A look into purging eating disorder

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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 purging 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.

Last updated on 
September 15, 2022
In this article

What is purging disorder?

Individuals with purging disorder engage in repeated purging behaviors, such as: (1)

  • Laxative misuse
  • Self-induced vomiting
  • Diuretics use
  • Excessive exercise 

Purging disorder does not involve binge eating. As such, the main component of this condition is purging behaviors. (1) People with purging disorder engage in these behaviors in an attempt to control their weight, size, or shape.

Purging 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)

How is purging disorder different than bulimia nervosa?

Both eating disorders involve self-induced vomiting as well as other types of purging, 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, purging 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, purging 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)

Symptoms of purging disorder

As with other eating disorders, purging disorder is characterized by significant impairment in life functioning. Although there is no formal criterion for purging disorder, other symptoms may include: (1)

  • Recurring episodes of purging in an attempt to lose or control weight, such as: Compulsive exercise, misusing laxatives, misusing diuretics, using enemas, compensatory restriction, using other medications to attempt to lose weight
  • Preoccupation with weight and appearance
  • Self-esteem heavily dependent on weight or appearance
  • Profound fear of gaining weight
  • Significant psychological and emotional distress

Contrary to popular belief, people of all sizes, shapes, and weights can struggle with eating disorders like purging disorder, which is why it’s so important to know the symptoms.

Risk factors 

Like other eating disorders and mental health conditions, purging 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 purging disorder, but general eating disorder risk factors include: (3, 4)

  • Physical abuse
  • Sexual abuse
  • History of trauma or PTSD
  • Obsessive compulsive traits or disorder
  • Participating in weight-focused or appearance-based sports, such as wrestling, gymnastics, figure skating, or dance
  • Perfectionism
  • Dieting
  • Family dieting
  • Higher body weight in childhood
  • Weight-based bullying
  • Family history of eating disorders
  • Stress
  • Body dissatisfaction
  • Low self-esteem
  • Depression and anxiety
  • Adopting cultural norms related to the “ideal” body

Harmful consequences of purging disorder

Purging 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)

  • Oral bleeding
  • Small bleeds in the eyes
  • Tooth pain
  • Gingival recession
  • Dental lesions
  • Tooth decay
  • Parotid gland swelling
  • Esophagitis
  • Gastroesophageal reflux
  • Heartburn
  • Acid regurgitation
  • Severe dehydration
  • Irregular esophageal contractions
  • Rectal prolapse
  • Rectal bleeding
  • Relaxed sphincter tone
  • Irritable bowel syndrome
  • Cardiovascular complications, such as congestive heart failure, heart attack, hypotension, and tachycardia
  • Kidney inflammation
  • Bowel dysfunction
  • Seizures
  • Rhabdomyolysis (dangerous breakdown of muscle tissue)
  • Bloody stool
  • Constipation
  • Pancreas damage

Additionally, the mortality rate is much higher among people who have eating disorders, however the specific rate for purging 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 purging disorder as well as other eating disorders, is just over 5%. (6)

Treatment for purging disorder

Because purging 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 purging disorders. These therapies may include:

  • Cognitive behavioral therapy (CBT): Patients learn the connection between their thoughts, feelings, and behaviors to reduce purging behaviors, prevent relapse, and modulate mood.
  • Dialectical behavior therapy (DBT): Patients learn many different skills that can help reduce or eliminate purging behaviors, such as mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. 
  • Exposure therapy: Patients are gradually exposed to fears in a safe, monitored environment. For people with purging disorder, this may involve an inability to engage in their preferred behaviors, such as not being allowed to exercise that day.
  • Acceptance and commitment therapy (ACT): Patients are encouraged to accept various parts of their lives, even the negative emotions and experiences, as well as to change maladaptive behaviors, such as purging, and to act in line with their individual values.

Some people may benefit from outpatient treatment for purging 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.

Resources

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
  2. Science Daily. (2022). Researcher looks into little known ‘purging disorder.’
  3. Mitchison D. and Hay, P. (2013). The epidemiology of eating disorders: Genetic, environmental, and societal factors. Clinical Epidemiology 6: 89-97.
  4. National Eating Disorders Collaboration. (n.d.). Risk & Protective Factors.
  5. Forney, K. J., Buchman-Schmitt, J. M., Keel, P. K., & Frank, G. K. (2016). The medical complications associated with purging. The International journal of eating disorders, 49(3), 249–259.
  6. Crow, S. J., Peterson, C. B., Swanson, S. A., Raymond, N. C., Specker, S., Eckert, E. D., & Mitchell, J. E. (2009). Increased mortality in bulimia nervosa and other eating disorders. The American journal of psychiatry, 166(12), 1342–1346.

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