Alcohol and Eating Disorders
Alcohol and eating disorders often go together. The frequency at which eating disorders and alcohol use disorders co-occur is extremely high.
The Relationship Between Alcohol and Eating Disorders
There is a close link between alcohol and eating disorders. Alcohol is commonly presumed to disinhibit food consumption, i.e. cause individuals to consume larger amounts of food; however, this is not always the case, especially in those with dual diagnosis.
Research has shown that alcohol use disorders frequently co-occur with eating disorders, as alcohol is often used as for emotional regulation or as a part of impulsive behavior in those suffering from unhealthy eating conditions. Patterns of co-occurrence vary based on eating disorder subtypes, of which the American Psychiatric Association formally identifies four: anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified.
Eating disorders most frequently develop during adolescence or early adulthood but can occur much later into adulthood as well. Individuals with eating disorders and alcohol use disorders often exhibit the same self-destructive personality profile, which is characterized by anxious, perfectionist traits and impulsive, dramatic dispositions. These qualities suggest that individuals with eating disorders often turn to alcohol use/abuse as a way of coping with everyday problems and stress caused by their eating disorder. Eating disorders are often categorized as addictive disorders and the majority of those that suffer from one have an addictive personality. Addictive personalities are predisposed to both eating disorders and alcohol abuse, increasing the likelihood that the two co-occur.
Research has shown that eating disorder patients who abuse substances demonstrate worse symptoms and poorer outcomes than those with eating disorders alone, including: increased general medical complications and psychiatric conditions, longer recovery times, poorer functional outcomes, and higher relapse rates.
Anorexia Nervosa and Alcohol Use Disorder
Anorexia nervosa is characterized by a refusal to maintain a healthy body weight for height and age, an intense fear of becoming fat, and malnutrition. Anorexia is divided into two subtypes: a restricting type that is characterized by strict, extreme dieting and a binge eating/purging type that is marked by episodes of self-induced binge eating and/or purging by means of vomiting or diuretics. People that suffer from anorexia have a severely distorted body image, in which they see themselves as overweight despite being excessively thin and will often deny the seriousness of their unhealthy weight. Anorexia affects people of all ages, although the typical age group for onset anorexia ranges from 14 to 18 years of age. The disorder occurs disproportionately in women and has a high relapse rate. In severe cases, medical complications or even death due to starvation can occur.
Warning Signs and Symptoms of Anorexia Nervosa:
- Dramatic weight loss
- Preoccupation with weight, food, calories, fat grams, and dieting
- Frequent commenting about being “fat” or overweight despite weight loss
- Has a strong need for control
- Consistent excuses to avoid mealtimes or situations involving food
- Withdrawing from usual friends and activities
- Isolation and secretiveness
While anorexia has lower rates of co-occurring substance abuse compared to bulimia and binge eating disorder, most individuals suffering from both anorexia and an alcohol use disorder utilize alcohol to suppress their appetites. Drinking on an empty stomach is particularly dangerous as it increases the risk of alcohol poisoning, memory loss, and alcohol-related injuries.
Bulimia Nervosa and Alcohol Use Disorder
Bulimia nervosa is an eating disorder characterized by recurrent episodes of binge eating (consuming large amounts of food in a small period of time plus a sense of lack of control while eating), and then purging to counteract the effects of binge eating. People that suffer from bulimia routinely use extreme methods of weight control in effort to compensate for binging, including:
- Abuse of laxatives, diet pills, or diuretics
- Severe dieting or fasting
- Vigorous exercise
In order to be diagnosed with bulimia nervosa, an individual has to have had engaged in both binging and inappropriate purging at least twice a week for the past 3 months. Those with bulimia and an alcohol use disorder frequently binge both food and alcohol, and then purge both as well. Binge drinking is a dangerous act where the drinker consumes excess amounts of alcohol in a short period of time. Adolescent bulimics that also abuse alcohol have an increased likelihood to participate in high-risk behaviors such as attempted suicide, theft, and unprotected sex.
Binge Eating Disorder and Alcohol Use Disorder
Formally categorized as an example of eating disorder not otherwise specified until recent years, binge eating disorder is characterized by recurrent episodes of binge eating without the compensatory weight control methods that are utilized in conjunction with bulimia nervosa. Binge eaters often experience a feeling of loss of control while binging and then extreme shame or guilt after a binge. To be diagnosed with binge eating disorder, an individual must binge eat an average of 2 days per week over a 6-month period.
Unlike anorexia and bulimia, binge eating disorder is not uncommon in males and is most frequently seen in adults. Binge eating disorder presents an increased risk for obesity and general medical complications that accompany being overweight. Like those with bulimia, individuals suffering from binge eating disorder often binge both food and alcohol; however, they do not purge the alcohol after like bulimics do. Because many with binge eating disorder are overweight, they must also consume larger amounts of alcohol to feel its effects, increasing alcohol-related health risks such as cirrhosis and other liver diseases.
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“Drunkorexia” is a slang term used to describe the unhealthy phenomenon of restricting an individual’s diet to little or nothing so that he or she may engage in binge-drinking without weight gain. The calories that “drunkorexics” deprive themselves of by means of starvation is to compensate for the calories that they consume from alcohol. Because alcohol has no nutritional value, people with this condition can easily become malnourished while additionally suffer from all of the health and social risks associated with alcoholism.
Drunkorexia is most prevalent among college-age females, although men and older ages of both genders have also been known to develop the disorder. Many researchers attribute this demographic to the cultural prevalence of drinking, peer pressure, and the fear of gaining the “freshman 15” that girls encounter during college. Initially, it may not be evident that someone is suffering from drunkorexia as they don’t lose a great deal of weight at first; however, when practiced for extended periods of time, it can become a serious issue.
Eating Disorders, Alcoholism, and Other Psychiatric Disorders
Alcohol use disorders and eating disorders also often co-occur in the presence of other psychiatric disorders. Some controlled studies have even revealed that some of the apparent co-occurrence between eating disorders and substance use disorders is caused by other psychiatric conditions. Research has found that patients who suffer from both disorders may have deficits in impulse control, which is also closely linked to personality disorders such as Obsessive-Compulsive Disorder and Borderline Personality Disorder. Common factors such as child abuse, sexual abuse, and family dysfunction are all seen as catalysts for co-occurring eating, substance use, and psychiatric disorders.
Treatment for Addiction to Alcohol and Eating Disorders
Multiple studies have found that during treatment, co-occurring eating disorders and alcohol use disorders should be addressed simultaneously using a multi-disciplinary approach. Cognitive behavioral therapy and dialectical behavioral therapy are considered to be the most promising approaches for treatment of the disorders.
Dialectal behavioral therapy includes:
- Focus on awareness of problems and choices
- Mood regulation techniques
- Coping skills
- Impulse control practices
Some opioids, such as naltrexone, have also proved to be useful in treating both alcohol and eating disorders. In addition to therapy, dietary education and planning should be addressed in conjunction with alcohol addiction as it is crucial for eating disorder recovery. Depending on the severity of the co-occurring disorders, medical stabilization, hospitalization, or inpatient treatment may be necessary.
Clinical Reviewer — Last Reveiwed: April 19, 2019
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Grilo, M. Carlos; Sinha, Rajita; O’Malley, Stephanie S. (2005). Eating Disorders and Alcohol Use Disorders. Retrieved on 9thOctober 2018 from https://pubs.niaaa.nih.gov/publications/arh26-2/151-160.htm.
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