders and alcohol use disorders most likely stem from inner emotion regulation issues, severe anxiety, and/or trauma, therapy and coping skills address every individual’s unique underlying issues, not just stopping eating disorder or substance use behaviors.
Related: This is why trauma treatment is necessary to make a full, lasting recovery.
Honesty is the best policy when it comes to getting the right treatment
If you struggle with substance use and an eating disorder, be honest with yourself and with others. Open up to the fact that you struggle with both of these issues, with your doctor and with those around you.
Then, seek out an eating disorder treatment center that is capable of treating comorbid issues. Ask specific questions about how they can help you with substance use problems.
Most importantly, understand that as you start removing eating disorder behaviors, you will find yourself wanting to use other things, such as alcohol, to deal with the distress that comes from losing your coping mechanism, your changing body, and the challenges of recovery in general.
That’s why you can’t just focus on recovering from one disorder at a time. It’s so much harder to recover from two disorders at once. But if you don’t, you risk falling deeper into your alcohol use disorder. It’s hard, but with the right treatment, recovery from both alcoholism and eating disorders is possible.
If you or a loved one is struggling with substance use and/or an eating disorder, take the first step today and talk to someone about recovery or simply learn more about the holistic eating disorder recovery programs we offer.