From fad to FAD: A theoretical formulation and proposed name change for “drunkorexia” to food and alcohol disturbance (FAD)

Abstract

"Drunkorexia" is a term that has been used to describe behaviors such as restricting food intake in anticipation of alcohol consumption to offset total caloric intake, and/or to enhance the intoxicating effect of alcohol consumption. Scattered studies over the past few years have indicated the potential problematic nature of the intersection of these behaviors, yet there remain significant gaps in the operationalization of the construct, limiting research progress. In this article, we articulate limitations of the current research, including problems with the definition of the construct and a lack of theoretical guidance. We suggest a broader and more accurate phrase to guide future work with this phenomenon: Food and alcohol disturbance (FAD). Additionally, we suggest adapting Fairburn's transdiagnostic theoretical model for FAD. It is hoped these changes might provide a roadmap for future work in this area on risk factors and adaptations of current preventive and treatment approaches to focus on this emerging form of eating disturbance.

Drunkorexia: is it really “just” a university lifestyle choice?

“…It could, therefore, be further suggested that Drunkorexia, therefore, acts mainly as a compensatory behaviour to mask low appearance confidence in individuals with high disinhibition levels. These are important findings; as they link to the debate as to whether Drunkorexia is driven by similar motivations as eating disorders or substance abuse disorder [16,17]. The current results now suggest that it could possibly be either a symptom of EDs, i.e., engagement in Drunkorexia to prevent weight gain from alcohol, while the disinhibition factors of increased sensation-seeking may explain the aspect of substance use as a compensatory behaviour to feel the effects of alcohol quicker (i.e., to feel better about their appearance).…”

“…In this context, reduced eating is seen as both an inappropriate compensatory behaviour to avoid weight gain [16], and a food and alcohol disturbance [11]. While some limited research has been conducted investigating the prevalence of these behaviours, as well as underlying motivations and reasonings; many questions are left unanswered [17].…”

“…Furthering the debate as to whether Drunkorexia should be classes as an eating disorder or substance use disorder, Choquette et al [17], proposed that an adaptation of Fairburn's [26] well-known transdiagnostic model of eating disorders, to explain the onset and maintenance of 'Drunkorexic' behaviours. The authors argued that Drunkorexia should be viewed as a food and alcohol disturbance, rather than as a disorder (either eating disorder or substance use disorder).…”

“…While an increasing number of studies investigating Drunkorexia are being conducted, there are still a plethora of unanswered questions, often as a result of methodological limitations [17]:…”

Food and alcohol disturbance among young adults during the COVID-19 lockdown in Italy: risk and protective factors

“…However, to our knowledge, no study so far has investigated an emerging and serious combination of disordered eating and alcohol consumption named “food and alcohol disturbance” (FAD) [ 13 ] during the lockdown, and the potential factors that may have been involved in protecting or increasing vulnerability to this behavior. Sometimes referred to also as “drunkorexia” [ 14 , 15 ], FAD concerns a variety of unhealthy eating behaviors in which people engage in preparation or in response to alcohol consumption [ 16 ], and can include calorie restriction, fasting, self-induced vomiting, use of laxatives and/or diuretics, and excessive exercising [ 17 – 20 ].…”