What is purging disorder?
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.
Signs and symptoms of purging disorder
Here are some common warning signs of purging disorder: (3,5)
- Recurring episodes of purging behavior to lose weight or change body shape, including:
- Self-induced vomiting
- Laxative and diuretic misuse
- Excessive exercise
- Extreme fasting
- Enema misuse
- Fear of gaining weight or an obsession with losing weight and dissatisfaction with body shape
- Self-esteem issues linked to weight and/or body shape
- Emotional distress, such as anxiety or depression
- Significant disruption to personal, work, or social life
- Frequent trips to the bathroom
- Calluses on hands from self-induced vomiting
- Dental problems
Effects of purging disorder
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)
- Feeling faint
- Muscle weakness
- Tooth sensitivity
- Facial swelling
- Stomach pain or discomfort
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)
- Nutrient deficiencies
- Electrolyte and chemical imbalances
- Small bleeds in the eyes
- Receding gums
- Tooth decay, erosion, and loss
- Calloused or scarred hands
- Stomach ulcers
- Damage to the esophagus
- Kidney problems from the use of laxatives
- Heart issues, including irregular heartbeat, damage to the heart muscles, hypotension, and congestive heart failure
- Pregnancy complications
- Mood swings
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.
Diagnosing purging disorder
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)
- Up to 70% have a co-occurring mood disorder
- Up to 43% have a co-occurring anxiety disorder
- Up to 17% have issues with substance use
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.
Treatment of purging disorder
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)
- Prevent purging and disordered eating behaviors
- Establish normal eating
- Address nutritional deficiencies
- Challenge unhelpful purging disorder related thoughts
- Create a plan to prevent relapse
- Address ongoing medical and mental health problems
Therapies for purging disorder
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:
- Cognitive Behavioral Therapy (CBT): CBT is a traditional approach to psychotherapy that helps individuals cope with the triggers of their purging disorder. Research has shown that CBT improves body dissatisfaction, obsession with being thin, anxiety and depression, and purging behaviors. (9) However there are many other types of talk therapy that can be just as effective. They include cognitive emotional behavioral therapy (CEBT), dialectical behavioral therapy (DBT), emotionally focused therapy (EFT), internal family systems (IFS), interpersonal therapy (IPT), and psychoanalysis.
- Nutrition Counseling: This form of therapy teaches people how purging disorder may prevent the body from receiving all the nutrients it needs to stay healthy. Through nutritional counseling, a therapist can work with a patient to develop meal plans that ensure nutritional needs are met and help reduce purging behaviors.
- Family Therapy: This type of therapy involves family members and teaches families about purging disorder and how they can support their loved ones during treatment. Family therapy can also help address unresolved conflicts at home.
- Group Therapy: This therapy involves a therapist who moderates a small group of individuals who have the same or similar disorders and meet to share experiences and support each other. It can be very healing for people to talk to others with the same disorder.
- Intensive Outpatient Treatment (IOP): IOP is a great option for those with purging disorder who have a stable home environment, but would benefit from structured treatment. Patients usually attend an outpatient clinic for a few days a week, while continuing with their treatment plan at home the rest of the time.
- Partial Hospitalization Programs (PHP): PHP is good for those with purging disorder who could benefit from more significant support than IOP. These programs consist of structured day treatment that individuals attend several days a week for several hours—they’re a step down from 24-hour inpatient hospitalization and a step up from IOP.
Medications for purging disorder
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)
How to help someone with purging disorder
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.