1. History of binge drinking and eating disorders among college students

2. Link between binge drinking and eating disorders

3. Symptoms of drunkorexia

4. Treatment of drunkorexia

5. Effects of drunkorexia

6. Who is at most risk

7. Motivations for drunkorexia

8. Drunkorexia as a diagnosis

9. References

Research on the combination of an eating disorder and binge drinking has primarily focused on the patterns of college-aged women, but the phenomenon has also been noted among young men. Studies show that college students engage in this combination of self-imposed malnutrition and binge drinking to avoid weight gain from alcohol.^[3] A study by the University of Missouri found that 30% of female college students admitted that within the last year they had restricted food in order to consume greater quantities of alcohol. The same study found that men are more likely engage in similar behavior in order to save money for purchasing alcohol. According to the study, 67% of students who restrict calories prior to alcoholic beverage consumption do so to prevent weight gain, while 21% did so to facilitate alcohol intoxication.^[4]

According to the Eating Disorder Center of Denver, of the participating college-aged females in an adjunct research study, about 75% met the criteria for alcohol abuse.^[5]

'Showbuzz', a CBS news site, has broadcast that, "Drunkorexia is a media coined term reflecting an alarmingly real trend among young women. The non-medical slang term refers to women who choose to eat less so they can party without gaining weight." ^[6]

R. Andrew Chambers, MD, Assistant Professor, Institute of Psychiatric Research and Director, Laboratory for Translational Neuroscience of Dual Diagnosis Disorders notes that many celebrity blog sites report similar patterns of behavior among young actresses such as Lindsay Lohan and Paris Hilton, and that the condition could be mimicked within the entertainment industry and contemporary youth culture at large.^[6]

History of binge drinking and eating disorders among college students

A 2002 study from O'Malley and Johnston reviewed data from the national College Alcohol Study, the Core Institute, Monitoring the Future, and the National College Health Risk Behavior Survey affirming that 70% of participating college students reported consuming alcohol within the prior month and 40% had engaged in binge drinking.^[7] First-year college students have been identified as uniquely predisposed to binge drinking.^[7]

According to disclosure from the National Eating Disorder Association in 2006, approximately 20% of college students, both male and female, admitted to suffering from an eating disorder at some point in their life. Clinical eating disorders encompass binge eating, chronic dieting, fasting or purging and the use of laxatives to control weight.^[8] Furthermore, first-year college students are predisposed to eating disorders as an attempt to avoid the fabled "Freshman 15", weight gain that results from adjusting to a college lifestyle.

A study was conducted in 2010 at a Southeastern University, using 692 freshmen. This study examined caloric restriction among students prior to planned alcohol consumption. These results indicated that 99 of 695 (14%) of first year students reported restricting calories prior to drinking. 6% reported this behaviour to avoid weight gain.^[9]

A 2001 CASA report estimated that 30-50% of individuals with bulimia and 12-18% of individuals with anorexia had previously abused or were currently dependent on alcohol. 35% of those with alcohol or drug dependency reported a concurrent eating disorder. Results demonstrated a clear correlation between individual histories of eating disorders and binge drinking and/or alcohol dependence.^[7]

A survey was conducted in 2013, using 107 female university students, to study the frequency and correlates of self-induced vomiting after consuming alcohol. The 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.^[10]

In an Australian context, a study was undertaken in 2013 that surveyed 139 Australian women, aged between 18 and 29, who were enrolled in an undergraduate degree at university. These women were asked to complete a survey regarding compensatory eating and behaviours in response to alcohol consumption to test for drunkorexia symptomatology. In the sample tested, 79% of participants demonstrated engaging in characterised drunkorexia behaviour. Further analysis of the results showed that social norms of drinking and the social norms associated with body image and thinness impacted heavily upon the motivation for these behaviours.^[11]

Another study undertaken in 2012 showed that there exists a further correlation between college students who are very physically active and alcohol dependence. 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. The study showed that those individuals who were more physically active than their peers had a higher tendency to be alcohol dependent or to engage in regular binge drinking.^[12]

The National Association of Anorexia Nervosa and Associated Disorders reports that 72% of women who admit to alcohol abuse also classify as suffering from an eating disorder.^[5]

Link between binge drinking and eating disorders

There appears to be a link between eating disorders and substance abuse, with studies revealing people experiencing an eating disorder are at a higher risk of developing substance abuse problems.^[13]

According to the National Institutes of Health, 1 in 6 people in the US have a drinking problem and approximately 10 million Americans are believed to suffer from potentially life-threatening eating disorders.^[14]

Furthermore, those who suffer from drunkorexia, have a greater likelihood of developing a more serious eating disorder.

A previous report published in the American journal Biological Psychiatry found that up to one third of bulimics struggle with alcohol or drug abuse.

A report in the U.S examining the relationship between eating disorders and substance abuse revealed that anorexia and bulimia are the eating disorders most commonly linked to substance abuse, and up to half of the people with eating disorders abuse alcohol or illicit drugs.^[13]

• Occur in times of transition or stress.
• Common brain chemistry and family history.
• Low self-esteem, depression, anxiety and impulsivity.
• History of sexual or physical abuse.
• Unhealthy parental behaviours and low monitoring of children's activities.
• Unhealthy peer norms and social pressures.
• Susceptibility to messages from advertising and entertainment media.

Symptoms of drunkorexia

Drunkorexia consists of three major aspects: alcohol use/abuse, food intake restriction, and excessive physical activity.^[15] It is commonly summarised in the following activities:

• Counting daily calorie intake (commonly known as "calorie counting") to ensure no weight will be gained when consuming alcohol.
• Missing or skipping meals to conserve calories for consumption of alcoholic beverages.
• Over exercising to counterweigh for calories consumed from alcoholic beverages.
• Consuming an extreme amount of alcohol to vomit previously digested food.^[6]

Treatment of drunkorexia

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 will need to address both.^[16]

Effects of drunkorexia

The combination of self-starvation and alcohol abuse can lead to an array of physical and psychological consequences. For example, 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 at a swifter pace and raises one's blood alcohol content with an often dangerous speed. This can render the drinker more vulnerable to alcohol-related brain damage. In addition, alcohol abuse can have a detrimental impact on hydration and the body's retention of minerals and nutrients, further exacerbating the consequences of malnutrition and denigrating an individual's cognitive faculties. This can ultimately have a negative impact on academic performance.

These harmful consequences can be more easily induced in women, as women are oftentimes less capable of metabolizing alcohol than men.^[4] On CBS News, Carrie Wilkins, PhD, of the Center for Motivation and Change describes how women are more vulnerable to particular toxic side effects of alcohol consumption.^[17]

Drunkorexia can lead to short term and long term cognitive problems including difficulty concentrating and difficulty making decisions. It also increases the risk of developing more serious eating disorders or alcohol abuse problems. As binge drinking is involved there is a greater risk for violence, risky sexual behavior, alcohol poisoning, substance abuse and chronic disease later in life.

Who is at most risk

Drunkorexia is found to be most common among university students who are faced with the conflicting pressure of heavy drinking and maintaining a slim physique.

Researchers from the University of Missouri who questioned college students found that 16% of those surveyed reported restricting calories to save them for drinking. This practice of restricting calories for drinking was found to be three times more common in women than men.^[18]

Motivations for drunkorexia

The motivations behind drunkorexia as a pattern of behaviour 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, as a coping mechanism for anxiety and depression and as a means of getting intoxicated rapidly in response to stress and or peer pressure.^[19]

A study undertaken in 1983 sought to investigate if individuals who regularly participated in binge drinking, or were alcohol dependent, had a more distorted self perception than those individuals who were not abusing alcohol. The study measured the relative rate of body image distortion by asking participants in both a control, non-alcoholic abusive group and a group of alcohol dependent individuals to estimate the length and width of 22 different body parts, including the shoulders, arms, chest etc. The results showed that those individuals who were alcohol abusers saw their body parts as much larger than they actually were, indicating a distorted perception of self.^[20] The results from this study indicate that there may be a link between those who are predispositioned to engage in alcohol dependant or binge drinking behavior and a distorted perception of self which would help psychiatrists and clinical practitioners establish an at risk population and further would aid in better understanding and treating drunkorexia.

Other motivations for drunkorexia include; preventing weight gain, saving money that would be spent on food to buy alcohol, and getting intoxicated faster which also saves money as they won't need to buy as many drinks.^[21]

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]

References

• 1986 Alpine Skiing World Cup – Men's Downhill
• 1986 Alpine Skiing World Cup – Men's Super G
• 1986 american music awards
• 1986 American Racing Series season
• 1986 Amnesty
• 1986 amnesty
• 1986 Amstel Gold Race
• 1986 Asia Cup
• 1986 Asian Club Championship
• 1986 Asian Games
• 1986 Asian Winter Games
• 1986 Atlanta Braves season
• 1986 atlanta falcons
• 1986 Atlanta Falcons season
• 1986 atlanta falcons season
• 1986 Australian 2.0 Litre Touring Car Championship
• 1986 Australian Drivers' Championship
• 1986 Baden-Württemberg Grand Prix
• 1986 Baden-Württemberg motorcycle Grand Prix
• 1986 Baltimore Orioles season
• 1986 Bangladeshi general election
• 1986 Barbadian general election
• 1986 Bathurst 1000
• 1986 BDO World Darts Championship
• 1986 Belfast East by-election