Alcohol & Eating Disorders

Alcohol & Anorexia

Anorexia nervosa is an eating disorder characterized by restrictive food intake or binge-purge cycles. People with this ED often develop an extreme fear of weight gain and have body dysmorphia (distorted body image). They may engage in excessive dieting, fasting, or vomiting and refuse to eat in public places where they cannot control caloric intake. Social withdrawal is driven by a desire to hide the eating disorder for fear of judgment.

Signs & Symptoms of Anorexia Include:

• Extreme weight loss or very low body weight (emaciation).
• Dry, brittle hair and skin.
• Blue nailbed discoloration.
• Swollen arms and legs.
• Fine, soft hair covering the body.
• Fatigue.
• Insomnia.
• Feeling dizzy.
• Constipation.
• Loss of monthly period.
• Irregular heartbeat.
• Dehydration.
• Low blood pressure.
• Anemia.

People with anorexia tend to display perfectionism, hypersensitivity, and obsessive-compulsive behaviors rooted in anxiety and poor self-image. Drinking either alleviates this anxiety to cope with the eating disorder or acts as a substitute for food. Among those with AUD and anorexia, greater eating disorder severity is linked to higher levels of intoxication and adverse physical effects from alcohol.

Alcohol & Bulimia

Unlike anorexia, characterized by extreme thinness and low body weight, people with bulimia nervosa tend to be normal or overweight. This eating disorder usually involves over-consuming food (binging), followed by either self-induced vomiting (purging), laxative or supplement use, or excessive exercise to undo the effects of binging. Whereas anorexia is strict control of eating, people with bulimia tend to feel they lack control over what, when, and how much they consume. 

Other Features of Bulimia Include:

• Eating unusually large portions in one sitting.
• Perseverance on body image and weight.
• Compulsive urge to find a bathroom after eating to purge.
• Social isolation during a binge-purge cycle.
• Mouth sores, gum irritation, and dental corrosion due to constant vomiting.
• Scabs or scratch marks on knuckles from self-induced vomiting.
• Swollen legs, arms, face, or neck.
• Fluctuating weight.

Alcohol can be used after a binge to help induce vomiting or to quell the guilt and shame associated with overeating. People with bulimia or binge eating disorder are more likely to use alcohol as a coping mechanism than those with anorexia. As a result, individuals with bulimia have a greater likelihood of developing AUD.

Alcohol & Binge Eating Disorder

Binge eating disorder (BED) involves a lack of control over eating, leading to the consumption of unnecessarily large meals in a short period, followed by extreme shame. The guilt many times leads to further binging in an attempt to alleviate low mood, further perpetuating the cycle. Most people with BED are clinically overweight or obese. They may continue to gain weight if untreated because there is no compensatory behavior like the purging or exercising seen with anorexia and bulimia. 

BED Can Result in the Following:

• Abdominal pain after binging.
• Continuing to eat when full.
• Social isolation during binging.
• Feeling helpless over the urge to binge.
• Nausea.
• Heart disease.
• Diabetes.
• Gastrointestinal complications (e.g., reflux, gallbladder disease).
• Sleep apnea.
• Joint problems and mobility issues.
• Depression.

BED is the most common eating disorder, and people with this condition often had anxiety or depressive disorders that led to emotional or “stress eating” before their BED diagnosis. The same factors contributing to BED also give rise to alcohol misuse and self-medicating with other substances. Alcohol misuse is frequent during binging periods, though it also mitigates the sensations of guilt and shame after the fact.