RESEARCH
Journal of Young Investigators
REVIEW
Examination of Drunkorexia, Excessive Exercising, and
Extreme Drinking
Stephanie Babiaz,1* Rose Marie Ward,1 and Craig Brinkman 1
The purpose of this study is to examine the relationship between extreme drinking, drunkorexia, and excessive exercise output in
college students. Drunkorexia, defined as the practice of restricting calories so that alcohol can be consumed without gaining weight
(CBS News 2008; Kershaw 2008; Smith 2008; Stoppler 2008), and excessive exercising are on the rise amongst college students.
Researchers have found associations between both eating disorders and excessive exercising (Mond et al. 2008) as well as between
eating disorders and extreme drinking (Krahn et al. 2004).. This previous research has led to further investigation of college students
to determine whether significant relationships exist between these three behaviors. This study aims to discover the percentage of
college students engaging in extreme drinking, which is defined in this study as the planned or unplanned consumption of alcohol in
greater quantity than one normally would on a drinking occasion. It aims to further look at the eating and exercising habits of college
students to determine if these two behaviors previously mentioned are affecting this specific population, and to what extent. An online
survey was distributed to students (n=254) from a medium sized Midwest university. Results showed a significant correlation between
excessive exercising and drunkorexia, r (130) = .37, p < .001. However, the findings of this study did not show a relationship between
either of these two behaviors and extreme drinking. Through these results, this study has provided further information on drunkorexia,
and given insight into other characteristics of individuals suffering from this rising eating disorder.
INTRODUCTION
The degree of alcohol consumption has steadily increased on
college campuses across the nation. With this rise, the negative
consequences of drinking episodes have increased as well
(Mallett et al. 2006). Some of the most common negative
consequences of these drinking episodes for college students are
physical, legal, academic, interpersonal, and sexual in nature
(Wechsler et al. 1994). Specifically, many common issues
associated with drinking include vomiting, unwanted sexual
experiences, hangovers, and blackouts (Mallet et al. 2006).
This study examines extreme drinking, which is defined
as the planned or unplanned consumption of alcohol in a greater
quantity than one would normally consume on a drinking
occasion. Although students may be aware that they are drinking
more than their usual amount, according to Mallett et al.’s 2006
survey, they may not realize how their extreme drinking
behaviors are increasing their risks for the aforementioned
negative consequences because of their misperception of the
amount of alcohol needed for these outcomes to occur.
Unfortunately, extreme alcohol usage is not the only dangerous
behavior in which college students participate. Other unhealthy
actions include excessive exercising and disordered eating
behaviors. Using college students, this study investigates the
relationship between these three extreme behaviors – extreme
alcohol consumption, excessive exercise, and drunkorexia.
Eating disorders cause both psychological and physical
problems, and in extreme cases, complications arising from
eating disorders can lead to death (Munoz et al. 2009). New
1
Miami University 501 E High St. Oxford, OH 45056
*
To whom correspondence should be addressed: babiarsa@muohio.edu
forms of eating disorders arisen, and one such form, primarily a
concern for college students, is drunkorexia (Burke et al. 2010).
Drunkorexia, defined as the “practice of restricting calories so
more alcohol can be consumed without gaining weight”, is an
extremely dangerous eating disorder, because the majority of
caloric intake is derived from alcohol (CBS News 2008;
Kershaw 2008; Smith 2008; Stoppler 2008). The high risks for
this eating disorder are associated with a lack of sufficient
nutrients t for the body, as well as the extreme effects of alcohol
on the body due to the lack of food consumption prior to drinking
(Burke et al. 2010).
While excessive drinking is not limited to people with
eating disorders, there is a link between alcohol consumption and
eating disorders (Krahn et al. 2004). A study looking at the
relationship between dieting, bingeing severity, and alcohol use
in a sample of 1,384 women in their first year of college
produced significant findings on this matter. Results showed that
prevalence of alcohol use in the past month, drinking enough to
become intoxicated on one half or more drinking occasions, and
heavy drinking (≥ 5 drinks in a row) in these women was
positively associated with dieting and bingeing severity in a
graded manner for all of these behaviors (Krahn et al. 2004). In
reference to such findings as shown in previous research, this
study expects to show a positive correlation between amount of
alcohol consumed and prevalence of eating disorders,
specifically drunkorexia, in college students.
The appeal of drunkorexia for teenagers and young
adults is the ability to continue consuming large quantities of
alcohol while still maintaining, or possibly decreasing, body
weight (Chambers 2008). Social pressure of physical fitness or to
participate in excessive alcohol consumption has influenced
young adults, particularly women, to resort to extreme measures.
Two of these measures are drunkorexia and excessive exercising.
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Excessive exercising is defined as performing exercise to
influence weight, shape, or body tone, as well as experiencing
guilt when exercise is postponed or cancelled (Mond et al. 2008).
Males who exercise excessively feel the need to not only stay
lean but also to increase their muscle mass (Barlett et al. 2008);
in contrast, women are often trying to burn off excessive
amounts of calories in order to reduce their body weight and fat
percentage drastically (Johnstone and Rickard 2006). Individuals
who excessively exercise allow this behavior to take over their
lives through such activities as counting calories consumed and
expended, and spending much more time at the gym than the
average exerciser (Mond et al. 2008). For these individuals,
missing even a single session of excercise may bring about
feelings of guilt and other negative feelings towards themselves
and their bodies (Mond et al. 2008). These negative body images
can cross over into other aspects of those individuals’ lives, such
as their eating behaviors.
Whereas exercising is a normal and healthy behavior,
when taken to the extreme, the individual burns calories than
they provide their body, causing abnormal physiological
responses to gain energy (Eisler and le Grange 1990). In
comparison, eating disorders result in unhealthy caloric intake
levels stemming from negative body image, resulting in multiple
physiological and psychological health consequences as well
(Eisler and le Grange 1990). Research links excessive exercising
and disordered eating behaviors, and it can be concluded that
these issues often times coexist (Burke et al. 2008; Mond et al.
2008).
The expected relationships of this study are significant
positive correlations between excessive exercise, extreme alcohol
use, and drunkorexia due to a common association of eating
disorders between both excessive exercising and extreme
drinking. Whereas studies have already looked into the
relationships between two of these variables at a time, this is the
first attempt at finding a correlation between all three variables in
a single study.
METHODS
Participants
We recruited college students (n = 254) from a medium sized
Midwest university, with a mean age of 20.36 (SD = 3.31). The
majority of the students were female (69.7%, n = 177). Most
participants reported being Caucasian (90.2%; Asian or Asian
American, 2.8%, Black, African American, or Haitian, 4.3%,
Hispanic, 2.0%,), completely heterosexual (92.5%; mostly
heterosexual, 4.3%, equally heterosexual and homosexual, 0.8%,
mostly homosexual, 0.4%), not married (92.9%; married, 1.2%,
not married but living with partner, 2.4%, separated, 0.4%,
divorced, 0.4%, or ‘don’t know’, 1.6%), and having a mean GPA
of 3.27 (SD = .44). 1.6% (n = 4) reported receiving treatment for
eating disorders. A majority of the participants reported that their
parents were still married (71.7%; separated, 2.0%, divorced with
one or both parents remarried, 11.4%, divorced with neither
parent remarried, 7.9%, parents never married, 2.0%) and well
educated (mother’s education level – some high school, 1.6%,
REVIEW
high school, 12.6%, some college, 14.2%, college or above,
68.1% ; father’s education level – some high school, 2.0%, high
school, 9.4%, some college, 11.0%, college or above, 73.2%).
Procedure
Participants for this cross-sectional study were recruited via
asnowball sampling method. An email invitation was sent with a
hyperlink to the study. The invitation explained that the
participants had approximately one week to complete the online
survey and did not have to complete all questions in the survey.
Email invitations were posted on a variety of listservs, electronic
course sites, and announcements were made in various classes on
campus, including psychology, kinesiology and health, and
statistics courses. Participants were eligible for extra credit in a
select number of classes, and for a random drawing for four $50
gift cards to local establishments. All procedures were prior
approved by the Institutional Review Board of the primary
author.
Measures
The online survey consisted of the measures described below.
Following the demographic questions, the order of the remaining
questionnaires was randomized for each participant, with all of
the questions from one measure appearing together.
Demographics
Participants were asked to indicate their age, gender, ethnicity,
sexual orientation, marital status, parental marital status, parental
education level, and GPA. For ethnicity, participants were
instructed to select all categories that applied.
Extreme Drinking
The definition for extreme drinking was given as the planned or
unplanned consumption of alcohol in greater quantity than “you
normally would on a drinking occasion”. Subjects were then
asked if they had ever participated in extreme drinking, prompted
with a “yes” or “no” answer. They were also given the definition
of ‘blacking out’, as “a portion of time when you have an
inability to recall the past due to the intake of alcohol,” and asked
whether they have ever blacked out. They were further asked if
they have ever blacked out as a result of extreme drinking.
Drunkorexia
The Drunkorexia Scale (Burke et al. 2010) was revised and
expanded for the current investigation. The unmodified
Drunkorexia Scale (Burke et al. 2010) has one scale containing
11 questions, examining eating behaviors on the night of a
drinking episode. A sample item states “How often do you
restrict eating before drinking in order to feel the affects of
alcohol better or more?” (“Never =1,Very Often =5”). The
expanded scale includes 3 scenario items and one response item
examining the amount of calories, fat, and total food intake on
days that participants plan to drink, and the frequency of these
behaviors. The response item includes 5 response options (never
to very often). An example scenario that participants are
provided with is as follows, “It is a typical Saturday during the
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school year. You know that you are going to a party tonight and
that you will be drinking. Which of the following best describes
how you would most likely eat that day.” The expanded scale
also includes an open-ended item asking “How often do you
restrict your fat intake or your caloric intake before drinking
because of other reasons? Please explain.” Higher scores
indicate more endorsement of drunkorexic behaviors. The
Cronbach’s alpha was .84, and the scale had a mean of 13.62 (SD
= 5.40).
The Obligatory Exercise Questionnaire
The Obligatory Exercise questionnaire (OEQ: Thompson and
Pasman 1998) measures the degree of excessive exercising in
which the participant partakes. It examines the behaviors of
participants whose lives are consumed with exercising, and have
feelings of guilt and shame when missing an exercise session.
The OEQ consists of 25 questions, and with the exception of
questions 8 and 10 which are reverse scored, all items indicate
higher endorsement of, and engagement in, obligatory exercise
behaviors. The directions state: “Listed below are a series of
statements about people’s exercise habits, please circle the
number (scale 1-4, where 1 is never and 4 is always) that reflects
how often you could make the following statements.” The
Cronbach’s alpha was a .90, and the scale had a mean of 44.92
(SD = 10.05).
RESULTS
The Pearson correlations between the three variables, extreme
drinking, drunkorexia, and excessive exercise, showed mixed
results (Table 1). While the OEQ and drunkorexia results were
significantly correlated, r(130) = .37, p<.001, there was no
significant correlation between OEQ and extreme drinking,
r(144) = .07, p = .39, and no significant correlation between
drunkorexia and extreme drinking, r(149) = .01, p = .91.
Although not particularly important for the implications of this
study, it is significant to note a correlation between extreme
drinking and blacking out, r(187) = .73, p < .001, for further
research.
Two independent t-tests examined the relationship
between those who endorsed extreme drinking and those who did
not on the OEQ and the drunkorexia scale. When comparing
those who reported extreme drinking (n = 98, M = 44.32, SD =
9.00) to those who did not report extreme drinking (n = 46, M =
45.85, SD = 11.88), the independent t-test on the OEQ was not
significant, t(142) = -.86, p = .39. When examining those who
did report extreme drinking (n = 106, M = 13.57, SD = 5.20) and
those who did not report extreme drinking (n = 43, M = 13.67,
SD = 5.89), the independent t-test on the drunkorexia scale was
not significant, t (147) = -.11, p = .91.
DISCUSSION
This study was designed to show the relationship between three
variables: extreme drinking, excessive exercising, and
drunkorexia. While both excessive exercising and increased
REVIEW
alcohol consumption have independently been found to
positively correlate with eating disorders (Mond et al. 2008;
Krahn et al. 2004), this study utilized the novel approach of
examining the three variables together. This study is also novel
in the aspect that a specific eating disorder, drunkorexia, was
examined. Although the results did not show the three variables
in question being interrelated, there were significant findings that
provide new insight into this field of study, and could be useful
for further research.
For example, an interesting finding was the positive
correlation between drunkorexia and excessive exercising.
Previous research indicates that there is a relationship between
eating disorders and increased exercising (Mond et al. 2008);
however, this study extends the literature by examining a specific
subtype of eating disorder, namely, drunkorexia. Drunkorexia is
a newer eating disorder, and it is still being defined and
examined. Being able to recognize other characteristics of
individuals with drunkorexia could provide benefit for diagnosis,
treatment, and recovery.
When reflecting upon the
psychological reasons behind the correlation of drunkorexia and
excessive exercising, individuals affected by both conditions
have an underlying fear of excessive caloric intake and weight
gain (Burke et al. 2010; Mond et al. 2008). Individuals with both
conditions often feel guilt with the amount of calories consumed
for drunkorexia, or the lack of exercise with excessive
exercising. In both conditions, there is a similar psychological
response, i.e. the need to control one’s physical appearance.
According to Mond et al.’s (2008), the combination of exercising
solely for weight and shape, and intense guilt when exercise is
missed, is associated with very high levels of eating disorder
psychopathology, further supporting the psychological
significance behind the relationship.
Although there were no significant correlations found in
this study between extreme drinking and the other two variables
of concern, drunkorexia and excessive exercising, this
relationship should not be ruled out. One explanation for the nonsignificant correlations could be the definition provided for
extreme drinking in the survey. The broad definition given, “the
planned or unplanned consumption of alcohol in greater quantity
than you normally would on a drinking occasion,” could be
misinterpreted or viewed differently by participants. Thus, if a
more systematic definition could be formulated for the term
“extreme drinking,” perhaps the data would be more consistent.
A study on binge drinking cut-offs separated heavy drinkers into
three groups, those who typically drink below the traditional
“binge” cutoff (less than 4+/5+ drinks per occasion for
women/men), those who met traditional “binge” drinking
criteria, and those who drank above the “binge” cutoff (more
than 6+/7+ drinks per occasion for women/men; Read et al.
2007). Such guidelines as these imposed upon the definition of
extreme drinking may assist in the collection of more reliable
data. With more concrete guidelines, a significant relationship
between drunkorexia and extreme drinking may have been
shown. Past research has shown an association between
increased alcohol consumption and eating disorders (Krahn et al.
2004), thus there is logical reason to believe that these two
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variables are interrelated. Although this study did not find a
correlation of drunkorexia with = extreme drinking, this does not
rule out its correlation with alcohol consumption as a whole.
Thus, the vague definition of extreme drinking can be considered
a limitation to this study.
Another possible limitation is the survey population.
The majority of subjects were Caucasian (90.2%), female
(69.7%), college students with a mean GPA of 3.27 (SD = .44),
whose parents achieved a high education status (mother
education – college or above, 68.1%; father education – college
or above, 73.2%), make the population specific and unique
compared to many college campuses. The Fiske Guide to
Colleges 2013 named this medium Midwest university in its list
of the nation’s best colleges.. It also stated that the university is
“gaining national recognition as an excellent state university that
has the true look and feel of a private, with picture-perfect
campus and high-caliber student body” (“Miami in Fiske Guide
to Colleges” 2012). The students at this university strive to
succeed in school and carry on their families’ education level,
which could have opposing consequences in terms of the
concerns of this study. These students may be less likely to
participate in the three behaviors, excessive exercising,
drunkorexia, and extreme drinking, due to busy schedules and a
focus on schoolwork. However, on the other end of the spectrum,
being expected to succeed in school and carry on family
education levels could also lead to added pressure, and thus
increased levels of these behaviors as coping mechanisms. In
2012, this Midwest university was ranked in the “top ten party
schools” in the nation from the Princeton review (CBS News
2012) implying that the participants in this study may have a
higher rate of alcohol consumption than the average college
student. Further research on how students on elite campuses deal
with the pressure to succeed in school, and how this affects their
extracurricular activities and behaviors, would be an interesting
and important addition to the current research.
Overall, this study has shown an important correlation
between drunkorexia and excessive exercising. With two such
extreme behaviors being practiced in college extensively, student
health decline is likely to occur at a faster rate. Without alcohol
consumption being ruled out as another factor related to these
two behaviors, this would add another dimension of health risk to
this population, although based on these results it does not seem
probable that extreme drinking is strongly correlated to either of
these conditions. Further research can be conducted to estimate
the amount of alcohol consumption that is seen with individuals
who participate in both excessive exercising and drunkorexia.
This knowledge would help health professionals better
understand this new and growing population, and help with
possible recovery and preventative methods in the future.
REFERENCES
Barlett, C. P., C.L. Vowels and D.A. Saucier (2008) Metaanalyses of the effects of media images on men’s body
image concerns. Journal of Social & Clinical Psychology 27,
279-310.
REVIEW
Burke, S.C., J. Creemens, K. Vail-Smith and C. Woolsey (2010)
Drunkorexia: calorie restriction prior to alcohol consumption
among college freshman. Journal of Alcohol & Drug
Education 54, 17-34.
CBS News (2008) Drunkorexia: Health dangers for women.
Retrieved
on
September
6,
2012
from
http://www.cbsnews.com/stories/2008/01/23/entertainment/
main3744289.shtml
CBS News (2012) Princeton review’s top 20 party, sober
schools. Retrieved on September 6, 2012 from
http://www.cbsnews.com/8301-501363_16257496480/princeton-reviews-top-20-party-sober-schools/.
Chambers, R. (2008) Drunkorexia. Journal Of Dual Diagnosis
4, 414-416.
Cooper, M.L. (1994) Motivations for alcohol use among
adolescents: development and validation of a four-factor
model. Psychological Assessment 6, 117–128.
Eisler, I. and D. le Grange (1990) Excessive Exercise and
Anorexia Nervosa. International Journal of Eating Disorders
9, 377-386.
Johnstone, J.R. and K.M. Rickard (2006) Perceptions of college
women with disordered eating and exercise patterns. Social
Behavior & Personality: An International Journal 34, 10351050.
Kershaw, S. (2008, March 2). Starving themselves, cocktail in
hand.
New
York
Times
Retrieved
from
http://www.nytimes.com
Krahn, D.D., C.L. Kurth, E. Gomberg and A. Drewnowski
(2004) Pathological dieting and alcohol use in college
women – a continuum of behaviors. Eating Behaviors 6, 4352.
Mallet, K.A., C.M. Lee, C. Neighbors, M.E. Larimer and R.
Turrisi (2006) Do we learn from our mistakes? An
examination of the impact of negative alcohol-related
consequences on college students’ drinking patterns and
perceptions. Journal of Studies on Alcohol 67, 269-276.
Miami in fiske guide to colleges 2013; Architecture, business
and music among strong programs cited (2012) Retrieved
August
30,
2012,
from
http://www.miami.muohio.edu/news/article/view/17348.
Mond, J., T. Meyers, R. Crosby, P. Hay and J. Mitchell (2008)
Excessive exercise and eating-disordered behaviour in
young adult women: further evidence from a primary care
sample. European Eating Disorders Review 16, 215-221.
Muñoz, P.P., J.M. Quintana, C. Hayas, U.U. Aguirre, A.A.
Padierna and M.A. González-Torres (2009) Assessment of
the impact of eating disorders on quality of life using the
disease-specific, health-related quality of life for eating
disorders questionnaire. Quality of Life Research 18, 11371146.
Pasman, L.J. and J.K. Thompson (1988) Body image and eating
disturbance in obligatory runners, obligatory weightlifters,
and sedentary individuals. International Journal of Eating
Disorders 7, 759-769.
Read, J.P., M. Beattie, R. Chamberlain and J.E. Merrill (2007)
Beyond the “binge” threshold: heavy drinking patterns and
55
JYI | April 2013 | Vol. 25 Issue 4
 2013 Journal of Young Investigators
Journal of Young Investigators
RESEARCH
REVIEW
their association with alcohol involvement indices in college
students. Addictive Behaviors 33, 225-234.
Smith, R. (2008) Drunkorexia slimmers skip means for alcohol.
Daily Telegraph. Retrieved on September 6, 2012 from
http://www.telegraph.co.uk/news/
uknews/1582071/Drunkorexia-slimmers-skip-meals-foralcohol.html.
Stoppler, M.C. (2008) Drunkorexia, manorexia, diabulimia:
New eating disorders? MedicineNet. Retrieved on
September
6,
2012
from
http://www.medicinenet.com/script/main/art.asp?articlekey=
88014.
Wechsler, H. and S.B. Austin (1998) Binge drinking: the
five/four measure. Journal of Studies on Alcohol 59, 122124.
Wechsler, H., A. Davenport, G. Dowdall, B. Moeykens and S.
Castillo (1994) Health and behavioral consequences of binge
drinking in college. JAMA 272, 1672-1677.
56
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