College Drinking and Disordered Eating: Drunkorexia

College brings with it a number of challenging situations with which young adults must contend: living away from parents, living with unfamiliar peers, lack of personal space and privacy, institutional foods, increased independence, the presence of drugs and alcohol, social pressure to fit in, increased academic pressure, and sororities and fraternities.

The college party culture has been identified as problematic. Binge drinking, which seems deeply woven into campus culture and considered “normal behavior," has become a major concern. It contributes to lower grades, sexual assaults, and alcohol use disorders. But there is another related danger lurking: "drunkorexia."

Food and Alcohol Disturbance

Disordered eating and binge drinking are both common problems on college campuses. Furthermore, disordered eating and alcohol abuse often occur together—and when they do, the problems they create can be greater than the sum of the parts.

A particular issue at the intersection of disordered eating and problematic alcohol use is a behavior pattern that the lay community has dubbed “drunkorexia.” This is not a clinical term—there is no formal psychological diagnosis of drunkorexia. Even so, this phrase has come to describe the intentional tendency to skip meals prior to drinking alcohol.

What Is Drunkorexia?

Drunkorexia was first described in a 2008 New York Times article by Sarah Kershaw, who wrote that “Drunkorexics are college-age binge drinkers, typically women, who starve all day to offset the calories in the alcohol they consume.” Since then, several studies have further elucidated and described the phenomenon.

The research team of Choquette and colleagues has recently proposed the term “Food and Alcohol Disturbance” (FAD) as a clinical designation for drunkorexia.

The core component of drunkorexia is the use of compensatory behaviors—which may include restricting eating, purging, or exercise—in order to offset the calories ingested from alcohol, enhance intoxication, or both.

This problem does not necessarily indicate a clinical diagnosis of an eating disorder or an alcohol use disorder, nor does it preclude such a diagnosis from being made. So an individual might have an eating disorder such as anorexia nervosa, bulimia nervosa, or binge eating disorder, and also engage in drunkorexia. However, what makes this problem unique from either independent diagnosis is the “intertwined motivations of the behaviors that are not necessarily present in a comorbid presentation.”

Caloric compensation for drinking may occur before, during, or after alcohol consumption. Some individuals may restrict eating in anticipation of consuming alcohol. Alternatively, an episode of binge drinking that occurs without prior restriction may create feelings of guilt, which in turn lead to compensatory behaviors such as purging, diuretics, exercise, or dieting to offset the alcohol calories that were ingested.

Research shows that the presence of either disordered eating or alcohol use increases the likelihood a person will engage in drunkorexia, supporting the conceptualization of drunkorexia as an overlapping of dysfunctional eating and drinking patterns.

Who Gets Drunkorexia?

This problematic behavior pattern appears to be most common among college populations, although it can also occur in people who are not in college. Some studies have found that one-third of university students report deliberately eating less food prior to alcohol use in an effort to compensate for alcohol calories they plan to consume. Other studies have reported as many as 46 percent to 58 percent of college students engage in these behaviors at least “sometimes.”

Of a large sample of university students who had drunk heavily at least once during the past 30 days, more than 80 percent endorsed having engaged in at least one disordered eating behavior in the last three months. The behaviors included induction of vomiting, consumption of laxatives or diuretics, or food restriction prior to a drinking episode.

Drunkorexia is not merely an American phenomenon—it has been identified in college students around the world including those in Italy and Australia. The risk may be greatest to first-year college students due to the additional stress and environmental changes including loss of parental supervision during this year. Students who live in fraternity and sorority houses appear more likely to engage in the behavior. 

Motivations appear to differ between men and women who engage in drunkorexic behavior, and it appears to be more common among females. One study reported that college women were more than 1.5 times as likely as men to report restriction of food intake before drinking. Studies have shown that the majority of women who engage in caloric restriction prior to drinking do so in order to avoid weight gain. While this is the case for some men as well, there is a larger proportion that appears to restrict intake in order to get intoxicated faster.

It has been proposed that this gender differential is due to the greater pressure to be thin that women face compared to men. Some researchers have noted that the two common pressures faced by college women—to get drunk and remain thin—are in direct conflict and may facilitate drunkorexia. Research has shown that the connection to weight control motivation is especially strong among women who drink more heavily.

Women who engage in restricting eating prior to alcohol use have been shown to have more disordered eating, alcohol problems, and symptoms of depression and anxiety.

Risks of Drunkorexia

The combination of self-imposed starvation and binge drinking can have serious physical and psychological consequences.

Alcohol consumption on an empty stomach accelerates alcohol’s entry into the bloodstream, which can increase the blood alcohol content to life-threatening levels with little warning. The intensified effects of alcohol while drinking during a state of malnutrition can intensify consequences such as blacking out, alcohol poisoning, brain damage, organ damage, vomiting, aggressive behavior, and unwanted sexual activity.

Over time, the behavior can contribute to liver cirrhosis. Alcohol use also can inhibit the storage and formation of new memories and reduce cognitive functioning. Alcohol abuse can also exacerbate the many consequences of malnutrition including vitamin deficiency and risks to the heart, liver, and kidneys. Additionally, alcohol misuse itself may contribute to social, academic, and physical problems such as missed classes, legal troubles, family or work issues.

Interventions for Drunkorexia

If you are eating less in order to be able to drink more, recognize that this is dangerous behavior and it is important to get help. Since drunkorexia is not a clinical diagnosis, there is relatively little research on it and no specific treatments.

Treatment should focus on maintaining regular eating and drinking in moderation or abstinence from drinking. Therapists trained in either eating disorders or substance use should be able to help.

If you are—or are soon to be—a parent of a college student, especially one who has dieted or had an eating disorder, you should be watchful for this behavior and educate your child about the increased dangers of skipping meals or restricting food before drinking. Let them know that it can exacerbate their eating problems and that alcohol calories are never an adequate substitute for food calories.

Even though your child in college may technically be an adult, it does not mean that you should not stay involved. Especially if there is a history of an eating disorder or a history of substance abuse in the family, stay in contact with them and check in periodically. Pay attention to any signs that they may be drinking too much or engaging in increased eating disorder behaviors or both. Talk to them and express any concern in a non-judgmental way. Seek help from a professional if you are concerned.  

Recommendations for Colleges

Colleges and universities should address the problematic behavior of drunkorexia by educating incoming freshman about the increased health risks associated with calorie restriction prior to alcohol consumption.

Colleges should also implement screening and provide additional support to high-risk groups such as those in sororities and fraternities which are often associated with drinking and dieting.

Programs such as the Body Project have been implemented in college populations such as sororities and have been shown to be effective in reducing participants’ pursuit of the thin ideal.

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By Lauren Muhlheim, PsyD, CEDS
 Lauren Muhlheim, PsyD, is a certified eating disorders expert and clinical psychologist who provides cognitive behavioral psychotherapy.