Drunkorexia

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Drunkorexia is a colloquialism for anorexia or bulimia combined with an alcohol use disorder. [1] The term is generally used to denote the utilization of extreme weight control methods to compensate for planned binge drinking. [2] Research on the combination of an eating disorder and binge drinking has primarily focused on college-aged women, though the phenomenon has also been noted among young men. Studies suggest that individuals engage in this combination of self-imposed malnutrition and binge drinking to avoid weight gain from alcohol, to save money for purchasing alcohol, [3] and to facilitate alcohol intoxication. [4]

Contents

Studies reveal that individuals experiencing an eating disorder are at a higher risk of developing substance use disorders. [5] It is reported that up to half of individuals with eating disorders misuse alcohol or illicit substances, with anorexia and bulimia being the disorders most commonly linked to substance use. [5] The National Association of Anorexia Nervosa and Associated Disorders reports that 72% of women who admit to inappropriate alcohol use also classify as suffering from an eating disorder. [6]

Symptoms

Drunkorexia consists of three major aspects: alcohol use/misuse, food intake restriction, and excessive physical activity. [7] It is commonly summarized in the following activities:

Treatment

Drunkorexia is not a medically diagnosed disorder; therefore, there is no specific treatment. However, as drunkorexia is a combination of two different disorders, binge drinking and eating disorders such as anorexia and bulimia, the treatment needs to address both. [8]

Effects

The combination of self-starvation and excessive consumption of alcohol can lead to an array of physical and psychological consequences. Drinking in a state of malnutrition can predispose individuals to a higher rate of blackouts, alcohol poisoning, alcohol-related injury, violence, or illness. Drinking on an empty stomach allows ethanol to reach the blood system faster and raises one's blood alcohol content at a dangerous speed, which can render the drinker more vulnerable to alcohol-related brain damage. In addition, excessive alcohol consumption can have a detrimental impact on hydration and mineral and nutrient retention, which exacerbates the consequences of malnutrition and compromises an individual's cognitive faculties. [3] These effects are more pronounced in women, as women usually metabolize alcohol slower than men. [4]

At risk populations

Drunkorexia is found to be most common among university students, as they are faced with the conflicting pressure of heavy drinking and maintaining a slim physique. First-year college students are said to be especially predisposed to eating disorders as an attempt to avoid the fabled "Freshman 15", defined as the weight gain that results from adjusting to a college lifestyle. [9] [10]

The National Eating Disorder Association disclosed that approximately 20% of college students of both sexes admitted to suffering from an eating disorder at some point in their life. In addition, a 2002 study reported 70%, of participating college students, reported consumed alcohol within the prior month and 40% had engaged in binge drinking. [9]

A 2013 survey observed 107 female university students in order to study the frequency and correlation of self-induced vomiting after consuming alcohol. Results showed that 59.8% of the participants who reported drinking alcohol also appeared to have engaged in self-induced vomiting after alcohol consumption. Participants that reported self-induced vomiting after alcohol consumption also reported more bulimia nervosa symptomatology. [11]

In Australia, a 2013 study surveyed 139 Australian women between the ages of 18 and 29 enrolled in an undergraduate degree at university. These women were asked to complete a survey regarding compensatory eating and behaviors in response to alcohol consumption to test for drunkorexia symptomatology. In the sample tested, 79% of participants demonstrated engaging in characterized drunkorexia behavior. Further analysis of the results showed that the social norms of drinking and the social norms associated with body image and thinness impacted heavily upon the motivation for these behaviors. [12]

Other research has shown that a further correlation exists between college students who participate in physical activity and alcohol dependence. Individuals who were more physically active than their peers had a higher tendency to be alcohol dependent or to engage in regular binge drinking. [13] Excessive exercise is often perceived as a symptom of anorexia nervosa and other associated eating disorders, which further exemplifies the existence of drunkorexia, particularly in college-age individuals.

Another study found that there was little difference between drunkorexia rates among students, non students and former students. [14]

Motivations

The motivations behind drunkorexia as a pattern of behavior is one of the lesser understood aspects of the condition. It is suspected that the predominant factors in the development of drunkorexia are a distorted self-perception congruent with unrealistic standards of body image, peer pressure to assimilate to the norm in terms of social drinking and societal standards of beauty, a coping mechanism against anxiety and depression, and as a means of getting intoxicated rapidly in response to stress and or peer pressure. [3]

Other motivations for drunkorexia include; preventing weight gain, saving money that would be spent on food to buy alcohol, and getting intoxicated faster. [15]

Drunkorexia as a diagnosis

Co-existing, and self-reinforcing starvation and alcohol disorders are gaining recognition in the fields of dual diagnosis, psychiatry, and addictionology. [6]

Related Research Articles

An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's physical or mental health. Types of eating disorders include binge eating disorder, where the patient eats a large amount in a short period of time; anorexia nervosa, where the person has an intense fear of gaining weight and restricts food or overexercises to manage this fear; bulimia nervosa, where individuals eat a large quantity (binging) then try to rid themselves of the food (purging); pica, where the patient eats non-food items; rumination syndrome, where the patient regurgitates undigested or minimally digested food; avoidant/restrictive food intake disorder (ARFID), where people have a reduced or selective food intake due to some psychological reasons; and a group of other specified feeding or eating disorders. Anxiety disorders, depression and substance abuse are common among people with eating disorders. These disorders do not include obesity. People often experience comorbidity between an eating disorder and OCD. It is estimated 20–60% of patients with an ED have a history of OCD.

<span class="mw-page-title-main">Bulimia nervosa</span> Type of eating disorder

Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging or fasting, and excessive concern with body shape and weight. This activity aims to expel the body of calories eaten from the binging phase of the process. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives.

Orthorexia nervosa (ON) is a proposed eating disorder characterized by an excessive preoccupation with eating healthy food. The term was introduced in 1997 by American physician Steven Bratman, M.D. He suggested that some people's dietary restrictions intended to promote health may paradoxically lead to unhealthy consequences, such as social isolation; anxiety; loss of ability to eat in a natural, intuitive manner; reduced interest in the full range of other healthy human activities; and, in rare cases, severe malnutrition or even death.

Appetite is the desire to eat food items, usually due to hunger. Appealing foods can stimulate appetite even when hunger is absent, although appetite can be greatly reduced by satiety. Appetite exists in all higher life-forms, and serves to regulate adequate energy intake to maintain metabolic needs. It is regulated by a close interplay between the digestive tract, adipose tissue and the brain. Appetite has a relationship with every individual's behavior. Appetitive behaviour also known as approach behaviour, and consummatory behaviour, are the only processes that involve energy intake, whereas all other behaviours affect the release of energy. When stressed, appetite levels may increase and result in an increase of food intake. Decreased desire to eat is termed anorexia, while polyphagia is increased eating. Dysregulation of appetite contributes to anorexia nervosa, bulimia nervosa, cachexia, overeating, and binge eating disorder.

Binge eating disorder (BED) is an eating disorder characterized by frequent and recurrent binge eating episodes with associated negative psychological and social problems, but without the compensatory behaviors common to bulimia nervosa, OSFED, or the binge-purge subtype of anorexia nervosa.

Binge eating is a pattern of disordered eating which consists of episodes of uncontrollable eating. It is a common symptom of eating disorders such as binge eating disorder and bulimia nervosa. During such binges, a person rapidly consumes an excessive quantity of food. A diagnosis of binge eating is associated with feelings of loss of control. Binge eating disorder is also linked with being overweight and obesity.

Overeating occurs when an individual consumes more calories in relation to the energy that is expended via physical activity or expelled via excretion, leading to weight gain and often obesity. Overeating is the defining characteristic of binge eating disorder.

A food addiction or eating addiction is any behavioral addiction that is primarily characterized by the compulsive consumption of palatable food items which markedly activate the reward system in humans and other animals despite adverse consequences.

<span class="mw-page-title-main">Sociology of the body</span> Branch of sociology studying the human body

Sociology of the body is a branch of sociology studying the representations and social uses of the human body in modern societies.

Night eating syndrome (NES) is an eating disorder, characterized by a delayed circadian pattern of food intake. Although there is some degree of comorbidity with binge eating disorder, it differs from binge eating in that the amount of food consumed in the night is not necessarily objectively large nor is a loss of control over food intake required. It was originally described by Albert Stunkard in 1955 and is currently included in the other specified feeding or eating disorder category of the DSM-5. Research diagnostic criteria have been proposed and include evening hyperphagia and/or nocturnal awakening and ingestion of food two or more times per week. The person must have awareness of the night eating to differentiate it from the parasomnia sleep-related eating disorder (SRED). Three of five associated symptoms must also be present: lack of appetite in the morning, urges to eat at night, belief that one must eat in order to fall back to sleep at night, depressed mood, and/or difficulty sleeping.

The Eating Attitudes Test, created by David Garner, is a widely used 26-item, standardized self-reported questionnaire of symptoms and concerns characteristic of eating disorders. The EAT is useful in assessing "eating disorder risk" in high school, college and other special risk samples such as athletes. EAT has been extremely effective in screening for anorexia nervosa in many populations.

Purging disorder is an eating disorder characterized by the DSM-5 as self-induced vomiting, or misuse of laxatives, diuretics, or enemas to forcefully evacuate matter from the body. Purging disorder differs from bulimia nervosa (BN) because individuals do not consume a large amount of food before they purge. In current diagnostic systems, purging disorder is a form of other specified feeding or eating disorder. Research indicates that purging disorder, while not rare, is not as commonly found as anorexia nervosa or bulimia nervosa. This syndrome is associated with clinically significant levels of distress, and that it appears to be distinct from bulimia nervosa on measures of hunger and ability to control food intake. Some of the signs of purging disorder are frequent trips to the bathroom directly after a meal, frequent use of laxatives, and obsession over one's appearance and weight. Other signs include swollen cheeks, popped blood vessels in the eyes, and clear teeth which are all signs of excessive vomiting.

The Eating Disorder Diagnostic Scale (EDDS) is a self-report questionnaire that assesses the presence of three eating disorders; anorexia nervosa, bulimia nervosa and binge eating disorder. It was adapted by Stice et al. in 2000 from the validated structured psychiatric interview: The Eating Disorder Examination (EDE) and the eating disorder module of the Structured Clinical Interview for DSM-IV (SCID)16.

<span class="mw-page-title-main">Anorexia nervosa</span> Type of eating disorder

Anorexia nervosa (AN), often referred to simply as anorexia, is an eating disorder characterized by low weight, food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin.

The differential diagnoses of anorexia nervosa (AN) includes various types of medical and psychological conditions, which may be misdiagnosed as AN. In some cases, these conditions may be comorbid with AN because the misdiagnosis of AN is not uncommon. For example, a case of achalasia was misdiagnosed as AN and the patient spent two months confined to a psychiatric hospital. A reason for the differential diagnoses that surround AN arise mainly because, like other disorders, it is primarily, albeit defensively and adaptive for, the individual concerned. Anorexia Nervosa is a psychological disorder characterized by extremely reduced intake of food. People with anorexia nervosa have a low self-image and consider themselves overweight.

The term "Freshman 15" is an expression commonly used in the United States and Canada that refers to an amount of weight gained during a student's first year at college. In Australia and New Zealand, it is sometimes referred to as "First Year Fatties", "Fresher Spread", or "Fresher Five", the latter referring to a five-kilogram gain.

<span class="mw-page-title-main">Eating disorders and memory</span> Memory impairments linked to eating disorders

Many memory impairments exist as a result from or cause of eating disorders. Eating disorders (EDs) are characterized by abnormal and disturbed eating patterns that affect the lives of the individuals who worry about their weight to the extreme. These abnormal eating patterns involve either inadequate or excessive food intake, affecting the individual's physical and mental health.

Cognitive behavioral therapy (CBT) is derived from both the cognitive and behavioral schools of psychology and focuses on the alteration of thoughts and actions with the goal of treating various disorders. The cognitive behavioral treatment of eating disorders emphasizes on the minimization of negative thoughts about body image and the act of eating, and attempts to alter negative and harmful behaviors that are involved in and perpetuate eating disorders. It also encourages the ability to tolerate negative thoughts and feelings as well as the ability to think about food and body perception in a multi-dimensional way. The emphasis is not only placed on altering cognition, but also on tangible practices like making goals and being rewarded for meeting those goals. CBT is a "time-limited and focused approach" which means that it is important for the patients of this type of therapy to have particular issues that they want to address when they begin treatment. CBT has also proven to be one of the most effective treatments for eating disorders.

Other specified feeding or eating disorder (OSFED) is a subclinical DSM-5 category that, along with unspecified feeding or eating disorder (UFED), replaces the category formerly called eating disorder not otherwise specified (EDNOS) in the DSM-IV-TR. It captures feeding disorders and eating disorders of clinical severity that do not meet diagnostic criteria for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), avoidant/restrictive food intake disorder (ARFID), pica, or rumination disorder. OSFED includes five examples:

Body image disturbance (BID) is a common symptom in patients with eating disorders and is characterized by an altered perception of one's own body.

References

  1. ↑ Reimold, Dan (May 29, 2012). "College Word of the Year Contest contenders: Drunkorexia, shmacked and FOMO". The Washington Post. Retrieved 16 November 2012.
  2. ↑ Knight, Alissa (2013-11-14). "Drunkorexia: an empirical investigation of disordered eating in direct response to saving calories for alcohol use amongst Australian female university students". Journal of Eating Disorders. 1 (Suppl 1): P6. doi: 10.1186/2050-2974-1-S1-P6 . PMC   3981584 .
  3. 1 2 3 Osborne, V. A.; Sher, K. J.; Winograd, R. P. (2011). "Disordered eating patterns and alcohol misuse in college students: Evidence for "drunkorexia"?". Comprehensive Psychiatry. 52 (6): e12. doi:10.1016/j.comppsych.2011.04.038.
  4. 1 2 "'Drunkorexia:' A Recipe for Disaster". ScienceDaily. October 17, 2011.
  5. 1 2 Eating Disorders (2014). Eating disorders, drug, and alcohol addiction. Eating Disorders. Retrieved from http://www.eatingdisorders.org.au/eating-disorders/eating-disorders-a-other-health-problems/eating-disorders-drug-a-alcohol-addiction Archived 2015-04-17 at the Wayback Machine
  6. 1 2 3 Chambers, R. A. (2008). "Drunkorexia". Journal of Dual Diagnosis. 4 (4): 414–416. doi:10.1080/15504260802086677. S2CID   216134769.
  7. ↑ Barry PhD, Adam E.; Piazza-Gardner MS, Anna K. (March 2012). "Drunkorexia: Understanding the Co-occurrence of Alcohol Consumption and Eating/Exercise Weight Management Behaviors". Journal of American College Health. 60 (3): 236–43. doi: 10.1080/07448481.2011.587487 . PMID   22420701. S2CID   34405533.
  8. ↑ Recovery Connections (2014). Drunkorexia. Retrieved from http://www.recoveryconnection.org/drunkorexia/ Archived 2015-04-21 at the Wayback Machine
  9. 1 2 Burke, Sloane C.; Cremeens, Jennifer; Vail-Smith, Karen; Woolsey, Conrad (1 August 2010). "Drunkorexia: calorie restriction prior to alcohol consumption among college freshman". Journal of Alcohol & Drug Education. 54 (2): 17–35. OCLC   797979880. Gale   A236247802.
  10. ↑ "National Eating Disorders Association Announces Results of Eating Disorders Poll On College Campuses Across the Nation". National Eating Disorders Association. September 26, 2006. Retrieved 16 November 2012.[ permanent dead link ]
  11. ↑ Blackmore, Natalie P. I.; Gleaves, David H. (August 2013). "Self-Induced Vomiting after Drinking Alcohol". International Journal of Mental Health and Addiction. 11 (4): 453–457. doi:10.1007/s11469-013-9430-9. S2CID   29873600.
  12. ↑ Knight, Alissa; Simpson, Susan (November 2013). "Drunkorexia: an empirical investigation of disordered eating in direct response to saving calories for alcohol use amongst Australian female university students". Journal of Eating Disorders. 1 (S1): P6, 2050–2974–1-S1-P6. doi: 10.1186/2050-2974-1-S1-P6 . S2CID   27924124.
  13. ↑ Barry, Adam E.; Piazza-Gardner, Anna K. (April 2012). "Drunkorexia: Understanding the Co-occurrence of Alcohol Consumption and Eating/Exercise Weight Management Behaviors". Journal of American College Health. 60 (3): 236–243. doi: 10.1080/07448481.2011.587487 . PMID   22420701. S2CID   34405533.
  14. ↑ Simons, Raluca M.; Hansen, Jamie M.; Simons, Jeffrey S.; Hovrud, Lindsey; Hahn, Austin M. (January 2021). "Drunkorexia: Normative behavior or gateway to alcohol and eating pathology?". Addictive Behaviors. 112: 106577. doi:10.1016/j.addbeh.2020.106577. ISSN   0306-4603. PMID   32861988. S2CID   221382307.
  15. ↑ University of Missouri (2011). MU study finds disordered eating and alcohol don't mix. KOMU. Retrieved from http://www.komu.com/news/mu-study-finds-disordered-eating-and-alcohol-don-t-mix/ Archived 2015-04-16 at the Wayback Machine
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