Purging Disorder (PD) is a serious eating disorder that involves recurrent episodes of compensatory behaviors aimed at influencing weight or body shape. Recognized by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), PD involves actions such as self-induced vomiting or the misuse of laxatives, diuretics, or enemas. Crucially, it occurs without the characteristic objective binge-eating episodes that define Bulimia Nervosa.
Defining Purging Disorder
Purging Disorder is formally classified under the category of Other Specified Feeding or Eating Disorder (OSFED) in the DSM-5. This designation is for presentations that cause significant distress but do not meet the full criteria for Anorexia Nervosa or Bulimia Nervosa. The central feature that distinguishes PD is the presence of recurrent purging behaviors in the absence of objective binge eating, meaning the individual purges after consuming a normal or small amount of food.
The distinction from Bulimia Nervosa is based on the absence of objective binge episodes, as both disorders involve recurrent inappropriate compensatory behaviors. PD is differentiated from Anorexia Nervosa, purging type, by the individual’s weight status; people with Purging Disorder maintain a normal or higher body weight, whereas an Anorexia Nervosa diagnosis requires the individual to be significantly underweight. The diagnosis is reserved for individuals who experience significant distress and impairment due to the purging behaviors and preoccupation with body shape and weight.
Specific Behaviors and Warning Signs
The behaviors associated with Purging Disorder center on intentionally removing food from the body. The most commonly recognized method is self-induced vomiting, which is often done immediately after eating a meal or snack. Other pharmaceutical methods include the misuse of laxatives, diuretics, or enemas.
Behavioral indicators often involve secretiveness and isolation surrounding food and eating. A common warning sign is frequent trips to the bathroom immediately following meals, or spending excessive amounts of time in the restroom.
Psychological indicators include an intense preoccupation with body shape and weight, which unduly influences the person’s self-evaluation. Individuals may also exhibit withdrawal from social activities, particularly those that involve eating, or may engage in excessive exercise as another form of compensation.
Physical and Psychological Effects
The chronic nature of purging behaviors leads to severe medical complications throughout the body. One of the most dangerous physical effects is the disruption of the body’s electrolyte balance, particularly involving potassium and sodium, which can lead to life-threatening cardiac arrhythmias. Dehydration from fluid loss is also common, contributing to feelings of dizziness, fainting, and potential kidney inflammation.
Repeated self-induced vomiting exposes the mouth and esophagus to strong stomach acid, resulting in dental erosion and chronic sore throats. This acid exposure can also cause damage to the lining of the esophagus and lead to gastroesophageal reflux disease. Swelling of the parotid and salivary glands in the cheeks is another visible sign, often giving the face a puffy appearance.
Purging Disorder is frequently accompanied by significant psychological co-morbidities. High rates of depression and anxiety are observed. The secretive nature of the disorder can foster feelings of intense guilt and shame, which perpetuates the cycle of disordered eating behavior.
Diagnosis and Treatment Options
Diagnosis of Purging Disorder is a clinical process that relies on a thorough interview and assessment of the individual’s eating behaviors and psychological state. Clinicians use the criteria outlined in the DSM-5, which involves confirming the recurrent purging behaviors and the absence of binge eating, along with ruling out other diagnoses like Anorexia Nervosa. A medical evaluation, including laboratory tests to check for electrolyte imbalances, is also conducted to identify and address immediate health risks.
Treatment for Purging Disorder typically involves a multidisciplinary approach encompassing psychological therapy, nutritional rehabilitation, and medical monitoring. The leading evidence-based psychological intervention is Enhanced Cognitive Behavioral Therapy (CBT-E), which is a “transdiagnostic” treatment effective for all eating disorders. CBT-E works by addressing the core psychopathology, such as the overvaluation of body shape and weight, and helps the individual establish a regular pattern of eating.
Nutritional rehabilitation focuses on normalizing eating habits and restoring a healthy relationship with food, guided by a specialized dietitian. For co-occurring mental health conditions like severe depression or anxiety, medications such as selective serotonin reuptake inhibitors (SSRIs) may be considered as an adjunct to psychotherapy. Medical monitoring is continuous, especially in the early stages, to correct any dangerous electrolyte disturbances and manage physical complications resulting from the purging behaviors.