Psychiatrist and eating disorders specialist David Herzog, MD, believes alcohol may help alleviate the anxiety about food that plagues women with eating disorders. Comments from chat rooms devoted to drunkorexia seem to confirm Herzog's observation. "I don't eat a lot because when I get my glass of wine, it will go straight to my head and then I can relax," writes one commenter. "I find when I have a few glasses, I feel less guilty about eating—and that's the excuse I give myself to finally eat."
Not surprisingly, drunkorexia can have serious consequences. Substituting alcohol for food leads quickly to malnutrition, and from there to organ damage and weak bones. There is also the more immediate concern of blackouts and the potential for physical injury along with leaving oneself vulnerable to sexual assault. In a long-term study of 136 anorexics co-directed by Herzog and colleagues, alcohol abuse was the strongest predictor of an early death.
Treating an eating disorder alone is tricky enough; trying to control alcohol abuse simultaneously means that therapists must use addiction techniques to help sufferers. "We try to get them to identify what the alcohol is giving them that's so important—is it to manage social or food anxiety?" says Wilkens. "Then we help them learn alternative ways to cope—stress reduction techniques such as yoga and exercise."