The sad reasons college students develop ‘drunkorexia’

When I was in college, a typical Saturday night drinking session involved some combination of shots, mixed drinks, jungle juice, beer, and possibly watermelon soaked in grain alcohol. Which is why a typical Sunday involved running between four and six miles through the hilly streets of New Haven. Regardless of how crappy we felt after drinking more than any sane person should, week after week, my best friend and I would put our dehydrated bodies through hell because we were terrified of gaining weight.

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We weren’t the only ones trying to sweat out calories from booze. I regularly saw girls sprinting on the treadmill at midnight, their second workout of the day, to make up for partying. Or skipping meals to save room for drinks. If the lack of food plus binge drinking led to barfing, the running joke was, “At least you got rid of the calories.”

There wasn’t a special name for these behaviors when I was in school, but today, nutrition and exercise experts say they are symptomatic of a condition called “drunkorexia.” And according to a new study published in the journal Eating Behaviors, the motivations for engaging in these behaviors extend beyond simply caring about calories.

Never heard of drunkorexia? The term first entered the vernacular back in 2008, when The New York Times profiled the disorder. A few years later, in 2012, a major academic study claimed the term “newly coined”—and since then, several more studies have been conducted and published on the phenomenon.

Across the research, drunkorexia is defined by behaviors that include skipping meals in order to “save” calories on days and nights when drinking is expected, excessive exercising to compensate for calories consumed from drinking, and drinking so much alcohol that one becomes sick and can purge the previously consumed food and drink.

While drunkorexia isn’t limited to college students, given the binge drinking that occurs on college campuses, much of the research has focused on the way it manifests within this demographic.

And indeed, perhaps not shocking to anyone who went to a party school (or any school), these behaviors are not uncommon on college campuses. Recent studies have found that up to nearly 40% of college students use drunkorexic tactics to maintain their weight, according to self-reported data.

It’s tough to say whether drunkorexic behaviors are becoming more prevalent or whether they’re simply just now garnering the attention of researchers—but either way, they have experts concerned. Among them is Rose Marie Ward, a professor in the department of kinesiology and health at Miami University in Ohio. While previous studies had explored who is most likely to show signs of drunkorexia, Ward and her team wanted to know more about students’ motivations behind this behavior. Her new study reveals some sad but interesting findings.

For the study, researchers recruited 349 college students to answer a series of questions about alcohol consumption, motivations for drinking, eating attitudes, and other alcohol-related behaviors. For example, participants were prompted with questions like this:

Consider this scenario: It is a typical Saturday during the school year. You know that you are going to a party tonight and that you will be drinking. Which of the following best describes how you would most likely eat that day?

On average, the students reported consuming four drinks per drinking occasion, and 6.31 drinks on “peak” drinking occasions. Bearing in mind that there are roughly 200 calories in a vodka-cranberry cocktail—one of the lowest calorie drinks—this means that some students are consuming 1,200 calories in booze per sitting.

That math appears to weigh on students’ minds. The study found that 10% of the participants reported that they would eat less than normal if they planned to drink that night, 13.8% reported restricting fat intake if they planned to drink, and 13.5% said they restricted calories. After looking at the results as a whole, Ward concluded that “Most of the participants reported some type of drunkorexia behavior.”

But why? Here are the top reasons students said they restricted food in relation to drinking, in descending order:

  • Pressure from friends to restrict eating or calories
  • It allowed them to enjoy a party more
  • It made the gathering more fun
  • It allowed them to drink without feeling left out
  • To fit in
  • So they could feel the affects of alcohol more
  • Because their friends were doing it

While weight was certainly a factor, social pressure played a larger role than Ward was anticipating. “Students seemed to be motivated to embrace drunkorexia due to peer pressure or conformity and social reasons,” she told me over email.

Ward also pointed out that these behaviors did not solely occur before drinking. “Students are reporting a variety of strategies before, during, and after alcohol consumption to deal with the calories,” she said.

For example, if students failed to restrict their food and found themselves in a situation in which people were drinking, they might drink less or, say, avoid high-calorie beer—or they might drink more to cope with the anxiety of excess calorie consumption. Many participants also reported making themselves throw up after drinking.

Ward found that the top ways in which students compensated for a night of drinking after the fact were to work out more the next day, restrict eating the next day, or make themselves vomit.

While cutting back on calories or exercising a little more to compensate for excess drinking now and then isn’t inherently dangerous, if these behaviors are exhibited over extended periods of time, drunkorexia can lead to serious health consequences.

One major risk of drunkorexia is that it “exacerbates the negative psychological, behavioral, and physiological effects of alcohol,” according to research from George Washington University. In other words, major alcohol consumption can already be dangerous—adding on disordered behaviors only worsens the potential repercussions.

Not to mention drinking on an empty stomach in general is associated with health risks including quicker intoxication, a higher likelihood of overdose, increased pressure on the liver, and risky behaviors. “Students who embrace these behaviors experience more negative alcohol-related consequences like blackouts and injuries,” Ward explained.

And while, in a general nutritional sense, counting calories is sometimes recommended to avoid gaining weight, the game changes when one restricts food in order to drink booze—because alcohol has very few nutrients your body actually needs. Skipping food calories for booze calories can actually lead to malnutrition.

Currently, drunkorexia is not considered an official medical disorder. However, given all of these factors, Ward concludes in her study by recommending that drunkorexia be viewed “as a phenomenon apart from alcohol consumption or disordered eating behaviors alone.” It’s not always indicative of a more serious eating disorder, she says—it’s its own beast entirely, and she advises that clinicians and health professionals treat it that way.

This advice has been echoed in previous studies. For example, research published last year in the Journal of American College Health suggested that “University officials may have much to gain by recognizing the conflicting pressures to get drunk and stay thin that college [students] face. Tailoring information and activities to address these pressures could help students reconcile these two norms safely, such as focusing on healthy eating (especially before drinking) along with drinking in moderation.”

That same study suggests that college campuses should begin identifying high-risk students such as sorority members, athletes, and college freshmen, as well as focusing on improving self-esteem and body image among its students.