To lose weight and maintain a stable fit, adolescents and adults resort to “purging” rituals, which lead to serious health problems.
Purging disorder (PD) affects 2.5% of women each year, making it one of the most common eating disorders (ED) [1].
PD falls between anorexia nervosa (AN) and bulimia nervosa (BN) in its clinical presentation, raising questions about whether it is classified as a separate diagnosis or is a partial variant of these disorders.
It has a higher mortality rate (5.0%) compared to BN and AN (3.9), indicating a significantly greater risk to life [2].
“Purging” behavior is manifested by uncontrolled intake of laxatives and diuretics, abuse of enemas, self-induced vomiting, and deliberate starvation. People with PD objectively consume less food to achieve satiety, gradually losing control over their diet.
For example, one study found that they eat an average of 535 calories before purging, which is five times less than in bulimia [3].
People with PD symptoms need to understand that they are not hostages of the disease – at the end of treatment, complete remission is observed in 36% of patients [4]. Yes, they have fought hard for a chance to recover.
Purging Disorder Causes
There are no reliable statistics to establish the number of such people since many neglect medical care without realizing their diagnosis. Not only adolescent girls aged 16-18 suffer from PD, but many adult women, men, and transgender individuals.
Social pressure, physical and sexual abuse, and weight-focused sports (such as gymnastics) are common causes of the disorder. For example, girls who diet with positive expectations of thinness are most often at increased risk [5].
About 89% of people with an eating disorder have a comorbid mental illness [6], such as depression. They have increased anxiety and sensitivity, which often leads to addiction to psychoactive substances.
There is a correlation between the ED presence in the family anamnesis and the disease manifestation in relatives [7]. It is estimated that the risk of predisposition rises to 50%, where the remaining difference is related to social and environmental factors influencing the development of the disorder.
Purging Disorder Symptoms
Purging disorder is based on the impaired perception of one’s own body, which changes the relationship with food. Moreover, this is how the behavior of the patient usually looks in a simple example. Just imagine: your mood has deteriorated because of a couple of pounds gained. To lose weight, you go to the gym and do a hard workout. You can eat a small portion of protein food at home, let us just say, 300 calories. If you are a healthy person, you will not burn out from feeling guilty about eating. If you have an eating disorder, you will get rid of the consumed food as quickly as possible because this causes oversaturation and changes the shape of the abdomen.
Often, breakdowns can occur against the background of restrictions when much more calories are consumed than the daily norm. There is another extreme of PD – a person can consume a lot of alcohol or other psychoactive substances while not eating anything. In any case, eating without overeating and even night trips to the refrigerator will end with self-induced vomiting. Recurring episodes of “purging” behavior also include:
- Uncontrolled intake of laxatives and diuretics;
- Starvation;
- Excessive exercise in the gym or running;
- Abuse of enemas.
The whole life gradually revolves around food: the sick control the nutrition of their loved ones, painfully perceive the use of “unhealthy” food, and noticeably restrict themselves in food. Low self-esteem and possible comorbid personality disorders provoke social distancing. The patients frequently avoid buying new things – they choose oversized clothes that hide the silhouette.
Diagnosing Purging Disorder
Psychiatrists use the fifth edition’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to make an accurate diagnosis. As mentioned, PD borders on BN and AN because it has similar symptoms but differs in their severity. For instance, people with bulimia have lower self-esteem and a stronger eating disorder.
The critical factors in making a diagnosis are:
- Frequency of repetitive purging;
- The level of depression and anxiety;
- Suicidality;
- Perfectionism;
- Dissatisfaction with the body;
- Impulsivity;
- The use of psychoactive substances;
- The severity of the symptoms described above.
Severity scores are criteria that distinguish PD from other syndromes and can be validated as an independent diagnosis.
Treatment For Purging Disorder
Because PD is poorly understood and is often considered the symptom of other atypical disorders, there are currently few (if any) studies on its treatment. Nevertheless, do not be upset because a universal therapy is used for eating disorders with similar manifestations.
This treatment usually involves going to see a doctor, who will examine you and prompt you with questions.
In the case of talking to loved ones as to gently nudge them towards seeking professional help, this is what NEDA recommends [8]:
- Find the right time and place to talk, avoiding a lot of strangers and distractions.
- Rehearse the conversation, and try to be gentle with the feelings of the interlocutor.
- Use expressions that begin with words about your own experience. For example: “When we were having lunch last night, you hurriedly went to the bathroom.”
- Remind him or her that being upset is not embarrassing.
- Talk about acquaintances or other people who have a similar problem.
It is essential to be courteous and not accidentally devalue the other person’s feelings. Otherwise, this may lead to a refusal to visit the clinic and a desire to change something in your life.
Frequent complications requiring urgent hospitalization are:
- Bleeding in the eyes;
- Parotid swelling;
- Heartburn;
- Pyelonephritis;
- Expressed cardiovascular pathologies.
You can find help from your healthcare provider or by calling the National Eating Disorders Association helpline. To get free or low-cost support options, visit the NEDA website.
In general, PD treatment is multidisciplinary. Along with antidepressants, patients undergo cognitive-behavioral therapy, whose primary goal is to improve the relationship between food and their bodies.
36% of cured patients were not afraid of weight gain and worked with a psychotherapist. They understood the need for treatment by changing their lifestyle and habits.
The Bottom Line
The number of people with purging disorder is increasing every day, many of which have experienced violence or social pressure. Undeniably, it can feel like a massive challenge to fight it.
Over time, this disorder can lead to irreparable damage to your body. Hence, it’s crucial to recognize these symptoms and seek professional advice as soon as you can.
If you notice behind yourself any of the above symptoms, especially systematic cleansing behavior, know that you are not alone. Your experience and symptoms are not an indication of weakness, and this disorder can happen to anyone. When you feel ready, open up to loved ones and seek professional help. You don’t have to walk this journey alone.
Disclaimer: This article is only a guide. It does not substitute the advice given by your own healthcare professional. Before making any health-related decision, consult your healthcare professional.
Editorial References And Fact-Checking
- Keel P. K. (2019). Purging disorder: recent advances and future challenges. Current opinion in psychiatry, 32(6), 518–524. https://doi.org/10.1097/YCO.0000000000000541
- Koch, S., Quadflieg, N., & Fichter, M. (2013). Purging disorder: a comparison to established eating disorders with purging behaviour. European eating disorders review : the journal of the Eating Disorders Association, 21(4), 265–275. https://doi.org/10.1002/erv.2231
- Keel, P. K., Haedt-Matt, A. A., Hildebrandt, B., Bodell, L. P., Wolfe, B. E., & Jimerson, D. C. (2018). Satiation deficits and binge eating: Probing differences between bulimia nervosa and purging disorder using an ad lib test meal. Appetite, 127, 119–125. https://doi.org/10.1016/j.appet.2018.04.009
- Riesco, N., Agüera, Z., Granero, R., Jiménez-Murcia, S., Menchón, J. M., & Fernández-Aranda, F. (2018). Other Specified Feeding or Eating Disorders (OSFED): Clinical heterogeneity and cognitive-behavioral therapy outcome. European psychiatry : the journal of the Association of European Psychiatrists, 54, 109–116. https://doi.org/10.1016/j.eurpsy.2018.08.001
- Stice, E., Gau, J. M., Rohde, P., & Shaw, H. (2017). Risk factors that predict future onset of each DSM-5 eating disorder: Predictive specificity in high-risk adolescent females. Journal of abnormal psychology, 126(1), 38–51. https://doi.org/10.1037/abn0000219
- 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
- Berrettini W. (2004). The genetics of eating disorders. Psychiatry (Edgmont (Pa. : Township)), 1(3), 18–25.
- National Eating Disorders Association. (2022). HOW TO HELP A LOVED ONE. Retrieved August 19, 2022, from https://www.nationaleatingdisorders.org/learn/help/caregivers
