Drunkorexia: When Drinking Meets Diet Culture

Nobody questions social drinking, and almost nobody tells you not to. In the same way, people seldom raise an eyebrow at diet culture.

“It’s what you do,” Meg Fee, who started a sobriety blog called You Don’t Have To Drink Today after noticing unhealthy drinking patterns in her social life, told Verywell. These patterns began in college and contributed to an eating disorder, she said.

Worried about gaining weight from alcohol and obsessed with fending off the “Freshman 15,” Fee initially restricted calories before fraternity parties, “saving them” for alcohol. But she let herself lose control of her appetite late at night, under the influence.

“Before a drink, I would say, ‘No, I can’t eat that,’” Fee said. “But then I’d have a drink, have two drinks, and feel just a little more free about eating that pizza.”

At times, Fee would wake beside crumbs of foods she didn’t remember eating, and engage in rituals like vomiting or over-exercising to compensate for her intake the next day. As this cycle began to consume her, no one asked Fee about her drinking habits, professionals included, and no one suggested that her eating and drinking struggles were intertwined. So it continued.

“College turned into my 20s, and that turned into working in Manhattan, client dinners, holiday parties, happy hours, and Thirsty Thursdays,” Fee said. “I drank my way through my 20s without noticing how messed up my relationship was with food.”

According to organizations like Center for Discovery Eating Disorder Treatment, the overlap of eating and drinking problems Fee experienced is often colloquially called “drunkorexia.” While it’s not officially recognized as an eating disorder or alcohol use disorder by the DSM-5 and should not be used clinically, the term refers to a combination of anorexia and alcohol use disorder, where people replace meals with alcohol.

But it’s not always about “saving” calories for alcohol. Lindsey Hall, who runs an eating disorder recovery blog and Instagram account, previously used alcohol as a way to numb hunger cues. Her struggle with disordered eating began as a teenager and collided with alcohol misuse in her early 20s.

“Instead of eating appetizers, I would just drink two glasses of wine so that I could get tipsy enough to not care about the food and not be present,” Hall told Verywell.

When Eating Disorders and Alcohol Mix

It’s common for people with drunkorexia to be deceived by the idea that alcohol can replace calories from food, Ashlee Knight, LMHC, a mental health counselor who works with the national eating disorder prevention organization Project Heal, told Verywell. But the math doesn’t add up.

“What we know is that the calories we get from food are nutrient dense; they provide the minerals and vitamins we need to keep our bodies functioning,” Knight said. “There’s nothing nutrient-dense about alcohol. It’s actually poison.”

Binging or over-indulging in sweets or greasy foods only while under the influence of alcohol is another common trait of drunkorexia, Knight said. This happens because many people set food rules for themselves as a part of their disorder, which dictate what they should or shouldn’t eat. Depending on the person and their relationship with alcohol, some of these rules may change when inhibitions dull.

“If it’s the drinking and the hangover that are needing the food versus the person, that can feel more permissible,” Knight said, explaining the logic.

How to Recognize Drunkorexia

Based on own experience and drawing from others, Hall offered tips for how someone might notice if they or a loved one is struggling with drunkorexia. Some questions to ask yourself include:

1. Am I eating less food? Or am I replacing food with mimosas, wine, Bloody Marys, etc., at a mealtime like brunch?
2. Am I avoiding eating with a glass of wine?
3. Are my friends engaging in this with me? 
4. How often do I refer to alcohol as a “liquid diet” before going out?
5. Do I cut out food to drink so that I’ll feel better in an outfit?
6. Do I binge eat often after consuming alcohol?
7. Have I blacked out multiple times due to lack of eating before drinking?
   

Why Recovery Is So Challenging

Recovering from an eating disorder and/or alcohol use disorder confers benefits like a clear mind, healthy body, and healthy mindset toward food. But that doesn’t mean pursuing these things is quick or easy. For drunkorexia in particular, Knight said media messages too often normalize the disorder and keep people stuck.

“If you look culturally at the way that alcohol is promoted—the way that it is so easy to think you should be drinking, and that there’s almost something wrong with you if you’re not—it’s similar to the way diet culture promoters the ‘thin ideal’ and the need to maintain a certain body image,” she said.

Hall said her roommates had similarly problematic relationships with drinking and dieting, which made cycles harder to break. She recalls a sign hanging in her college apartment that read, “There's nothing better than being tan, drunk, and toned,” and referring to happy hours as “liquid dinners.”

“We would joke about it so openly!” Hall said. “Looking back, at least two or three of us had pretty severe disordered eating. And I had a full-on eating disorder, but they didn’t know that back then.”

How Does Recovery Start?

Some people choose to pursue sobriety as a first step to in order to heal from drunkorexia. Others focus on eating disorder recovery along with sobriety, or don’t pursue sobriety at all.

The choice may be influenced by which disorder developed first, which varies from person to person.

“This is where it gets really tricky: What comes first? The eating disorder or the substance use disorder?” Knight said. “I don’t think it’s usually that clear-cut.”

Knight works with patients from a harm reduction approach, helping them decide how they want to adjust their relationship with food and alcohol. This allows people the ability and the dignity to carve out their own journey, which looks different for each person, she said.

Sobriety on a Spectrum

Fee pursued total sobriety as a first step to tackling drunkorexia, and she blogs about the benefits of a dry lifestyle. But not everyone wants or needs to cut out alcohol forever.

Hall has found that drinking mindfully and minimally is appropriate for her lifestyle, for now. Whether or not she will pursue complete sobriety in the future is something that she thinks hard about and is open to, she added.

“I’m still in this journey where, most likely, I want to quit completely, but I’m still getting there,” Hall said.

For now, she is mindful of her limits and sets boundaries around alcohol, like not drinking on an empty stomach.

Go Easy, Be Brave

Whether pursuing sobriety or mindful drinking, healing from drunkorexia can be journey. Hall’s journey involved going to an eating disorder treatment center, where she was also put on an alcohol track for extra support.

“It’s so socially normal, it’s damn near impossible to change it on your own,” she said.

Others may not be ready or able to go away for care, and they may not have to. Just voicing feelings or fears to a trusted ear is a commendable first step in recovery, Knight said.

“Part of what perpetuates unwanted behaviors is feeling like you have to do it on your own, but we’re not meant to do things on all our own,” she said. “The courage it takes to step back and say out loud, ‘this isn’t working for me,’ is huge. That’s such a brave thing to do.”