Abstract
Purpose
Drunkorexia represents an emerging phenomenon that is still understudied especially among adolescents. The present study aimed to investigate the relation between drunkorexia and psychological characteristics relevant and commonly associated with existing forms of eating disorders.
Methods
The sample was composed of 849 adolescents (513 boys, 334 girls, 2 unknown; range 14–22) who completed a survey composed of Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale and Psychological scales of the Eating Disorders Inventory-3.
Results
Our findings highlighted that drunkorexia was associated with low self-esteem, personal alienation, interoceptive deficits, emotional dysregulation, and asceticism. Hierarchical multiple regression analysis indicated that difficulties with emotion regulation and ascetic tendencies were significant predictors of drunkorexia among adolescents.
Conclusions
Our findings suggest the importance for programs preventing drunkorexia to be focused on training adolescents in using more adaptive strategies to manage emotions and accepting both emotional and physical signals without feeling guilty or threatened.
Level of evidence
Level V, descriptive study.
Similar content being viewed by others
References
Burke SC, Cremeens J, Vail-Smith K, Woolsey C (2010) Drunkorexia: calorie restriction prior to alcohol consumption among college freshman. J Alcohol Drug Educ 54(2):17–34
Eisenberg MH, Fitz CC (2014) “Drunkorexia”: exploring the who and why of a disturbing trend in college students’ eating and drinking behaviors. J Am Coll Health 62(8):570–577. https://doi.org/10.1080/07448481.2014.947991
Giles SM, Champion H, Sutfin EL, McCoy TP, Wagoner K (2009) Calorie restriction on drinking days: an examination of drinking consequences among college students. J Am Coll Health 57(6):603–610. https://doi.org/10.3200/JACH.57.6.603-610
Knight A, Castelnuovo G, Pietrabissa G, Manzoni GM, Simpson S (2017) Drunkorexia: an empirical investigation among Australian Female University students. Aust Psychol 52(6):414–423. https://doi.org/10.1111/ap.12212
Barry AE, Whiteman S, Piazza-Gardner AK, Jensen AC (2013) Gender differences in the associations among body mass index, weight loss, exercise, and drinking among college students. J Am Coll Health 61(7):407–413. https://doi.org/10.1080/07448481.2013.823973
Peralta RL (2002) Alcohol use and the fear of weight gain in college: reconciling two social norms. Gender Issues 20(4):23–42. https://doi.org/10.1007/s12147-002-0021-5
Piazza-Gardner AK, Barry AE (2013) Appropriate terminology for the alcohol, eating, and physical activity relationship. J Am Coll Health 61(5):311–313. https://doi.org/10.1080/07448481.2013.792259
Buchholz LJ, Crowther JH, Ciesla JA (2018) Examination of the relationships between dietary restraint, alcohol, and adverse problems among women. J Am Coll Health 66:384–392. https://doi.org/10.1080/07448481.2018.1431904
Wilkerson AH, Hackman CL, Rush SE, Usdan SL, Smith CS (2017) “Drunkorexia”: understanding eating and physical activity behaviors of weight conscious drinkers in a sample of college students. J Am Coll Health 65(7):492–501. https://doi.org/10.1080/07448481.2017.1344848
Bryant JB, Darkes J, Rahal C (2012) College students’ compensatory eating and behaviors in response to alcohol consumption. J Am Coll Health 60(5):350–356. https://doi.org/10.1080/07448481.2011.630702
Babiaz S, Ward RM, Brinkman C (2013) Examination of drunkorexia, excessive exercising, and extreme drinking. J Young Investig 25(4):52–56
Hunt TK, Forbush KT (2016) Is “drunkorexia” an eating disorder, substance use disorder, or both? Eat Behav 22:40–45. https://doi.org/10.1016/j.eatbeh.2016.03.034
Pompili S, Laghi F (2018) Drunkorexia among adolescents: the role of motivations and emotion regulation. Eat Behav 29:1–7. https://doi.org/10.1016/j.eatbeh.2018.01.001
Pompili S, Laghi F (2018) Drunkorexia: disordered eating behaviors and risky alcohol consumption among adolescents. J Health Psychol. https://doi.org/10.1177/1359105318791229
Rahal CJ, Bryant JB, Darkes J, Menzel JE, Thompson JK (2012) Development and validation of the compensatory eating and behaviors in response to alcohol consumption scale (CEBRACS). Eat Behav 13(2):83–87. https://doi.org/10.1016/j.eatbeh.2011.11.001
Ward RM, Galante M, Trivedi R, Kahrs J (2015) An examination of drunkorexia, greek affiliation, and alcohol consumption. J Alcohol Drug Educ 59(3):48–66
Roosen KM, Mills JS (2015) Exploring the motives and mental health correlates of intentional food restriction prior to alcohol use in university students. J Health Psychol 20(6):875–886. https://doi.org/10.1177/1359105315573436
Choquette EM, Rancourt D, Kevin Thompson J (2018) From fad to FAD: a theoretical formulation and proposed name change for “drunkorexia” to food and alcohol disturbance (FAD). Int J Eat Disord. https://doi.org/10.1002/eat.22926
Thompson-Memmer C, Glassman T, Diehr A (2018) Drunkorexia: a new term and diagnostic criteria. J Am Coll Health. https://doi.org/10.1080/07448481.2018.1500470
Luce KH, Crowther JH, Leahey T, Buchholz LJ (2013) Do restrained eaters restrict their caloric intake prior to drinking alcohol? Eat Behav 14(3):361–365. https://doi.org/10.1016/j.eatbeh.2013.06.004
Lupi M, Acciavatti T, Santacroce R, Cinosi E, Martinotti G, Di Giannantonio M (2015) “Drunkorexia”: a pilot study in an italian sample”. Res Adv Psychiatry 2(1):28–32
Lupi M, Martinotti G, Di Giannantonio M (2017) Drunkorexia: an emerging trend in young adults. Eat Weight Disord 22(4):619–622. https://doi.org/10.1007/s40519-017-0429-2
Pietrabissa G, Rossi A, Gaudenzi M et al (2018) Drunkorexia: empirical investigation and analysis of the characteristics of the phenomenon in an Italian sample of adolescents and young adults. Psychol Soc Educ 10(3):285–299. https://doi.org/10.25115/psye.v10i3.2135
Aldao A, Nolen-Hoeksema S, Schweizer S (2010) Emotion-regulation strategies across psychopathology: a meta-analytic review. Clin Psychol Rev 30(2):217–237. https://doi.org/10.1016/j.cpr.2009.11.004
Czaja J, Rief W, Hilbert A (2009) Emotion regulation and binge eating in children. Int J Eat Disord 42(4):356–362. https://doi.org/10.1002/eat.20630
Haynos AF, Wang SB, Fruzzetti AE (2018) Restrictive eating is associated with emotion regulation difficulties in a non-clinical sample. Eat Disord 26(1):5–12. https://doi.org/10.1080/10640266.2018.1418264
Lafrance Robinson A, Kosmerly S, Mansfield-Green S, Lafrance G (2014) Disordered eating behaviours in an undergraduate sample: associations among gender, body mass index, and difficulties in emotion regulation. Can J Behav Sci 46(3):320–326
Laghi F, Bianchi D, Pompili S, Lonigro A, Baiocco R (2018) Metacognition, emotional functioning and binge eating in adolescence: the moderation role of need to control thoughts. Eat Weight Disord 23(6):861–869. https://doi.org/10.1007/s40519-018-0603-1
Lavender JM, Anderson DA (2010) Contribution of emotion regulation difficulties to disordered eating and body dissatisfaction in college men. Int J Eat Disord 43(4):352–357. https://doi.org/10.1002/eat.20705
Muehlenkamp JJ, Peat CM, Claes L, Smits D (2012) Self-injury and disordered eating: expressing emotion dysregulation through the body. Life Threat Behav 42(4):416–425. https://doi.org/10.1111/j.1943-278X.2012.00100.x
Gianini LM, White MA, Masheb RM (2013) Eating pathology, emotion regulation, and emotional overeating in obese adults with binge eating disorder. Eat Behav 14(3):309–313. https://doi.org/10.1016/j.eatbeh.2013.05.008
Harrison A, Sullivan S, Tchanturia K, Treasure J (2009) Emotion recognition and regulation in anorexia nervosa. Clin Psychol Psychother 16(4):348–356. https://doi.org/10.1002/cpp.628
Mauler BI, Hamm AO, Weike AI, Tuschen-Caffier B (2006) Affect regulation and food intake in bulimia nervosa: emotional responding to food cues after deprivation and subsequent eating. J Abnorm Psychol 115(3):567–579
Nandrino JL, Doba K, Lesne A, Christophe V, Pezard L (2006) Autobiographical memory deficit in anorexia nervosa: emotion regulation and effect of duration of illness. J Psychosom Res 61(4):537–543. https://doi.org/10.1016/j.jpsychores.2006.02.008
Fassino S, Pierò A, Gramaglia C, Abbate-Daga G (2004) Clinical, psychopathological and personality correlates of interoceptive awareness in anorexia nervosa, bulimia nervosa and obesity. Psychopathology 37(4):168–174. https://doi.org/10.1159/000079420
Garner DM, Olmsted MP, Polivy J, Garfinkel PE (1984) Comparison between weight-preoccupied women and anorexia nervosa. Psychosom Med 46(3):255–266. https://doi.org/10.1097/00006842-198405000-00007
Pollatos O, Kurz AL, Albrecht J et al (2008) Reduced perception of bodily signals in anorexia nervosa. Eat Behav 9(4):381–388. https://doi.org/10.1016/j.eatbeh.2008.02.001
Matsumoto R, Kitabayashi Y, Narumoto J et al (2006) Regional cerebral blood flow changes associated with interoceptive awareness in the recovery process of anorexia nervosa. Prog Neuropsychopharmacol Biol Psychiatry 30(7):1265–1270. https://doi.org/10.1016/j.pnpbp.2006.03.042
Preyde M, Watson J, Remers S, Stuart R (2016) Emotional dysregulation, interoceptive deficits, and treatment outcomes in patients with eating disorders. Social Work Ment Health 14(3):227–244. https://doi.org/10.1080/15332985.2014.990076
Ruscitti C, Rufino K, Goodwin N, Wagner R (2016) Difficulties in emotion regulation in patients with eating disorders. Borderline Pers Disord Emot Dysregul 3(1):3. https://doi.org/10.1186/s40479-016-0037-1
Bardone-Cone AM (2007) Self-oriented and socially prescribed perfectionism dimensions and their associations with disordered eating. Behav Res Ther 45(8):1977–1986. https://doi.org/10.1016/j.brat.2006.10.004
Bardone-Cone AM, Wonderlich SA, Frost RO, Bulik CM, Mitchell JE, Uppala S, Simonich H (2007) Perfectionism and eating disorders: current status and future directions. Clin Psychol Rev 27(3):384–405. https://doi.org/10.1016/j.cpr.2006.12.005
Lampard AM, Byrne SM, McLean N, Fursland A (2012) The Eating Disorder Inventory-2 Perfectionism scale: factor structure and associations with dietary restraint and weight and shape concern in eating disorders. Eat Behav 13(1):49–53. https://doi.org/10.1016/j.eatbeh.2011.09.007
Stice E (2002) Risk and maintenance factors for eating pathology: a meta-analytic review. Psychol Bull 128(5):825–848
Ventura LM, Randall ET, Shapiro JB, Kirsch AC, Conley CS, Bohnert AM (2018) Looking good and making it seem easy: a prospective study of effortless perfectionism, body image, and BMI in unhealthy weight control behaviors among female adolescents and young adults. Emerg Adulthood 6(5): 327–335. https://doi.org/10.1177/2167696817737007
Sassaroli S, Ruggiero GM (2005) The role of stress in the association between low self-esteem, perfectionism, and worry, and eating disorders. Int J Eat Disord 37(2):135–141. https://doi.org/10.1002/eat.20079
Yeatts PE, Martin SB, Petrie TA, Greenleaf C (2016) Weight control behavior as an indicator of adolescent psychological well-being. J Sch Health 86(8):561–567. https://doi.org/10.1111/josh.12409
Furnham A, Badmin N, Sneade I (2002) Body image dissatisfaction: gender differences in eating attitudes, self-esteem, and reasons for exercise. J Psychol 136(6):581–596. https://doi.org/10.1080/00223980209604820
Mayer-Brown S, Lawless C, Fedele D, Dumont-Driscoll M, Janicke DM (2016) The effects of media, self-esteem, and BMI on youth’s unhealthy weight control behaviors. Eat Behav 21:59–65. https://doi.org/10.1016/j.eatbeh.2015.11.010
Stice E, Presnell K, Spangler D (2002) Risk factors for binge eating onset in adolescent girls: a 2-year prospective investigation. Health Psychol 21(2):131–138
Vohs KD, Bardone AM, Joiner TE Jr, Abramson LY (1999) Perfectionism, perceived weight status, and self-esteem interact to predict bulimic symptoms: a model of bulimic symptom development. J Abnorm Psychol 108(4):695
Akrawi D, Bartrop R, Surgenor L, Shanmugam S, Potter U, Touyz S (2017) The relationship between spiritual, religious and personal beliefs and disordered eating psychopathology. Transl Dev Psychiatry 5(1):1305719. https://doi.org/10.1080/20017022.2017.1305719
Behar R, Arancibia M (2015) Asceticism and spirituality in anorexia nervosa: a historical psychosocial analysis. Salud Ment 38(3):225–232. https://doi.org/10.17711/SM.0185-3325.2015.031
Corrington G (1986) Anorexia, asceticism, and autonomy: self-control as liberation and transcendence. J Femi Stud Relig 2(2):51–61. https://www.jstor.org/stable/25002041
Fassino S, Pierò A, Gramaglia C, Daga GA, Gandione M, Rovera GG, Bartocci G (2006) Clinical, psychological, and personality correlates of asceticism in anorexia nervosa: from saint anorexia to pathologic perfectionism. Transcult Psychiatry 43(4):600–614. https://doi.org/10.1177/1363461506070785
Fassino S, Daga GA, Amianto F et al (2001) Outcome predictors in anorectic patients after 6 months of multimodal treatment. Psychother Psychosom 70(4):201–208. https://doi.org/10.1159/000056254
Garner DM (2004) The Eating Disorder Inventory-3: professional manual. Psychological Assessment Resources, Odessa
Astudillo RB, Meza MA (2013) Maturity fears in anorexia nervosa. Rev Mex Trastor Aliment 4(2):143–152. https://doi.org/10.1016/S2007-1523(13)72001-9
Fassino S, Pierò A, Tomba E, Abbate-Daga G (2009) Factors associated with dropout from treatment for eating disorders: a comprehensive literature review. BMC Psychiatry 9(1):67. https://doi.org/10.1186/1471-244X-9-67
Pike KM, Mizushima H (2005) The clinical presentation of Japanese women with anorexia nervosa and bulimia nervosa: a study of the Eating Disorders Inventory-2. Int J Eat Disord 37(1):26–31. https://doi.org/10.1002/eat.20065
van der Ham T, van Strien DC, Van Engeland H (1994) A four-year prospective follow-up study of 49 eating-disordered adolescents: differences in course of illness. Acta Psychiatr Scand 90(3):229–235. https://doi.org/10.1111/j.1600-0447.1994.tb01582.x
Hanna AC, Bond MJ (2006) Relationships between family conflict, perceived maternal verbal messages, and daughters’ disturbed eating symptomatology. Appetite 47(2):205–211. https://doi.org/10.1016/j.appet.2006.02.013
Laghi F, Pompili S, Zanna V et al (2017) How adolescents with anorexia nervosa and their parents perceive family functioning? J Health Psychol 22(2):197–207. https://doi.org/10.1177/1359105315597055
Laghi F, McPhie ML, Baumgartner E, Rawana JS, Pompili S, Baiocco R (2016) Family functioning and dysfunctional eating among Italian adolescents: the moderating role of gender. Child Psychiatry Hum Dev 47(1):43–52. https://doi.org/10.1007/s10578-015-0543-1
Pelletier Brochu J, Meilleur D et al (2018) Adolescents’ perceptions of the quality of interpersonal relationships and eating disorder symptom severity: the mediating role of low self-esteem and negative mood. Eat Disord 26(4):388–406. https://doi.org/10.1080/10640266.2018.1454806
Pinna F, Milia P, Mereu A et al (2015) Validation of the Italian version of the compensatory eating and behaviors in response to alcohol consumption scale (CEBRACS). Eat Behav 19:120–126. https://doi.org/10.1016/j.eatbeh.2015.08.004
Giannini M, Pannicchia L, Dalle Grave R, Muratori F, Viglione V (eds) (2008) EDI-3. Eating Disorder Inventory—3. Manuale. Organizzazioni Speciali, Firenze
Cohen J (1988) Statistical power analysis for the behavioral sciences. Lawrence Erlbaum Associates, Hillsdale
Coakes SJ (2005) SPPS version 12.0 for windows: analysis without anguish. Wiley, Queensland
Tabachnick BG, Fidell LS, Osterlind SJ (2001) Using multivariate statistics, 4th edn. Allyn and Bacon, Boston
Fitzgibbon ML, Spring B, Avellone ME, Blackman LR, Pingitore R, Stolley MR (1998) Correlates of binge eating in Hispanic, Black, and White women. Int J Eat Disord 24(1):43–52
Dragan M (2015) Difficulties in emotion regulation and problem drinking in young women: the mediating effect of metacognitions about alcohol use. Addict Behav 48:30–35. https://doi.org/10.1016/j.addbeh.2015.04.008
Boggiano MM, Burgess EE, Turan B et al (2014) Motives for eating tasty foods associated with binge-eating. Results from a student and a weight-loss seeking population. Appetite 83:160–166. https://doi.org/10.1016/j.appet.2014.08.026
Pompili S, Laghi F (2017) Binge eating and binge drinking among adolescents: the role of drinking and eating motives. J Health Psychol. https://doi.org/10.1177/1359105317713359
Veilleux JC, Skinner KD, Reese ED, Shaver JA (2014) Negative affect intensity influences drinking to cope through facets of emotion dysregulation. Pers Individ Differ 59:96–101. https://doi.org/10.1016/j.paid.2013.11.012
Birch CD, Stewart SH, Brown CG (2007) Exploring differential patterns of situational risk for binge eating and heavy drinking. Addict Behav 32(3):433–448. https://doi.org/10.1016/j.addbeh.2006.05.014
Kenny TE, Singleton C, Carter JC (2017) Testing predictions of the emotion regulation model of binge-eating disorder. Int J Eat Disord 50(11):1297–1305. https://doi.org/10.1002/eat.22787
Nolen-Hoeksema S (2012) Emotion regulation and psychopathology: the role of gender. Annu Rev Clin Psychol 8:161–187. https://doi.org/10.1146/annurev-clinpsy-032511-143109
Weiss NH, Sullivan TP, Tull MT (2015) Explicating the role of emotion dysregulation in risky behaviors: a review and synthesis of the literature with directions for future research and clinical practice. Curr Opin Psychol 3:22–29. https://doi.org/10.1016/j.copsyc.2015.01.013
Herman CP, Polivy J (2004) The self-regulation of eating: theoretical and practical problems. In: Baumeister RF, Vohs KD (eds) Handbook of self-regulation: research, theory, and applications. Guilford Press, New York, pp 492–508
Dinger MK, Brittain DR, O’Mara HM, Peterson BM, Hall KC, Hadley MK, Sharp T (2018) The relationship between physical activity and binge drinking among college students: a qualitative investigation. Am J Health Educ 49(1):33–39. https://doi.org/10.1080/19325037.2017.1369198
Huline-Dickens S (2000) Anorexia nervosa: some connections with the religious attitude. Br J Med Psychol 73(1):67–76. https://doi.org/10.1348/000711200160309
Ferriter C, Ray LA (2011) Binge eating and binge drinking: an integrative review. Eat Behav 12(2):99–107. https://doi.org/10.1016/j.eatbeh.2011.01.001
McBride NM, Barrett B, Moore KA, Schonfeld L (2014) The role of positive alcohol expectancies in underage binge drinking among college students. J Am Coll Health 62(6):370–379. https://doi.org/10.1080/07448481.2014.907297
Biolcati R, Passini S, Mancini G (2016) “I cannot stand the boredom.” Binge drinking expectancies in adolescence. Addict Behav Rep 3:70–76. https://doi.org/10.1016/j.abrep.2016.05.001
Funding
This study was not funded.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no competing interests.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Approval from the Research Ethics Board of Department of Developmental and Social Psychology, Sapienza University of Rome was obtained before data were collected for the current study.
Informed consent
Participants gave their informed consent to take part to the study, and for underage students below 18 years written informed consents were also obtained from parents.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of topical collection on Personality and eating and weight disorders.
Rights and permissions
About this article
Cite this article
Laghi, F., Pompili, S., Bianchi, D. et al. Psychological characteristics and eating attitudes in adolescents with drunkorexia behavior: an exploratory study. Eat Weight Disord 25, 709–718 (2020). https://doi.org/10.1007/s40519-019-00675-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40519-019-00675-y