Purging

When related to eating disorders, purging means abruptly expelling food from the body to avoid weight gain after consumption.

Behaviors that may illustrate purging include:

• Self-induced vomiting
• Taking laxatives/diuretics

While purging may have physical symptoms, it's generally the product of an underlying mental health issue. Understanding the definitions and traits associated with purging can you help identify this behavior in yourself or someone you care about. It's important to seek medical help for any signs of purging.

This article discusses the symptoms, causes, and risks of purging, how it relates to disordered eating, and when to see a doctor.

Symptoms of Purging

Purging involves trying to rid the body of food after eating in order to lose weight. It may occur along with the following behaviors and symptoms:

• Frequent bathroom visits during or shortly after meals
• Avoiding social situations that involve food
• Refusing to interrupt exercise for any reason
• Insisting on performing a certain number of repetitions of exercises
• Exhibiting distress if unable to exercise
• Strong focus on body shape, weight, and appearance
• Social withdrawal or isolation from friends
• Avoidance of previously enjoyed activities
• Distorted body image
• Heightened sensitivity to comments or criticism about body shape or weight, eating, or exercise habits
• Depression or anxiety
• Moodiness or irritability
• Obsessive behaviors or self-loathing
• Change in clothing style (such as wearing baggy clothes or dressing in layers)
• Sudden or rapid weight loss
• Frequent changes in weight
• Excessive use of mouthwash, mints, and gum
• Swollen cheeks or jawline
• Chronically inflamed or sore throat
• Vomit smell on their breath or person
• Broken blood vessels in the eyes
• Calluses or scrapes on knuckles
• Damage to teeth
• Fainting
• Dizziness
• Fatigue
• Stomach cramps, or other nonspecific gastrointestinal complaints (constipation, acid reflux, etc.) 
• Using laxatives or diuretics

Purging can cause serious harm to the body, and even be fatal. Anyone with symptoms of purging disorder should see a healthcare provider for help with treatment and protecting long-term health.

Sometimes purging can cause a need for immediate or emergency medical attention that cannot wait.

Serious symptoms that indicate urgent medical attention may be needed include:

• Dizziness or fainting: Dizziness or fainting can be caused by a number of factors, but dehydration is a major and likely cause with purging disorder.
• Chest pain, shortness of breath, or heart palpitations: Purging disorder can cause damage to the heart. It can also cause low electrolyte levels. These can lead to a drop in blood pressure, cardiac arrest, and other cardiovascular problems.
• Dehydration: Dehydration is a major and common complication of purging disorder, and can happen with any of the forms of purging. It is dangerous and can be fatal. Signs of dehydration include headache, delirium, confusion, fatigue, dizziness, weakness, lightheadedness, dry mouth and/or a dry cough, high heart rate but low blood pressure, loss of appetite but may be craving sugar, flushed (red) skin, swollen feet, muscle cramps, heat intolerance or chills, constipation, and dark-colored urine.
• Severe sore throat or acid reflux: Regular or forceful vomiting can damage the esophagus, sometimes irreversibly. It can cause a tear in the esophagus, causing bright red bleeding. It can also cause a burst in the esophagus, which requires emergency surgery.
• Tremors, weakness, or blurry vision: The imbalance of electrolytes and minerals that comes with dehydration can cause these symptoms and indicate medical treatment is needed.
• Abdominal pain: Purging disorder can cause a number of serious gastrointestinal and abdominal complications including kidney damage, tearing, and obstructions.
• Rectal bleeding: Purging can cause problems such as rectal prolapse.
• You think medical attention is needed urgently: If you think you or someone else needs immediate medical attention, seek it immediately, even if the symptoms don't fall under "typical" complications of purging. Purging can be damaging in many ways.

Causes of Purging

Several types of eating disorders can involve purging, including:

• Anorexia, which involves obsessing over food and weight and losing more weight than is healthy
• Bulemia, which involves excessive eating followed by self-induced vomiting
• Purging disorder, which doesn't share all of the symptoms of anorexia, and doesn't have the "bingeing and purging" associated with bulimia

In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), purging disorder falls under the category of other specified feeding and eating disorder (OSFED), previously known as eating disorder not otherwise specified (EDNOS).

To meet the criteria for OSFED, you must:

• Have predominant symptoms characteristic of a feeding/eating disorder without meeting the full criteria for any of the other feeding/eating disorder diagnostic classes.
• Exhibit behaviors that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The five presentations of OSFED are:

• Atypical anorexia nervosa
• Bulimia nervosa of low frequency and/or limited duration
• Binge-eating disorder of low frequency and/or limited duration
• Purging disorder
• Night eating syndrome

If you have purging disorder, you may exhibit purging behaviors without meeting the criteria for a diagnosis of another eating disorder such as anorexia or bulimia.

How to Treat Purging

Purging must be addressed by a healthcare professional. While there is no specific treatment for this symptom, there are treatments for the underlying conditions that can lead to it, such as binge eating disorder and bulimia nervosa.

Although each person’s symptoms and care needs will be different, some of the common therapies for these conditions include, but are not limited to: 

• Cognitive behavioral therapy
• Family of origin therapy 
• Dialectical behavioral therapy 
• Traditional talk therapy 

Therapy for purging and eating disorders can be conducted in an inpatient, outpatient, or virtual setting, depending upon your care needs and lifestyle. These therapies are meant to help you reframe your relationship with food and address the underlying causes of your dysfunctional relationship with it. At the same time, you can get help for the immediate physical risks and impact related to chronic purging.

Complications and Risk Factors Associated with Purging

Purging can cause many different complications depending on the type of purging. Some complications from self-induced vomiting or laxatives include the following:

Self-Induced Vomiting

• Dental problems: Gum disease, decayed or discolored teeth, sensitivity, and damage to tooth enamel
• Electrolyte imbalance or abnormalities: This can cause heart problems, and can be fatal.
• Cardiovascular problems: Low blood pressure, heart palpitations (rapid pounding or fluttering), an abnormal rhythm of your heart, cardiac arrest
• Enlarged parotid glands: Can cause pain and/or swelling under cheeks and in the jaw
• Bloating and constipation: Vomiting can slow the intestines.
• Frequent infections and sore throat: Inducing vomiting, and accidentally inhaling vomit, can cause throat and upper respiratory infections. Exposure to stomach acid can cause a sore throat and hoarse voice.
• Involuntary vomiting: A loosened gastroesophageal sphincter from repeated vomiting can make vomiting happen even with a burp.
• Cancer: Self-induced vomiting has been linked to esophageal cancer, though it is unknown if it causes the cancer.

Laxatives and Diuretics

• Kidney damage: Dehydration can damage the kidneys and cause them to function improperly.
• Electrolyte imbalance: Electrolytes such as potassium, sodium, chloride, calcium, phosphate, and magnesium that are needed for the body to function normally are lost through self-induced diarrhea. This affects the function of nerves, muscles, and vital organs. Kidney or heart failure or death may result
• Edema: The body retains fluid in response to excessive fluid loss, causing swelling. This can cause tight or stiff joints and skin, decreased blood circulation, and difficulty walking.
• Gastrointestinal problems: Can cause irregular digestive function, pancreatic damage, and constipation
• Permanent damage to the muscles used during digestion: Can cause paralysis to these muscles. Surgical removal of a section or the whole colon may be necessary, resulting in the need for a colostomy bag.
• Dependency: Prolonged use changes normal body functions, making the body dependent on the drugs to trigger bowel movement.
• Increased risk of cancer: Damage to the colon increases the risk of colon cancer.
• Cardiovascular and neurological problems: Misuse of laxatives and diuretics has been associated with cardiac arrest and seizures.
  

Are There Tests to Diagnose the Cause of Purging?

While there are no direct laboratory diagnostic methods for identifying purging disorder or associated conditions, there are multiple general lab tests and mental health assessments that can detect it. If you think you or your loved one may be struggling with disordered eating, here are some assessments to help you start your diagnosis and treatment journey:

• Mental Health America. Eating disorder test. MHA Screening
• National Eating Disorder Association (NEDA) Screening Tool

It's important to see your healthcare provider for purging behaviors. Your healthcare provider will conduct tests to help recommend treatment. Some of the initial tests at your first appointment may include:

• Comprehensive medical exam
• Complete blood count (CBC)
• Blood sugar testing
• Liver and kidney panels 
• Urine analysis
  

When to See a Healthcare Provider 

Getting help for purging disorder is vital. Early intervention is most effective.

If you think you may have purging disorder, see your healthcare provider.

If you suspect a loved one has purging disorder, encourage them to get help, but do so sensitively. Criticism and shame are likely to cause them to retreat. Establishing trust and communication, helping the person to see how their behavior is causing harm, is usually more effective.

For help with purging disorder coping and recovery:

• The National Eating Disorders Association (NEDA): A leading eating disorder nonprofit
• The National Association of Anorexia Nervosa and Associated Disorders, Inc. (ANAD): A nonprofit organization serving in areas of support, awareness, advocacy, referral, education, and prevention
• National Eating Disorders Association Free and Low Cost Support: Links to support groups and other resources
• National Eating Disorders Association Helpline: Online chat, phone, and text help

Summary

Purging is generally the result of an underlying mental health condition, but it can lead to serious physical health issues. It is best treated through a combination of immediate medical care and long-term mental health treatment to determine the root causes and sustaining factors.

A Word From Verywell

Left untreated, purging can cause complications that put your health at risk, and may be life-threatening. Untreated purging can be hard to handle psychologically as well.

Help for purging is available and effective, especially when started early.

If you or someone you know has symptoms of an eating disorder, including purging, make an appointment with a healthcare provider to discuss diagnosis and treatment plans.