Starving Themselves, Cocktail in Hand

Manorexia. Orthorexia. Diabulimia. Binge Eating Disorder.

All are dangerous variations on the eating disorders anorexia and bulimia and have become buzzwords that are popping up on Web sites and blogs, on television and in newspaper articles.

As celebrity magazines chronicle the glamorous and the suffering, therapists and a growing number of researchers are trying to treat and understand the conditions.

The latest entry in the lexicon of food-related ills is drunkorexia, shorthand for a disturbing blend of behaviors: self-imposed starvation or bingeing and purging, combined with alcohol abuse.

Drunkorexia is not an official medical term. But it hints at a troubling phenomenon in addiction and eating disorders. Among those who are described as drunkorexics are college-age binge drinkers, typically women, who starve all day to offset the calories in the alcohol they consume.

The term is also associated with serious eating disorders, particularly bulimia, which often involve behavior like bingeing on food — and alcohol — and then purging.

Anorexics, because they severely restrict their calorie intake, tend to avoid alcohol. But some drink to calm down before eating or to ease the anxiety of having indulged in a meal. Others consume alcohol as their only sustenance. Still others use drugs like cocaine and methamphetamine to suppress their appetites.

Dr. Bunnell, the past president of the National Eating Disorders Association, said the obsession with being skinny and the social acceptance of drinking and using drugs — along with the sense, lately, that among celebrities, checking into rehab is almost a given, if not downright chic — are partly to blame.

“Both disorders are behaviors that are glorified and reinforced,” Dr. Bunnell said. “Binge drinking is almost cool and hip, and losing weight and being thin is a cultural imperative for young women in America. Mixing both is not surprising, and it has reached a tipping point in terms of public awareness.”

Psychologists say that eating disorders, like other addictions, are often rooted in the need to numb emotional pain with substances or the rush provided by bingeing and purging. The disorders are often driven by childhood trauma like sexual abuse, neglect and other sources of mental anguish.

Manorexia is the male version of anorexia. Orthorexia is an obsession with what is perceived as healthy food — eliminating fats and preservatives, for example. But people with this condition can dangerously deprive themselves of needed nutrients.

Diabulimia refers to diabetics who avoid taking insulin, which can cause weight gain, in order to control their weight. Despite the name, the disorder does not typically involve purging.

Binge Eating Disorder refers to obsessive overeating, especially of foods high in salt and sugar, that does not involve excessive exercise or purging to compensate for the high caloric intake.

Many bulimics who drink use alcohol to vomit, experts on eating disorders say, because liquid is easier to purge. They also tend to vomit because they often drink on empty stomachs.

“In the beginning of my eating disorder I wouldn’t touch alcohol because it is so high in calories,” who later found herself regularly hospitalized for dehydration. “But I have the disease of more: I just want more no matter what it is.”

Two years into her drinking problem, she joined a 12-step program. She spent the next two years in and out of six residential rehab programs, spending about $25,000 of her own money. But none of the programs were equipped to address eating disorders, so she binged and purged and her eating disorder raged.

Studies show that binge drinking and alcohol abuse are on the rise among women, who are also more prone than men to eating disorders.

About 25 to 33 percent of bulimics also struggle with alcohol or drugs, according to a study published last year in the journal Biological Psychiatry. Between 20 and 25 percent of anorexics have substance abuse problems.

A growing number of researchers are examining the psychological and neurological links between eating disorders and substance abuse: Does eating a chocolate bar, or bingeing and purging, stimulate the same pleasure centers in the brain as drugs or alcohol?

Suzette M. Evans, a professor of clinical neuroscience at Columbia, recently began a study of the connection between bulimia and substance abuse, a field she said has been neglected.

“People are finally beginning to realize that food can function in the same way as drugs and alcohol,” Dr. Evans said.

As more patients seek treatment for both eating disorders and substance abuse, a complicated set of mixed messages can arise. The response to addiction is abstinence; but quitting food is not an option.