Problematic Labelling: The Case of “Drunkorexia”

Recently, I was browsing the Twittersphere and came across (yet another) tweet about so-called “drunkorexia,” or the phenomenon of drinking to excess coupled with restrictive behaviours around food. After firing off a mildly miffed tweet bemoaning our societal tendency to add the suffix “orexia” to all “new” potentially problematic behaviours around food, I took to Scholar’s Portal to see if academics, too, were using this term. I wondered if “drunkorexia” was piquing scholarly interest, or just circulating in media headlines.

Beyond its problematic moniker, coupling problem drinking and restrictive eating is a phenomenon that might be worth delving into in greater detail, particularly if, as the reports claim, its incidence is rising. Barry & Piazza-Gardner (2012) explored the co-occurrence of weight maintenance behaviours and alcohol consumption, and their article clarifies what people mean when they say “drunkorexia.” I’ll get more into my issues with this terminology following a brief overview of the authors’ study.

Alcohol and “Weight Management” Behaviours

Barry & Piazza-Gardner begin their article with reference to an interesting trend observed by those studying problem drinking in college students: “the incongruous alcohol-activity association” (Musselman & Rutledge, 2010).

Essentially, researchers have revealed that drinkers may in fact be more active than non-drinking peers; some even go so far as to suggest that as drinking increases, so too does physical activity, in a dose-response relationship (Piazza-Gardner & Barry, 2012). The “why” of this relationship is left unexplained, and the authors argue that studying the weight-management behaviours of drinkers may help to understand these links.

What Do People Mean When They Say “drunkorexia”?

Try as I might, I can’t seem to find a way to write this article without using the term that irks me. Importantly, “drunkorexia” is not a diagnosis. It is not even well-represented in the scientific literature; the authors acknowledge the colloquial nature of the term. With this in mind, the term could be used in a number of different ways. When they say “drunkorexia,” Barry & Piazza-Gardner are referring to engagement in one or more of the following:

• “Saving” or compensating for calories consumed in the form of alcoholic drinks by skipping meals
• Engaging in excessive exercise as a compensatory mechanism for calories consumed in the form of alcoholic drinks
• Drinking alcoholic beverages in excess in order to facilitate purging

They suggest, using these guidelines, that “drunkorexia” is comprised of the use/abuse of alcohol, disordered eating, and physical activity.

Disordered Eating and Alcohol Use

Despite claims to the “novelty” of this phenomenon, disordered eating and alcohol consumption have long been associated. For example, the documented incidence of comorbidity between bulimia nervosa and substance abuse/dependence averages at 22.9% (Holderness, Brooks-Gunn, Warren, 1994), with lower rates of comorbidity for anorexia nervosa (particularly restricting subtype; Bulik et al., 2004).

However, as the authors suggest, prior research examining the relationship between alcohol use and physical activity has largely left disordered eating out of the equation. Accordingly, they sought to examine whether drinking behaviours can be predicted by physical activity and disordered eating, and whether there are social and environmental factors that may mediate the “incongruous alcohol-activity association.”

Why College Students?

The authors used a sample of college students to study these behaviours, because:

• Young adults 18-24 are among the highest consumers of alcohol
• This age group is generally more physically active than older adults
• There is a relatively high prevalence of disordered eating (clinical and sub-clinical) in this age group

To ascertain the links between weight management behaviours and drinking, the researchers used data from a large school study assessing college student health, the American College Health Association’s National College Health Assessment (ACHA-NCHA). The study from 2008 surveyed 40 U.S. campuses with varied demographics.

The authors used responses on items related to:

• Alcohol use: (1 item) assessed students’ drinking behaviours; those who reported binge-drinking one or more times over a week’s period were classified as “binge drinkers”
• Physical activity: (3 items) looked at students’ levels of moderate, vigorous, and strength-training activities
• Disordered eating behaviours: (4 items) examined dieting behaviour, vomiting/laxative use, diet pill use, and exercise with a weight-loss goal

The authors also took the following sociodemographic factors into account: gender, age, racial background and ethnicity, membership in fraternity/sorority, and place of residence.

The responses to the above items from 22,488 students were included in final statistical analysis.

SUMMARY OF MAIN FINDINGS

Overall, the researchers found some support for the idea that students who are highly active are relatively more likely to drink heavily (vs. non-active peers), supporting the “incongruous activity-alcohol association.”

Importantly, when taking into account the above-mentioned sociodemographic characteristics of the sample (i.e., holding these constant), both engagement in vigorous physical activity and disordered eating were predictive of binge drinking.

As the authors point out, we are still unable to fully explain the “why” using this kind of secondary data analysis; future studies might delve deeper into these connections to explore the motivations behind engagement in physical activity and disordered eating behaviours for individuals who binge drink.

Among disordered eating behaviours, vomiting, laxative and diet pill use were particularly likely to predict binge drinking. I think there might be a lot more to this link than the authors are able to claim based on their data and analysis techniques; once again, it would be interesting to explore causal mechanisms behind this link.

So, If Links Exist, Why Contest the Use of the Term “drunkorexia”?

I’d like to answer this question with several more questions…

1. Are the behaviours identified above (i.e., limiting caloric intake, engaging in excessive exercise as a compensatory mechanism and/or other “dieting behaviours”) in their own category of disordered eating (i.e., “drunkorexia”) when they are linked to alcohol consumption, or are they simply part and parcel of disordered eating in general?

2. Does the use of the term “drunkorexia” and subsequent media coverage of this phenomenon actually lead to better recognition and treatment, or do medical professionals brush off these behaviours as fad-like and a passing phase?

• This is particularly likely, I would say, given the extent to which media coverage of “drunkorexia” is linked to college students, who are often represented as being in a period of flux in their lives
• Problematically, this might feed into stereotypical perceptions of eating disorders as a passing phase, which they are certainly not

3. Putting my critical feminist hat on, do we need to create categories and labels for all “disordered behaviours”?

• There are a wide range of behaviours associated with disordered eating; it is possible that problematic alcohol consumption and restrictive/ “dieting” behaviours fall into these variations, without requiring a “buzz-word” or label

I’m sure there are many more issues with calling these behaviours “drunkorexia.” I’m curious to know how readers feel about the term and other, similar terms (e.g., pregorexia etc.). Any opinions?

References

Barry AE, & Piazza-Gardner AK (2012). Drunkorexia: understanding the co-occurrence of alcohol consumption and eating/exercise weight management behaviors. Journal of American College Health, 60 (3), 236-43 PMID: 22420701