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Purging disorder is an eating disorder that involves purging to lose weight or change body shape, but no binging. It can be confused with bulimia nervosa (BN), because it has some of the same signs and symptoms. (1)
Purging disorder behaviors include vomiting after meals, laxative and diuretic misuse, excessive exercise, and extreme fasting–but no binge episodes. (2)
It is estimated that up to 10% of adults and nearly 30% of adolescents who seek treatment for an eating disorder have purging disorder. (3) This eating disorder usually develops in late adolescence and early adulthood, and it primarily affects women who are a “normal” weight or slightly higher. (4) But like all eating disorders, purging disorder can affect people of any age, gender identity, or size.
While purging disorder may not be as well understood as other eating disorders, it can still cause serious harm to both mental and physical health.
Here are some common warning signs of purging disorder: (3,5)
In the short term, the effects of purging disorder can be hard to detect. Electrolyte imbalances can cause a person to feel overly tired and lethargic. Stress on the digestive system can lead to gastrointestinal issues and dental problems.
Common short-term effects of purging disorder include: (3,5)
The long-term dental, digestive, muscular-skeletal, cardiovascular and kidney issues associated with purging disorder are significantly more serious and can lead to death. They include: (3,5,6)
The effects of purging disorder can also have a serious impact on a person’s emotional well-being. People who engage in purging behaviors often feel shame and therefore become increasingly isolated, which can put a strain on their relationships, as well as impact their social, work, and personal life.
For a diagnosis of purging disorder, an individual must present with purging behaviors that cause clinically significant distress, to the point where daily life is disrupted, but don’t meet the full criteria for other eating disorders. (2) These behaviors include self-induced vomiting, laxative and diuretic misuse, excessive exercise, and extreme fasting.
As the current diagnostic system prioritizes the diagnosis of anorexia nervosa (AN), purging disorder cannot be diagnosed in underweight individuals. In the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5), purging disorder is categorized as an “Otherwise Specified Feeding or Eating Disorder,” or OSFED. (3)
Purging disorder often occurs with other psychiatric disorders. These are called comorbidities. Research suggests that: (2)
Research has indicated those with purging disorder have higher levels of eating psychopathology, impulsivity, dietary restraint, and body dissatisfaction, as well. (7) Purging disorder is also associated with an increased risk of self-harm and suicidal ideation.
As with any eating disorder, treatment of purging disorder is more successful the earlier it is diagnosed. (8) Treatment involves a multidisciplinary approach, with collaboration from a dietician, physician, psychotherapist, psychiatrist, and other medical professionals if necessary.
The course of treatment depends on severity of the purging disorder and co-occurring disorders. Often, a single therapy is not always effective in the treatment of purging disorder. Therefore, an individualized treatment plan consisting of several treatment modalities is likely to be the best approach for each patient .
The goals of treatment for purging disorder are to: (8)
While residential treatment may be necessary in some cases where purging behavior is extreme and there is a serious health risk, the most common treatments for purging disorder include:
Medications aren’t prescribed to treat purging disorder. Instead, they may be used to treat co-occurring mood disorders--such as anxiety and depression--that cause additional stress to a patient and must also be treated for recovery to be possible. (3)
Early treatment is key if you or your loved one is showing signs of purging disorder. The first steps on the road to recovery are recognizing there’s a problem and asking for help. It’s not easy. But the earlier you seek treatment, the better the chances are for a full recovery. Our intake team is a phone call away if you’d like to start eating disorder treatment at Within Health, or learn more about our virtual care programs.
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.
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