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Many people are familiar with eating disorders like anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), but they may not be aware of purge disorder. Purging disorder, which is characterized by excessive purging behaviors but no binging, is often mistaken for bulimia nervosa but is considered by the DSM-5 to be a different diagnosis.
Individuals with purge eating disorder engage in repeated purging behaviors, such as: (1)
Purge disorder does not involve binge eating. As such, the main component of this condition is purging behaviors. (1) People with purge disorder engage in these behaviors in an attempt to control their weight, size, or shape.
Purge disorder falls under the category of Other Specified Feeding and Eating Disorders (OSFED) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is the standard classification of mental health conditions used by mental health professionals throughout the U.S. (1)
Both eating disorders involve self-induced vomiting as well as other types of purge such as excessive exercise or laxative use. However, bulimia nervosa also involves binge eating episodes in which a person consumes a large quantity of food, often uncontrollably, in a short period of time. Unlike bulimia nervosa, purging disorder doesn’t include binge eating episodes. (2)
Moreover, purge is the main behavior and characteristic of purging disorder, whereas someone with bulimia nervosa may engage in other disordered eating behaviors, such as restricting and body image distortions. (2)
Another difference is that because it is well understood by most professionals, bulimia nervosa has its own diagnosis in the DSM-5. Conversely, purge disorder, which is under researched, falls under the broad category of Other Specified Feeding and Eating Disorder. This category is reserved for eating disorders that don’t meet the diagnostic criteria for binge eating disorder, anorexia nervosa, and bulimia nervosa. There is a misconception that these additional eating disorders aren’t as severe as the three most common types, but that’s not true; purging disorder can be just as dangerous as bulimia nervosa and other eating disorders. (1, 2)
As with other eating disorders, purge disorder is characterized by significant impairment in life functioning. Although there is no formal criterion for purging disorder, other symptoms may include: (1)
Contrary to popular belief, people of all sizes, shapes, and weights can struggle with eating disorders like purge disorder, which is why it’s so important to know the symptoms.
Like other eating disorders and mental health conditions, purge disorder does not have a singular cause; rather, it is caused by many intersecting biological, psychological, and sociological influences known as risk factors. Risk factors increase a person’s likelihood of developing purging disorder, although they don’t necessarily mean that someone is destined to develop this condition.
There is little known about the risk factors that are specific to purge disorder, but general eating disorder risk factors include: (3, 4)
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Purge disorder is a severe and dangerous eating disorder that can significantly harm a person’s physical and mental health. Dangerous effects of purging disorder may depend on a person’s specific purging behaviors (i.e. self-induced vomiting may have different effects compared to laxative misuse). However, potential risks include: (5)
Additionally, the mortality rate is much higher among people who have eating disorders, however the specific rate for purge disorder is not currently known. This may be due to challenges surrounding identifying the cause of death using death certificates since families frequently list other causes. (5) One study found that the mortality rate for Other Specified Feeding and Eating Disorders, which includes purge disorder as well as other eating disorders, is just over 5%. (6)
Because purge disorder hasn’t been well-studied, specific treatment has not been established for this condition. According to an eating disorder professional, most eating disorder treatment programs and modalities focus on treating binge eating and restriction and there is a greater need for specific modalities that treat symptoms when binge eating is absent. (1)
However, many different therapies are used to treat eating disorders at large, some of which may be beneficial for people with purge disorders. These therapies may include:
Some people may benefit from outpatient treatment for purge disorder while others may need a higher level of care, such as partial hospitalization (day treatment), intensive outpatient (IOP), or inpatient or residential treatment. Virtual treatment is also a beneficial option, especially for people who experience geographical barriers to care or have obligations that prevent them from attending in-person care.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
