A guide to differentiating Purging Disorder from all other eating disorders and understanding its nuances, intricacies, and treatment.
Eating disorders come in many forms, with shared commonalities and tendencies amongst them all. Purging disorder has parallels to both Anorexia and Bulimia disorder, however it is unique unto itself. Purging disorder is when an individual physically purges to prevent weight gain and to encourage weight loss. The intense fear and constant intrusive thoughts about weight gain is where Purging disorder and Anorexia cross paths; both eating disorders take active steps to prevent any type of weight gain and induce weight loss. The similarities between Purging disorder and Anorexia is the state of constant fear the individual finds themself in, which swiftly becomes an active and incessant motivator. Purging Disorder and Bulimia, however, share behaviour similarities. Both disorders are inclusive of the individual’s continuous purging to rid the body. There are psychological similarities amongst all eating disorders but Purging disorder and Bulimia are most alike in the way the mind manifests into specific action. Purging is not only self-induced vomiting, but can also include the misuse of diuretics, laxatives, extreme exercise, and prolonged restriction. Where Purging Disorder and Bulimia differ however is that Purging disorder does not include a binge prior to a purge. The binge-purge cycle is a key differentiation and a marquee behaviour for those who suffer from Bulimia Nervosa.
Purging disorder was first identified as an independent disorder in 2005 by Dr. Pamela Keel and colleagues. It is the belief however, that Purging disorder has been active long before its official introduction in 2005. Up until 2005 and the work done by Dr. Keel, those with Purging Disorder were either misdiagnosed with having Bulimia Nervosa or received no diagnosis at all. These two eating disorders are most similar in the behaviours displayed; however, the nuances of each eating disorder are different and are now treated as such. According to Dr. Keel’s research, Anorexia generally begins to develop at adolescence, whereas Bulimia begins to develop in an individual’s teenage years, at age 16 or 17. Purging Disorder, however, has been identified most in individuals in their late teens, and early 20’s. Much later in an individual’s emotional, psychological, and physical development than other common eating disorders. Purging disorder also affects 10x more women than men. Currently, Purging Disorder is a part of the eating disorder category known as Other Specified Feeding and Eating Disorder (OFSED) and is not listed as an official disorder in the Diagnostic and Statistical Manual of Mental Disorders.
The above statistics and information can seem bleak. And the truth of the matter is, it is bleak! Eating disorders are scary. They’re harmful. They’re manipulative. They’re all consuming. They’re also treatable. Eating disorders can be beat! Being diagnosed with an eating disorder does not need to define you or stay with you for the rest of your life. Treatment, healing, and help are all available and a future free of eating disorders is right around the corner.
What does Purging Disorder mean?
Purging disorder is a type of eating disorder wherein the individual purges or attempts to remove what has been consumed from their body. The removal is triggered by an overwhelming and all-consuming fear of gaining weight. Purging can include self-induced vomiting, inappropriate use of diuretics and laxatives, as well as extreme exercise or prolonged restrictive periods. Purging disorder is often mislabelled as Bulimia Nervosa however, Bulimia includes binges prior to a purge. Whereas with Purging disorder, “normal”, albeit sometimes small and restrictive portion sizes are consumed prior to a purge.
What causes Purging Disorder?
The singular similarity amongst all eating disorders is that there is no specific cause associated with any of them. There are no definitive connections between previous mental health diagnoses, life circumstances, or events that directly lead to an individual developing an eating disorder. What there is, however, are similar emotions, sentiments, and situations that those with Purging Disorder share. They are as follows, but not limited to:
– Nature (lived experiences)
– Nurture (your genetics)
– Pre-existing mental conditions
- Obsessive Compulsive Disorder
– Health conditions (allergies, sensitivities)
According to experts, those who suffer from Purging disorder have dual occurring psychological disorders:
- Up to 70% have a mood disorder
- Up to 43% have an anxiety disorder
- Up to 17% have a substance use disorder
What are symptoms of Purging?
Purging disorder is not classifiable as its own independent eating disorder, as it falls within the Other Specified Eating Disorder (OFSED) category ; however, there are clear signs and symptoms that an individual with Purging disorder displays. They are as follows:
- Recurring self-induced purges
- Inappropriate use of diuretics and laxatives
- Inappropriate use of enemas
- Periods of extreme fasting
- Excessive exercise
- Signs of emotional distress, highly anxious, intensely preoccupied
- Fear of weight gain; constantly checking, measuring, and analyzing their appearance
Who gets affected by purging disorder?
Similar to the way in which the causes of eating disorders are vast, there is not an archetype of who develops Purging disorder. With that being said, Purging disorder typically emerges in early adulthood, primarily in women. Although women are predominantly diagnosed with eating disorders, they affect all genders.
What are side effects of purging?
The side effects of Purging disorder can be severe. The constant purging and excessive use of diuretics and laxatives are incredibly detrimental to one’s health and taxing on the body. Although there are likely times in everyone’s life when they fall ill, and vomiting is a side effect (the flu, food poisoning) those limited times are not nearly as impactful as constantly induced purging. The side effects of Purging disorder are as follows:
- Tooth decay and tooth enamel wearing
- Throat swelling
- Facial swelling
- Cardiovascular irregularities
- Calloused and bruised hands, in particular knuckles
- Digestive problems, constipation, diarrhea
- Vitamin and mineral deficiencies
- Thinning hair
- Irregular sleep
- Irritated esophagus, possible abrasions
What does treatment look like for Purging disorder?
Treatment for Purging Disorder follows a similar structure to the treatment of other eating disorders. Although eating disorders are sometimes reflected most acutely in someone’s physical appearance, obsessed with body composition and the numbers on a scale, all eating disorders are psychological in their origin. It is therefore critical to address the individual’s mind. Therapy is a necessary component of dealing with eating disorders, inclusive of Purging disorder. Working through the root causes and present emotional challenges and beliefs are very important in creating a brighter path forward. Furthermore, it is often important that those with Purging disorder also work with a Naturopathic Doctor, Registered Dietician, or Nutritionist to gain a better understand of the physical needs of the body, the importance of fuel, and the impacts the individuals constant purging is taking on the mind and body.
Q: Is purging the same as vomiting?
A: Vomiting and purging both involve the removal of. More specifically vomiting is when the contents of one’s stomach are regurgitated. Vomiting is a type of purging, which can be self-induced or because one is sick. Vomiting can be passive wherein the individual is not initiating the action, they may have food poisoning or the flu. There are different kinds of purges, be it emotional or physical. The definition of purge is to “rid of unwanted quality, condition, or feeling”. Purging is an active state, the individual is taking steps to rid.
Q: How can purging disorder be prevented?
A: There is no singular way to prevent anyone from developing an eating disorder. In the same way that you can’t prevent anyone from developing anxiety, depression, obsessive compulsive disorder, or any other disease for that matter, it is believed that eating disorders are innate, those who develop them are born with the potential to develop them. With that being said, eating disorders do not develop overnight, they are gradual. It is important to stay cognizant of people you love and care about if you believe they are displaying signs of problematic behaviour. In a supportive and compassionate way, speak openly with the individual you are worried about, try to understand the precarious and challenging position they have found themselves in, free of judgements and assumptions. Developing a trusting connection is important to greeting a safe space for the individual to open up and share.
Q: How many people have purging disorder?
A: It is hard to quantify the amount of people or proportions of a population that suffer from purging disorder, or all eating disorders for that matter. There is an incredible amount of stigma that still surrounds eating disorders, they are notoriously under-reported therefore underrepresented. However, according to VeryWellMind, it is believed that purging disorder is present in 5 – 10% of adults, and 24 – 28% of adolescents.
Q: Do you lose weight from purging disorder?
A: Some eating disorders stem from a deeply troubling and overwhelming fear of gaining weight. So much so that extreme measures are taken to not only avoid gaining weight but to actively lose weight. It is not possible however, to lose such a severe amount of weight without terribly troubling consequences. It is possible that those individuals with purging disorder do lose weight, however, purging is one of the least productive and healthy behaviours an individual can engage in at the hands of their eating disorder.