Alcoholic anorexia, have you heard of it?

The disorder is not yet included as a disease in the Diagnostic Manual of Mental Disorders (DSM-5) or in the International Classification of Diseases (ICD), both international references for diagnosis and case management. Therefore, alcoholic anorexia does not have well-established criteria, which makes its identification and treatment difficult.

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“The term drunkorexia is very recent, it emerged in the United States. As soon as they created this terminology we had a 'boom' and everyone wanted to know what it was about. This topic has been discussed more frequently for about ten years now”, comments Silvia Brasiliano, psychologist and coordinator of the Chemical Dependent Women's Program (Promud) at the Institute of Psychiatry at the Faculty of Medicine of USP (IPq-USP).

The program completed 25 years and has served more than a thousand women with all types of chemical dependency. On social media, drunkorexia has already been the subject of videos, mainly on TikTok, showing that the practice may not be as rare as one might imagine:

How does alcoholic anorexia happen?

Around 30% of women diagnosed with alcoholism have associated eating disorders. Another 20% will have a subclinical pathology, with disordered eating, some compulsion, inadequate eating compensation methods that are not classified as diseases, but have typical symptoms.

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As alcoholic anorexia is a very new problem, science still cannot say which appears first: the eating disorder (anorexia) or alcoholism.

According to Silvia, when the woman arrives for treatment, both disorders are present. “This patient has both diagnoses at the same time: anorexia and problematic drinking and/or alcohol dependence. These are women who drink excessively but want to stay very thin.”

Identifying alcoholic anorexia is quite complex and is different from the most common dietary compensations, for example, when someone drinks a lot one day and fasts the next, to “compensate” in calories.

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“This is not what characterizes alcoholic anorexia, this compensation that occurs from one day to the next is common among young women. The pathological condition occurs when a woman completely alters her diet with super-restrictive diets or does excessive physical exercise [more than six hours per day] to stay thin and be able to continue drinking, without gaining weight from drinking”, explained Silvia.

Characteristics of alcoholic anorexia

In these cases, patients have very low weights – characteristic of anorexic people – and “feed” on alcohol, because they often have a very poor diet or exercise excessively to avoid gaining weight.

And the mathematics can be quite complex: the caloric calculation of what they can consume per day is based on what they will be able to drink, without thinking about eating. In general, says Silvia, patients fast with meals based on a few leaves of vegetables and raw, unseasoned foods.

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“These young women usually arrive for treatment with very serious conditions because they are absolutely malnourished, even though they don’t feel like it,” says Silvia. This is because although alcohol is a caloric drink, the calories are called “empty” because they have no nutritional power and do not translate into anything good for the body other than the accumulation of fat and water.

“The person will not nourish themselves by drinking, but the calories from the alcohol will give the feeling of a full stomach”, explains the specialist.

But if alcohol has a lot of calories and accumulates fat, won't a person gain weight if they drink it?

“You don't gain weight because, for example, the patient does some very complicated calculations of how many calories she needs to ingest that day to be able to drink without gaining weight. And this calculation is based on very restricted diets with few calories [A balanced diet for an adult involves a diet of, on average, 2.000 calories per day]. One patient I had, instead of eating, drank 800 calories of alcohol”, explains the specialist.

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This extreme diet, associated with weight and image distortion, is one of the classic criteria for diagnosing anorexia, which includes a very low weight for the person's size; besides the fact that she doesn't think she's thin.

When a woman combines this with an intense desire to drink – to the point of becoming drunk – with enough difficulty eating so that she does not gain any weight, we arrive at alcoholic anorexia.

In general, this patient receives the diagnosis only after having a serious clinical problem – usually severe malnutrition or hypoglycemia and an infection that cannot be cured. The problem gets worse, says the psychologist, because there is a social reinforcement around the slim and perfect body.

Treatment

Treatment is multidisciplinary, long-term and complex. It may include the use of medication, in addition to psychotherapy and nutritional monitoring, which must be carried out by a professional specialized in eating disorders.

“It is very difficult to get this woman to adhere to treatment. Because she often doesn't want to stop drinking and doesn't want to gain weight. She just wants to stop having problems and stay thin,” she concluded.

Source: Einstein Agency

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