New concern on college campuses: ‘drunkorexia,’ a combination drinking and eating disorder

My college experience included this life-skills lesson: Drink alcohol on a full stomach, so you don’t get inebriated too quickly. Of course, most college students shouldn’t be drinking at all, but we know from the National Institute on Alcohol Abuse and Alcoholism that close to 60 percent of college students ages 18 to 22 do consume alcohol, which makes harm-reducing approaches important.

Unfortunately, campus authorities and researchers are reporting a practice that turns the full-stomach drinking strategy on its head: Rather than filling up before a night of partying, significant numbers of students refuse to eat all day before consuming alcohol.

This is a high-risk behavior colloquially called “drunkorexia,” which is one part eating disorder, one part alcoholism – a very dangerous combination for college-age students. The term drunkorexia, which can also include excessive exercise or purging before consuming alcohol, was coined about 10 years ago, and it started showing up in medical research around 2012. Drunkorexia addresses the need to be the life of the party while staying extremely thin, pointing to a flawed mind-set about body image and alcoholism among college students, mostly women.

Imagine this scenario: A female college freshman doesn’t eat anything all day, exercises on an empty stomach, then downs five shots of tequila in less than two hours. Because there’s no food in her system to help slow the absorption of alcohol, those shots affect her rapidly, leading to inebriation and possibly passing out, vomiting or suffering alcohol poisoning. That’s drunkorexia.

Tavis Glassman, professor of health education and public health at University of Toledo in Ohio, researches drunkorexia and worries about scenarios such as the one described above: “With nothing in her system, alcohol hits quickly, and that brings up the same issues as with any high-risk drinking: getting home safely, sexual assault, unintentional injury, fights, blackouts, hangovers that affect class attendance and grades, and possibly ending up in emergency because the alcohol hits so hard,” he says.

From a medical point of view, Seattle-based registered dietitian Ginger Hultin points out that if alcohol is prioritized over food, it could result in nutrient deficiencies such as calcium, B-vitamins, magnesium, fiber and protein.

“Alcohol can negatively affect the liver or gastrointestinal system, it can interfere with sleep, lower the immune system and is linked to several types of cancers,” Hultin says.

With all of the noted harms, why would a promising college freshman choose this unhealthy pattern? Well, likely it’s not a choice, but mental health and addiction issues mixed together. Studies show that having a preexisting eating disorder or alcoholism are predictors of drunkorexia.

There are no national statistics on the prevalence of campus drunkorexia, and surveys from colleges range widely: One report concluded that 34 percent of all students surveyed had engaged in this behavior; another said 81 percent of students who drink heavily had done so. What experts and researchers do agree on is the seriousness of the practice. “As soon as this behavior is identified, it could actually be considered a problem,” Hultin says. There’s no safe level of starvation paired with binge drinking.

Glassman and his colleagues are seeking to have drunkorexia – or a more aptly named ‘alcoholimia’ – added as an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, as a subcategory of Other Specified Feeding and Eating Disorders. They hope for guidelines to help practitioners identify the condition in people who engage in high risk drinking; are very concerned with their body shape; and engage in either laxative use, vomiting, weight control stimulants, meal skipping, food restriction or excessive exercise.

Adding drunkorexia to the DSM would increase the likelihood that a person with this condition can receive insurance coverage for treatment. That’s an important consideration, since treatment may include a costly team approach, including dietitians, psychologists and medical doctors who are able to care for the “dual diagnosis” – a medical term for a practice that treats people who suffer from both an addiction and a psychiatric disorder.

At the University of Toledo, Glassman and his team are trying to prevent drunkorexia with body image education and are raising awareness about the harms of body shaming.

“We try to emphasize that the human body comes in different shapes and sizes, and remind students that when they look at the media, with computer enhancement and airbrushing, even the model may not really look like a model,” Glassman says. “We remind students to value people based on things besides their appearance.”

Their campaign focuses on health factors, by reminding students that they only have one body, and it’s time to take care of it instead of abusing, hating or shaming it. “Some students perceive drunkorexia to be harmless when in fact the behavior is extremely dangerous,” Glassman says. “Once they recognize that it’s unhealthy, a lot of students make the decision to change their behavior and get help as necessary.”

Hultin says parents, educators, school counselors and medical professionals can help identify drunkorexia in students, and adds that “if students see friends engaging in this type of behavior, they can intervene and encourage different choices or offer support or resources to address a potential problematic relationship with alcohol and/or food.” Help is always available. An on-campus medical or counseling center is a good place to start.