What is Purging Disorder?
Purging disorder is an eating disorder where a person engages in a purging behavior(s) to attempt to influence body shape or induce weight loss, but does not binge (1). Therefore, it’s sometimes described or thought of as bulimia nervosa without binging.
Purging behaviors are typically employed to compensate for eating food, and they include (1):
- Self-induced vomiting
- Use of laxatives or diuretics
- Excessive exercise
Purging behaviors are usually done in secret and are typically accompanied by feelings of shame, guilt, and self-loathing (2).
Defining Purging Disorder
As purging disorder is not currently well-defined, researchers have not fully agreed on the condition’s definition. A key challenge of the current diagnostic system is in deciding where a person fits based on their disordered eating behaviors.
For example, excessive exercise has recently been considered to be a potential purging behavior (3). However, it’s not yet clear between researchers if excessive exercise alone is enough for a diagnosis of purging disorder, despite a recent study discovering excessive exercise has a similar psychopathology than those who purge via vomiting or laxative use (4).
Purging disorder is not listed as an official disorder in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). Rather, it’s included as a described condition within the Other Specified Feeding and Eating Disorder (OSFED) category (5).
The OSFED category is used to describe those with clinically significant eating disorders that don’t meet the diagnostic criteria for a primary eating disorder, such as bulimia nervosa, anorexia nervosa, or binge eating disorder. Just because purging disorder lacks its own category in the DSM-5 doesn’t mean that it can’t be just as serious as any of the primary eating disorders.
Who is at Risk of Purging Disorder?
Purging disorder typically develops during late adolescence and early adulthood (6). Research indicates that as a proportion of those seeking treatment for an eating disorder, 5% to 50% of adult patients and 14 to 28% of adolescent patients present with purging disorder (7).
It primarily affects women and people who are not at very low body weights. Due to current diagnostic criteria that prioritizes diagnosing anorexia nervosa (AN), purging disorder is not diagnosed in those who meet DSM body weight criteria for AN. Instead, these individuals would be diagnosed with the binge/purge subtype of anorexia nervosa (5).
Signs and Symptoms of Purging Disorder
All eating disorders present with a variety of physical, emotional, and behavioral symptoms. The signs and symptoms of purging disorder include, but are not limited to (1,6,7):
- Recurring episodes of purging behaviors in an attempt to lose weight, which can be evidenced by a person going to the bathroom after meals, presenting signs or smells of vomiting, going extended periods without eating, etc.
- Obsession with losing weight or an intense fear of gaining weight
- Self-esteem heavily influenced by body size, shape, and weight
- A preoccupation with the composition and caloric content of food
- Eliminating certain foods or entire food groups, such as no fat or no carbohydrates
- Avoiding eating with others and in social situations
- Developing food rituals, such as excessive chewing, eating the same foods at the same time, etc.
- Avoiding mirrors or frequent body checking for perceived flaws
- Extreme mood swings and difficulty concentrating
- Significant emotional distress and/or disruption to school, work, social, or personal life
Underlying Causes of Purging Disorder
Eating disorders are complex mental illnesses that don’t have a single cause. Rather, it’s the interaction between a number of biological, psychological, and social factors that contribute to the onset of an eating disorder, like purging disorder (8).
Contributing Factors to Eating Disorders (9)
- Family history of eating disorders
- Family history of mental illness
- History of dieting
- Negative energy balance
- Type I diabetes diagnosis
- Body dissatisfaction or negative body image
- Body dysmorphia
- Poor self-esteem in relation to appearance
- Perfectionism and/or behavioral inflexibility
- Personal history of anxiety disorder
- Weight stigma (i.e. the discriminatory idea that “thinner is better”)
- Being teased or bullied, especially about weight
- Thin-ideal internalization
- Acculturalization i.e. people from minority groups undergoing rapid Westernization
- Limited social networks
- Historical trauma
- Major and stressful life changes
- Dysfunctional family dynamics
- Body-focused careers, such as an athlete or personal trainer
Health Complications of Purging Disorder
Purging disorders can have both significant short-term and long-term complications to your mental and physical health. Different forms of purging have similar side effects including electrolyte and hormonal imbalances, dehydration, and organ damage.
Self-induced vomiting can lead to lesions or scars on the knuckles, broken blood vessels in the eyes, face, and neck, swelling of the salivary glands and throat causing a “puffiness” of the face, and dental issues, such as sensitivity, gum disease, and erosion.
Laxative use is associated with chronic diarrhea, rectal bleeding, and constipation without the aid of laxatives (2). The psychological side effects of purging disorder typically occur as a result of the addictive nature of purging behaviors. These effects are like those seen with other disorders, including mood swings, irritability, and heightened anxiety, particularly when a person is unable to engage in purging behaviors.
Additional possible health complications of purging disorder include, but are not limited to (1, 8):
- Dry skin, nails, and hair.
- Hormonal imbalances and menstrual disturbances, including lack of and irregular periods.
- Nutritional deficiencies, electrolyte imbalances, and dehydration.
- Sleep disturbances, including difficulty falling asleep and insomnia
- Feeling cold and fatigued all the time
- Muscle weakness and feeling faint
- Dehydration, which can lead to serious medical problems, like kidney failure
- Cardiovascular issues, such as an irregular heartbeat, abnormal blood pressure, and heart failure, stemming from electrolyte imbalances
- Anxiety, depression, or other mental health issues
- Digestive issues, including ulcers, esophageal tears, chronic acid reflux, abdominal pain, and constipation
Common Co-occurring Disorders
People suffering from an eating disorder are also likely to be living with another mood disorder at the same time. Research has suggested that as many as 89% of people with eating disorders have a co-occurring mood disorder or mental illness (10). As expected, people with purging disorder often have other psychological disorders (5, 7):
- Up to 70% have a mood disorder, such as depression or bipolar disorder
- Up to 43% have an anxiety disorder, such as panic disorder or obsessive-compulsive disorder
- Up to 17% have a substance use disorder
Purging disorder has also been linked to an increased risk of intentional self-harm and suicide.
How is Purging Disorder Different from Bulimia Nervosa
The primary difference between purging disorder and bulimia nervosa is that those with purging disorder do not binge (i.e eat an abnormal amount of food in a single sitting) before they purge. They are likely to have feelings of guilt or shame after eating, but this can occur when eating a meal or just a small snack (6).
Another key difference between purging disorder and bulimia nervosa, is that individuals with BN describe a greater loss of control around food. People with purging disorder also typically have more intense feelings of gastrointestinal distress after eating when compared with people who don’t have eating disorders and those with bulimia nervosa (5).
Purging Disorder: In Summary
Purging disorder is a serious eating disorder in the OSFED category. A person with purging disorder does not binge but regularly engages in purging behaviors like self-induced vomiting, laxative and/or diuretic use, fasting, or excessive exercise to attempt to influence body shape and/or weight.
Adolescents and young adults are most at risk of developing purging disorder and its onset is believed to be the result of a complex interaction between numerous biological, psychological, and sociocultural factors. Repeated episodes of purging can lead to significant health complications and co-occurring mental disorders are common, signifying the need for swift intervention.
- Sutton, J. (2019, February 21). Purging disorder: Symptoms, treatments, and more. Healthline. Retrieved June 24, 2022, from https://www.healthline.com/health/eating-disorders/purging-disorder
- Howard, Courtney. (2020, August 25). Purging disorder: Signs and symptoms. Eating Disorder Hope. Retrieved June 24, 2022, from https://www.eatingdisorderhope.com/blog/purging-disorder-signs-and-symptoms
- Lydecker, J. A., Shea, M., & Grilo, C. M. (2017). Driven exercise in the absence of binge eating: Implications for purging disorder. International Journal of Eating Disorders, 51(2), 139–145. https://doi.org/10.1002/eat.22811
- Lauren Muhlheim, P. D. (2021, February 28). How to identify purging disorder? Verywell Mind. Retrieved June 24, 2022, from https://www.verywellmind.com/purging-disorder-4157658
- Barbie Cervoni MS, R. D. (2021, October 7). What is purging disorder and how does it differ from bulimia? Verywell Health. Retrieved June 24, 2022, from https://www.verywellhealth.com/purging-disorder-5203044
- Oxford University Press. (n.d.). Clinical Handbook of Complex and atypical eating disorders. Oxford Clinical Psychology. Retrieved June 24, 2022, from https://www.oxfordclinicalpsych.com/view/10.1093/med-psych/9780190630409.001.0001/med-9780190630409
- Pugle, M. (2021, May 22). Purging vs. bulimia: Definitions, differences, and similarities. Verywell Health. Retrieved June 24, 2022, from https://www.verywellhealth.com/purging-vs-bulimia-5096503
- Risk factors. National Eating Disorders Association. (2018, August 3). Retrieved June 24, 2022, from https://www.nationaleatingdisorders.org/risk-factors
- Hudson, J. I., Hiripi, E., Pope, H. G., Jr, & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological psychiatry, 61(3), 348–358. https://doi.org/10.1016/j.biopsych.2006.03.040