Purging Disorder

What is Purging Disorder?

Purging disorder is an eating disorder that falls in the category of Other Specified Feeding or Eating Disorder (OSFED). This means that people with purging disorder do not have the number or intensity of symptoms to be diagnosed with anorexia or bulimia nervosa, or binge eating disorder. Individuals with purging disorder regularly purge after eating, often by vomiting, and sometimes with the use of laxatives, or diuretics. The primary difference between purging disorder and both bulimia nervosa and binge eating disorder is the absence of binge eating. That is, people with purging disorder typically eat “normal” amounts of food without a sense of a lack of control over eating, eating speedily, eating until uncomfortably full, eating when not hungry, or experiencing feelings of shame, guilt, or disgust related to episodes of eating. Additionally, engaging in fasting, severe calorie restriction, or excessive exercise is typically not present in purging disorder. People with purging disorder are usually of normal weight, but they may be keeping their weight at a value that is below what is normal for their body. The prevalence of purging disorder is estimated to range from 1-5%.

What Are the Signs and Symptoms of Purging Disorder?

Like other eating disorders, signs of purging disorder include a preoccupation with body shape or weight and the ability to control weight and/or body shape. People with purging disorder may go to the bathroom consistently after eating (to throw up), or may regularly use laxatives or diuretics (if that is the preferred purging method). Changes in mood such as depression, or increased anxiety may also be observed. Other indicators are related to frequent vomiting such as swollen cheeks, broken blood vessels in the eyes, dental damage, scrapes, calluses, lesions, or erosion of the knuckles (from vomiting).

What Are the Dangers of Purging Disorder?

It is a misconception that purging is an effective method of weight control. Purging does not rid the body of all the calories consumed, even if done immediately after eating. Purging disorder is associated with a wide range of medical and mental health risks. Purging via vomiting (as opposed to laxative or diuretic use) is extremely harmful to the body. Eating disorders are serious mental health conditions associated with increased risk of death, partially related to the damage caused by vomiting. However, laxative and diuretic abuse carries it’s own set of serious and potentially life-threatening consequences. Medical risks can include:

  • Muscle weakness, lethargy, fatigue
  • Dehydration
  • Fluid and electrolyte imbalances
  • Abdominal discomfort
  • Broken blood vessels in the eyes
  • Dental damage (erosion, sensitivity)
  • Laxative dependence for bowel movements
  • Broken blood vessels in the eyes
  • Heartburn/acid reflux
  • Gastrointestinal problems, such as diarrhea and constipation
  • Stomach ulcers
  • Irritable bowel syndrome
  • Damage to the esophagus (such as tearing, in severe cases)
  • Kidney inflammation and damage (renal failure in extreme cases)
  • Cardiovascular complications are rare but serious and include irregular heart rate, congestive heart failure, or death)

With regard to mental health risks, purging disorder is associated with significant distress and/or impairment in social, employment, or other areas of functioning. Individuals with purging disorder are dissatisfied with their shape or weight and are purging in an attempt to change their bodies, so body dissatisfaction and poor self-esteem are common. In general, eating disorders are associated with other mental health disorders, especially anxiety and mood disorders such as depression. For some, depression and/or anxiety may be present before the onset of the eating disorder. However, depressed mood and increased anxiety commonly occur at the same time or soon after the onset of an eating disorder. People with purging disorder may also abuse substances like alcohol or stimulants. Mortality rates are high among people with eating disorders, and many of the deaths associated with eating disorders are due to suicide.

What Causes Purging Disorder?

The causes of eating disorders are complex and are generally thought to be the result of genetic (biological), environmental, and individual psychological factors. Placing a high value on body shape and weight, and how much these factors can be controlled, and engaging in methods to reduce food intake (dieting), increase the risk of developing purging disorder.

How is Purging Disorder Treated?

Given the serious medical and mental health risks associated with purging disorder, early treatment from a team of providers is important. Individuals with purging disorder should be seen by a medical doctor to determine the effects of purging on their physical health. On an outpatient basis, purging disorder is best treated with cognitive behavioral therapy (CBT), an evidence-based treatment for eating disorders. Treatment involves education, regular weighing, and self-monitoring of eating behavior, the introduction of regular eating, stopping purging behaviors, and engaging in discussions and activities aimed at eliminating factors contributing to the eating disorder. Depending on severity, however, patients with purging disorder may require more intensive treatment such as increased frequency of outpatient appointments, partial hospitalization, residential treatment, or medical hospitalization. In addition to a qualified mental health professional and physician, it is ideal to have a registered dietician on board as part of the treatment team.

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References:

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. New York, NY: Guilford.

Forney, K. J., Buchman-Schmitt, J. M., Keel, P. K., & Frank, G. K. W. (2016). The medical complications associated with purging. International Journal of Eating Disorders, 49(3), 249–259.

Written by Dr. Elisha Carcieri, 2019