What is Purging Disorder?
Updated: Oct 9, 2020
Purging disorder is characterized by purging activities such as vomiting, excessive exercise, laxatives, or fasting to lose weight or obtain a specific body shape. It is different from bulimia in that no binge eating occurs before the purge and from anorexia in that the person isn't underweight.
Diagnosis Criteria.
Purging Disorder is categorized under Other Specified Feeding or Eating Disorders in the DSM-5. To be diagnosed, a patient must engage in repeated purging behavior in the absence of binge eating to influence weight or shape.
Symptoms.
recurring episodes of purging behaviors to lose weight, including:
self-induced vomiting
laxative or diuretic misuse
misuse of enemas
fasting
excessive exercise
significant emotional distress or disruption to social, work, or personal life
fear of gaining weight or obsession with losing weight
self-esteem issues heavily influenced by body shape or weight
Causes
For the most part, the reason for purging disorder is unknown. Research has shown that there isn't one cause connected to every case of purging disorder, but a multitude of interchangeable reasons. Not every case is the same. Causes are physiological, biological, and environmental.
Mental Health Disorders. Studies have found that eating disorder patients often have other psychological disorders such as mood disorder, depression, and anxiety. Many people also report negative emotions associated with their eating disorder, such as anxiety, boredom, anger, and sadness.
Run in Families. Families share not only genetics but also eating habits. Research hasn't found any genetic risks yet. Parents pass down their eating habits to their children, so if the parents have a pattern of disordered eating, the children will more likely too. It has been shown that people who experience less care from their mother while growing up are more likely to develop purging disorder.
Body Image. People with a negative body image are more likely to develop purging disorder. Negative body image includes having a fear of gaining weight, are overly focused on being thin, or unhappiness or frustration with their body. Negative body image can lead to frequent dieting and overeating and vice versa. Constant dieting is another risk factor for developing an eating disorder.
Weight Problems. Individuals with weight problems or higher body mass index are more likely to develop purging disorder. The factor that distinguishes purging disorder from anorexia is that purging patients are not underweight but of average weight or larder. Purging disorder patients have a history of dieting. Additionally, individuals who participate in appearance or weight-focused sports such as dancing are more likely to have an eating disorder.
Emotional Trauma. Stress can cause purging disorder, specifically, stressful life events like divorce, abuse, or death. It can be used as a coping mechanism for traumatic experiences. If a person feels they are losing control over their eating, they are more likely to develop an eating disorder.
Adverse Food Reaction. Some studies show that people with purging disorder may react differently to food. For instance, their stomachs may make more of certain hormones after eating. Those hormones might cause them to feel too full even when they haven't eaten much.
Statistics
Purging disorder most commonly emerges in late adolescence and early adulthood.3
Rohde, Paul, et al. "Development and Predictive Effects of Eating Disorder Risk Factors during Adolescence: Implications for Prevention Efforts." International Journal of Eating Disorders, vol. 48, no. 2, June 2014, pp. 187–198., doi:10.1002/eat.22270.
Research indicates that purging disorder is the presenting problem in 5% to 10% of adult patients and 24% to 28% of adolescent patients.4
Approximately 70% of patients with purging disorder have a mood disorder, 43% have an anxiety disorder, and 17% have a substance use disorder.
Purging disorder is also associated with an elevated risk of suicide and intentional self-harm.
Anderson, Leslie, et al. Clinical Handbook of Complex and Atypical Eating Disorders. Oxford University Press, 2018.
A review concluded that at least 25 percent of people with eating disorders are male. Plus, eating disorders like purging disorder are increasing at a faster rate among males than females.
Sweeting, Helen et al. "Prevalence of eating disorders in males: a review of rates reported in academic research and UK mass media." International journal of men's health vol. 14,2 (2015): 10.3149/jmh.1402.86. doi:10.3149/jmh.1402.86
A study concluded that up to 89% of eating disorder patients have co-disorders such as anxiety, depression, impulse control issues, and substance abuse.
Hudson, James I., et al. "The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication." Biological Psychiatry, vol. 61, no. 3, 2007, pp. 348–358., doi:10.1016/j.biopsych.2006.03.040.
Health Consequences
Purging by vomiting is extremely concerning behavior because it carries numerous medical risks ranging from metabolic disturbances, electrolyte imbalances that could lead to heart attack, dental problems, esophageal tears, and swollen salivary glands. Purging disorder can also cause problems with the bones and gastrointestinal systems and is associated with an elevated mortality risk. Misuse of laxatives can cause dependence on them and the disruption of normal bowel functioning. Diuretic misuse can also lead to significant medical consequences.6
Purging disorder can cause many serious side effects on your health, including:
feeling faint
tooth decay
throat swelling
facial swelling
mood swings
irregular heartbeat and other heart problems
scarred hands
pregnancy complications
kidney failure
digestive issues or constipation
dehydration
nutrient deficiencies
electrolyte or chemical imbalances
Self-induced vomiting can also lead to severe damage to other areas of your body over time, including your:
teeth
esophagus
digestive system
cardiovascular system
Treatment Options
There has been no research on which treatment option works for purging disorder patients, though there is some indication that cognitive-behavioral therapy, the most successful treatment for bulimia nervosa patients, may work. Programs to address mood intolerance and problem-solving may prove helpful.
People with purging disorder may also benefit from exposure with response prevention, which could involve eating reasonable amounts of food, learning to reinterpret physical sensations as a normal part of the digestive process, and preventing purging. Adolescents with purging disorder may be best served by family-based treatment (FBT), the leading treatment for adolescents with anorexia nervosa, although research is limited.
Treatment can be tailored to an individual's reasons for purging. If they purge because of what they believe to be out of control eating, these patients might respond better to bulimia nervosa therapy. If they purge for fear of weight gain, they may be more like anorexia nervosa patients and respond better to such treatment.
Other treatment options include psychotherapy, medication, and nutrition counseling. Though there is no medication to treat purging disorder, there are medications for mood disorders and other co-occurring mental disorders.
Author: Anderson, L.K.; Murray, S.B.; Kaye, W.H.
Publish Date: September 26, 2017
Price: $69 (Paperback)
Description: "Clinical Handbook of Complex and Atypical Eating Disorders brings together into one comprehensive resource what is known about an array of complicating factors for patients with ED, serving as an accessible introduction to each of the comorbidities and symptom presentations highlighted in the volume. The first section of the book focuses on the treatment of ED in the presence of various comorbidities, and the second section explores the treatment of ED with atypical symptom presentations. The third section focuses on how to adapt ED treatments for diverse populations typically neglected in controlled treatment trials: LGBT, pediatric, male, ethnically diverse, and older adult populations. Each chapter includes a review of clinical presentation, prevalence, treatment approaches, resources, conclusions, and future directions. Cutting edge and practical, Clinical Handbook of Complex and Atypical Eating Disorders will appeal to researchers and health professionals involved in treating ED."
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