What Is Purging Disorder?

Purging disorder is defined as recurrent purging behavior to influence weight or shape in the absence of binge eating. Purging behavior includes vomiting, excessive exercise, extreme fasting, and using laxatives or diuretics (water pills) to control weight. Purging disorder is a serious and life-threatening disorder, yet it is treatable.

This disorder falls under the umbrella diagnosis of "other specified feeding or eating disorders (OSFED)" in the fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5). In previous editions of the DSM, it was known as "eating disorder not otherwise specified (EDNOS)."

Purging Disorder Symptoms

Eating disorders are complex and can present with an array of emotional, behavioral, and physical symptoms. The below symptoms are used in diagnosing an OSFED. Symptoms specifically for purging include, but are not limited to:

• Expressing behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns
• Having a preoccupation with weight, food, calories, grams of fat, and dieting
• Eliminating or refusing to eat certain foods or categories of food, such as no carbohydrates or no fat 
• Practicing purging behaviors such as going to the bathroom after meals, misusing laxatives, presenting with signs and/or smells of vomiting, going extended periods of time without eating, abusing diuretics
• Avoiding eating with others, appearing uncomfortable when eating with others, developing a fear of eating in public
• Developing food rituals, such as eating one type of food, eating the same foods at the same time daily, not allowing foods to touch, excessive chewing
• Skipping meals or eating very small portions of food
• Exercising excessively even when feeling tired, sick, injured, or fatigued to "burn off calories" 
• Showing extreme concern with body weight and shape  
• Checking the mirror frequently for perceived flaws in appearance
• Having extreme mood swings
• Feeling cold all the time
• Having difficulty sleeping
• Dry skin, hair, and nails
• Difficulty concentrating
• Menstrual and hormonal disturbances such as lack of menses, irregular menses
• Muscle weakness
• Dizziness
• Difficulty concentrating
• Dental issues such as teeth discoloration, erosion, sensitivity
• Experiencing complications of self-induced vomiting such as small bleeds in the eyes, lesions or scars on the hands, salivary gland swelling, dental issues such as teeth discoloration, erosion, sensitivity
  

Causes

Eating disorders typically appear in late adolescence and early adulthood, but risk factors are often present in early adolescence. There is no clear cause of purging disorder, rather there is a combination of causes.

Often eating disorders, like purging disorder, occur in conjunction with other psychiatric disorders, such as anxiety disorders, obsessive-compulsive disorder (OCD), and alcohol and drug abuse problems. In addition, genes and heritability can also play a role in increasing the risk of developing an eating disorder.

Certain personality traits, emotions, thinking patterns, and biological and environmental factors might be responsible.

Purging disorder is also associated with an elevated risk of suicide and intentional self-harm.

Diagnosis

To be diagnosed with purging disorder, a person must present with feeding or eating behaviors that cause clinically significant distress and impairment, but do not meet the full criteria for any of the other disorders, such as anorexia, bulimia, or binge eating disorder.

Identifying purging behaviors (such as excessive exercise, vomiting, and laxative and diuretic use) and complications of purging behaviors can help clinicians diagnose this type of eating disorder.

Treatment

Treatment of any eating disorder is typically more successful the earlier it is detected. Treatment involves a multidisciplinary approach, which includes guidance from a physician, registered dietitian, psychiatrist, psychotherapist, and other therapists as needed.

Depending on the severity of the disease, the course of treatment will be different. Often, a single therapy is not effective for every person with an eating disorder. Therefore, an individualized approach may be warranted. Many people with eating disorders benefit from cognitive behavioral therapy.

Genna Hymowitz, clinical assistant professor at Stony Brook University in New York, tells Verywell, "Purging disorder is generally treated using enhanced cognitive behavioral therapy, which is a version of cognitive behavioral therapy that was developed to help individuals with many types of disordered eating.

"Overall, there is very limited research looking at treatments specifically tailored to purging disorders. However, the research available does suggest that there is no significant difference in treatment outcomes between individuals with purging disorder and individuals with anorexia nervosa or bulimia nervosa."

Prognosis

In general, treatment of eating disorders can be easier if treatment begins before the disorder becomes chronic. But even people who've been experiencing eating disorders for years can and do recover.

Coping

For family members or loved ones of a person with an eating disorder, coping can be challenging. A strong support network is essential.

It's important to take care of your own needs and ask for help when you need it. Consider seeking counseling to help you work through feelings and situations. Mental health professionals can also help you to create tools for coping.

If you are a person living with purging disorder, know that it's OK to ask for help and that there are many resources available to guide you along your journey.

Purging Disorder vs. Bulimia

The main distinguishing factor between purging disorder and bulimia is that people with purging disorder do not binge. They may have feelings of shame or guilt after eating, but this can occur even when eating a small amount of food.

Hymowitz says, "One important thing to note is that some clinicians and researchers are proposing changes to the criteria we use to diagnose bulimia nervosa so that it includes individuals who feel out of control when eating or eat differently than they normally would but may not eat a large amount of food.

"This would likely mean that individuals who might now meet criteria for purging disorder would be considered as meeting criteria for a diagnosis of bulimia nervosa."

Summary

Purging disorder is a serious eating disorder classified under the umbrella term OSFED. In purging disorder, a person does not binge eat but repeatedly uses purging behavior such as vomiting, excessive exercise, fasting, or using medications to influence weight or shape.

The condition can be diagnosed by behavioral criteria. Treatment is through a multidisciplinary approach, including guidance from a physician, registered dietitian, and mental health professionals.

A Word From Verywell

Purging disorder is serious, but the good news is that, with early detection and intervention, it is treatable. If you think that you or someone you love has purging disorder, it's important to seek medical and psychological intervention as soon as possible.