Why Drunkorexia is More Than a Buzzword

Drunkorexia describes a pattern of people’s deciding to undereat during the day in anticipation of binge drinking at night. Both men and women engage in this behavior for two reasons. (1) Not eating food during the day will ensure that alcohol will have a stronger impact and get the person drunk quicker and (2) many people – especially women – want to save up their calorie consumption in order to indulge in alcohol. Their attempt to avoid consuming too many calories to not gain weight becomes an unhealthy weight management technique.

Years ago, The New York Times published an article on drunkorexia aptly entitled “Starving Themselves, Cocktail in Hand.” Although the topic was discussed in an international newspaper, it is hard to know how common drunkorexia is. Statistics do not accurately capture a basically secretive and hidden behavior. I have seen in my practice that college-age students and young adults do practice this behavior frequently. It is common to go bar hopping after class several nights a week with the goal of getting drunk.

The dangers of Drunkorexia

One young woman I worked with, let’s call her Tracy, was in law school and binged and purged during the day to get rid of calories. She would then head out to the bar with friends three to five nights a week and get drunk each time. Tracy believed her bulimia was her only problem, and she came to therapy to get it under control. In her therapy, we addressed her underlying depression following the recent death of her mother. We strategized her eating behaviors to eat small meals throughout the day so she wouldn’t feel so obligated to throw them up. Rather than bingeing on large amounts of food and then feeling guilty, eating small meals did not trigger her fear of weight gain.

However, Tracy did not want to address her drinking behavior because she felt it made her the “life of the party”. This was a welcome relief for someone who had previously considered herself a shy, wallflower. As her therapist, I pointed out she was suffering from an increasing number of hangovers, was having trouble remembering what happened the night before, and had engaged in unprotected sex more than once.

Alcohol has been called “liquid courage”. Many young women, like Tracy, find that getting drunk lubricates their ability to talk to others and lowers their self-consciousness about having sex. Sororities and fraternities may normalize this behavior which makes it difficult for the student to realize they are in trouble because “everyone is doing it”.

Being in college or grad school can be a perfect storm for drunkorexia. Anxiety about popularity, sexual relationships, appearance and weight, school grades, and anxiety about life after graduation.

Who is at risk?

Although drunkorexia is most often a young person’s behavior and going to the bar is a way to socialize and meet up with friends, I have also worked with older women who exhibit this behavior. Christine (name changed for confidentiality) was a 43-year old married woman who worked out extensively for many hours during the day. In just one day, she would take cycle classes, tennis classes, as well as strenuous workouts with her trainer. Christine ate very little during the day and saved up her calories to binge drink every night. In her therapy, we worked on stabilizing her eating patterns and modifying her drinking. Her fear of gaining weight made her therapy challenging. However, she came to see that she could eat nutritious food and feel stronger during the day. If she then also moderated her drinking at night, she would feel more refreshed the next morning. We will see if Christine can maintain these newfound healthy behaviors. I suspect Christine is an alcoholic and will return to heavy drinking. If so, we will then discuss the next options for her including alcohol rehab and a recovery program.

Drunkorexia, Bulimia, and Binge Eating Disorder

Many people with drunkorexia have diagnosable eating disorders of binge eating and bulimia. People with anorexia typically won’t engage in drunkorexia because they are fearful of any calories – including those in alcohol.

Studies have shown that binge eaters and bulimics may have a biological vulnerability (a genetic link) to alcoholism and eating disorders. Oftentimes, family members have alcohol-related problems and depression. We also know that alcohol can temporarily boost a depressed mood although the person winds up crashing later. People often turn to binge drinking as an attempt to self-medicate their depression.

For a more comprehensive picture of drunkorexia, we need to add that many people also resort to abusing drugs such as cocaine and methamphetamines to reduce hunger in the hope of losing weight.

The key for each person with an eating disorder is to honestly reflect on their relationship with alcohol and to get help if they are drinking increasing amounts and/or if it is affecting social or work relationships. Every therapist should also include ongoing alcohol assessments with their eating disorder clients.

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