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What to Know About Purging Disorder

Medically Reviewed by Mahammad Juber, MD on June 01, 2022

Purging disorder is an eating disorder similar to anorexia or bulimia. Despite not having a separate entry in the Diagnostic and Statistical Manual of Mental Disorders Text Revision (DSM-5-TR), it's a prevalent and harmful eating disorder.

About Eating Disorders

An eating disorder involves problematic eating behaviors. These behaviors are often the result of distressing thoughts and feelings about food, appearances, and weight.

There are many types of eating disorders. The most common eating disorders are:

Purging disorder is most similar to anorexia and bulimia, with some key differences. 

What Is Purging Disorder?

Purging disorder is when a person purges their food after eating. They may purge by vomiting or through excessive bowel movements.

Purging disorder is a mental health disorder, but it's not defined as a separate disorder in the DSM-5-TR. Purging disorder is considered an Eating Disorder Not Otherwise Specified (EDNOS).

Purging disorder vs. bulimia. Bulimia involves binge eating and getting rid of the food through vomiting or bowel movements. The person fears gaining weight, so they try to get rid of the food before they can gain weight.

Purging disorder vs. anorexia.Anorexia is similar to purging disorder. The difference is that someone with anorexia is underweight. Someone with purging disorder is an appropriate weight.

Prevalence. There are mixed findings on the prevalence of purging disorder. In the general population, about 1% to 5% of people have purging disorder.

Purging disorder is a common eating disorder. Around 7% of eating disorders are cases of purging disorder.

Like most eating disorders, purging disorder is more common in women. It most commonly develops around the age of 20.

Thoughts and Feelings Behind Purging Disorder

People with purging disorder often have misconceptions about their weight, body image, and health. They tend to develop negative feelings about food and eating because of these misconceptions.

People with purging disorder often have unrealistic goals about their bodies. They may purge to lose weight or change their body shape because of these misconceptions, despite being healthy. 

Purging Disorder Causes

Knowing why someone purges doesn't necessarily explain what causes purging disorder. Some suspected causes include:

  • Genetics
  • Neurotransmitter imbalances
  • Significant stress at home
  • Sexual abuse 

Purging Disorder Symptoms

Symptoms of purging disorder center around repeated purging. Someone who purges may self-induce vomiting or misuse laxatives, diuretics, or enemas.

A person with purging disorder may: 

  • Exercise too much 
  • Fear weight gain
  • Obsess over losing weight
  • Have self-image misconceptions about their weight or shape

Purging can lead to other symptoms and side effects that can be harmful to your health. These include:

  • Faintness
  • Hand scarring (Russell's sign)
  • Constipation
  • Dehydration
  • Nutrient deficiencies

Russell's sign is a unique symptom of self-induced vomiting. The back of the knuckles begins to scar after repeated contact scraping against your teeth. 

Complications. Purging can lead to severe damage over time. Self-induced vomiting can damage your teeth and esophagus as the acid from the vomit causes damage. 

Purging disorder's symptoms and side effects can damage your kidneys, cardiovascular system, and digestive system. Severe cases can even lead to kidney failure

Diagnosing Purging Disorder

Since purging disorder doesn't have a specific entry in the DSM-5-TR, there aren't exact guidelines for diagnosis. You'll be considered to have a purging disorder if you purge to change your weight or body shape.

Some studies have found that people with purging disorders purge once or twice a week. But this isn't a requirement for a diagnosis.

Purging Disorder Treatment

As an EDNOS, purging disorder doesn't have defined clinical treatments. Most doctors will use treatments that are effective against anorexia and bulimia.

You can treat purging disorder with the help of a team. You'll need friends, family, doctors, mental health professionals, and dietitians. 

Acknowledgment. The first hurdle for treatment is acknowledging the disorder. Many people with purging disorder don't realize that purging is a problem.

Cost and time. Treatments range in cost and time needed for treatment. Treatment can cost between $500 and $2,000. Successful inpatient treatment typically takes three to six months.

Cognitive behavioral therapy. Cognitive behavioral therapy is the most effective and preferred treatment method for purging disorders. It focuses on the ideas behind the disorder and the purging behaviors.

Cognitive behavioral therapy teaches you to identify and manage the thoughts behind your purging behaviors. You and your therapist will figure out the source of your disorder and the triggers for your self-image problems.

The final goal of cognitive behavioral therapy is to eliminate the purging behaviors and modify how you think about eating, weight, and self-image. You and your therapist can figure out how you conceptualize your goals and the method for approaching the disorder.

Family-based therapy. Treatment for purging disorder may lead to identifying the cause. Some purging disorders are rooted in stress at home or other family problems, so family therapy might be a beneficial treatment. 

Medication. If the cause of your purging disorder is a neurotransmitter imbalance, medications might help. Purging disorder can co-occur with depression or anxiety, so treating those conditions can help with purging disorder. 

There isn't a purging disorder medication. Your doctor may prescribe antidepressants, antipsychotics, or mood stabilizers to balance your brain's chemicals. 

If there are co-occurring conditions, they'll need treatment too. 

Nutrition counseling. People with purging disorder often have a concern about weight gain. The disorder makes it seem like purging is the way to manage your weight. 

Nutrition counseling can help you manage your diet and weight without purging. It teaches you how to make healthy diet choices and the importance of nutrition.

Hospitalization. In severe cases of purging disorder, you may need to be hospitalized. You'll be hospitalized if you're dangerously dehydrated, severely malnourished, or having a mental health emergency.

Outlook for Purging Disorder

Eating disorders are some of the deadliest mental health conditions. It becomes harder to treat eating disorders the longer they're left untreated. Relapses are also common. 

But with the right tools and support, you can overcome purging disorder. Treatment is long-term and requires commitment, support, and determination.

Show Sources

SOURCES:

Avalon Hills: "Purging Disorder."

Cleveland Clinic: "Anorexia Nervosa."

Clinical Orthopaedics and Related Research: "Russell's sign. Subtle hand changes in patients with bulimia nervosa."

Disorders.org: "Anorexia & Bulimia," "Purging Disorder."

Mayo Clinic: "Anorexia nervosa."

National Cancer Institute: "nutritional counseling."

National Institute of Mental Health: "Eating Disorders."

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