When many think of the behaviour of purging after eating food, they instantly associate it with bulimia or anorexia. However, did you know that there is a specific eating disorder called Purging Disorder, not diagnosed as one of the two main eating disorders?
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What is Purging Disorder?
Purging Disorder is an eating disorder characterised by recurrent episodes of purging behaviours to control weight or shape. While many people associate purging behaviours with bulimia and anorexia, those with Purging Disorder primarily engage in purging without showing any signs of binge eating episodes.
Recurrent purging behaviours
Regularly engaging in self-induced vomiting, excessive exercise or the misuse of laxatives, diuretics or other medications to control weight or shape.
Physical consequences
Potential physical signs may include dehydration, electrolyte imbalances, swollen glands, dental issues (such as erosion of tooth enamel due to frequent vomiting) and gastrointestinal problems.
Concerns about food intake
Experiencing distress or guilt about normal or small amounts of food consumed and feeling the need to compensate through purging behaviours. Binge eating is not a characteristic of Purging Disorder.
Weight fluctuations
While weight loss may be a goal, individuals with Purging Disorder may experience weight fluctuations or may maintain a normal weight.
Secretive behaviour
Individuals with Purging Disorder may try to hide their purging behaviours, which can include going to the bathroom immediately after meals or finding excuses to engage in excessive exercise.
Changes in mood
Emotional distress, anxiety or depression may be present, often related to body image concerns and the cycle of purging behaviours.
Preoccupation with body image
An intense focus on body weight and shape, with a strong desire to be thinner or have a specific body shape.
Social withdrawal
Avoiding social situations that involve food or withdrawing from activities that may interfere with purging routines.
Note
The signs and symptoms of Purging Disorder can vary among individuals, and a qualified healthcare professional should make a formal diagnosis. If you suspect someone may be struggling with Purging Disorder or any eating disorder, encourage them to seek help from a healthcare provider or mental health professional. Early intervention and support are crucial for effective treatment.
Is Purging Disorder the same as anorexia or bulimia?
Because of the characteristic of purging, Purging Disorder is often mistaken by many for anorexia or bulimia, but it is, in fact, its own disorder. Here’s why it’s different from the other two eating disorders:
Purging Disorder differs from anorexia as individuals with anorexia are typically underweight, whereas those with Purging Disorder do not show signs of being underweight.
Purging Disorder is also distinct from bulimia nervosa because those with bulimia experience binge episodes, a characteristic not observed in those with Purging Disorder.
Due to these distinctions, Purging Disorder ends up falling between anorexia and bulimia in its clinical presentation.
This is precisely why the DSM-5 lists Purging Disorder as one of the specific presentations under the category of Other Specified Feeding or Eating Disorders (OSFED).
The inclusion of Purging Disorder within OSFED reflects the understanding that people may show clinically significant eating disorder symptoms that do not fit neatly into the specific categories defined for anorexia nervosa, bulimia nervosa or binge-eating disorder.
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What are the causes of Purging Disorder?
While there isn’t a large body of research that defines the causes of Purging Disorder specifically, there are some studies that focus on this:
Dieting and body dissatisfaction
In studies examining the onset of PD, it was found that higher levels of body dissatisfaction and more frequent attempts at dieting were important factors predicting the development of the disorder in the future.
Mental health issues
The same study shows that those with onset PD were receiving mental health care. This suggests that those with PD, or those with the chance of developing PD, suffer from mental health issues. It wasn’t made clear whether the mental health issues caused the PD symptoms or the PD symptoms caused the mental health issues. Regardless, a link was made between the two.
Stomach issues
One study found that those with PD experienced greater feelings of nausea and stomachache after eating compared to those who didn’t have PD. These increases were linked to higher levels of a digestive peptide called PYY, which signals the brain to delay the start of the next meal. Notably, women with PD showed a notably elevated PYY response after eating, distinguishing them from those who didn’t have PD.
What are the risk factors associated with Purging Disorder?
Purging Disorder, like any eating disorder, can have strong, negative impacts on every aspect of the sufferer’s life. This includes physical, psychological and behavioural issues. Some of the issues could be short-term, but if left untreated, the following problems could turn into long-term and even life-threatening issues:
Physical issues
Individuals with Purging Disorder can experience a range of serious physical issues due to the recurrent purging behaviours inherent in the disorder. These physical complications can have both immediate and long-term consequences on overall health. Here are some of the physical issues associated with Purging Disorder:
- Electrolyte imbalances: Frequent vomiting or misuse of laxatives can lead to disruptions in the balance of electrolytes in the body, such as potassium, sodium and chloride. Electrolyte imbalances can result in weakness, dizziness, cardiac irregularities and, in severe cases, can be life-threatening.
- Dehydration: Purging often involves the loss of fluids from the body, contributing to dehydration. Dehydration can manifest in symptoms such as dry skin, dizziness, fatigue and impaired cognitive function.
- Gastrointestinal complications: The digestive system can be adversely affected by purging behaviours. Conditions such as gastroesophageal reflux disease (GERD), inflammation of the oesophagus and peptic ulcers may develop, leading to pain, discomfort and potential long-term damage to the digestive tract.
- Dental issues: The stomach acid brought up during vomiting can erode tooth enamel, leading to dental problems such as cavities, tooth sensitivity and overall deterioration of oral health.
- Menstrual irregularities: Purging behaviours can impact hormonal balance, leading to menstrual irregularities in females. Amenorrhea (absence of menstruation) or oligomenorrhea (infrequent menstruation) may occur.
Psychological issues
Given that Purging Disorder is classified as an eating disorder, it is associated with a variety of significant psychological issues that can have a profound impact on an individual’s mental well-being. This could be by worsening existing mental health issues or by creating new ones (although this area needs more research). Here are some of the psychological issues associated with the disorder:
- Low self-esteem: The persistent preoccupation with body weight and shape, coupled with societal pressures and internalised stigma, can contribute to low self-esteem. Individuals may base their self-worth on their appearance, leading to feelings of inadequacy and self-criticism.
- Obsessive thoughts: Thoughts related to food, weight and the act of purging can become obsessive, consuming a significant portion of an individual’s mental energy. This preoccupation may interfere with daily activities and relationships.
- Anxiety and depression: Purging behaviours and the challenges associated with managing food intake could contribute to heightened levels of anxiety and depression. The distress stemming from the disorder’s rituals and secrecy could potentially further exacerbate these mood disorders.
Behavioural issues
In addition to the physical and psychological risks associated with Purging Disorder, it’s important to consider the behavioural issues that often accompany this condition. Individuals with Purging Disorder may exhibit a range of behaviours that can impact their daily lives and interpersonal relationships.
- Secrecy and isolation: People with Purging Disorder may engage in purging behaviours in secret, attempting to conceal their actions from friends and family. This secrecy can lead to increased feelings of isolation and may hinder their ability to reach out for support.
- Ritualistic behaviours: Purging behaviours can become ritualistic, developing into ingrained patterns that dictate the individual’s daily life. These rituals may extend beyond mealtimes and involve specific routines associated with purging, contributing to a sense of loss of control.
- Excessive exercise: Some individuals with Purging Disorder may engage in compulsive exercise to compensate for perceived caloric intake. This excessive exercise could lead to physical strain and injury and further exacerbate the purging cycle.
- Distorted body image: Like other eating disorders, Purging Disorder is often accompanied by a distorted perception of one’s body. Individuals may experience dissatisfaction with their appearance, even in the absence of objective evidence, leading to further emotional distress and potentially contributing to the maintenance of purging behaviours.
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Can you overcome Purging Disorder?
Overcoming any eating disorder is a complex process that requires specialised help and support. It’s important to recognise that any eating disorder, including Purging Disorder, is a serious mental health condition that can have severe physical and psychological consequences. This means that early intervention and treatment are key to recovery.
Here are some key areas that focus on overcoming a Purging Disorder:
What are the next steps?
Recognising purging disorder is a crucial step towards healing. Don’t face it alone—reach out for help now. In our modern world, seeking treatment is more accessible than ever, with rehab centres offering support tailored to your needs. Embrace the journey to recovery, prioritise your well-being and connect with professionals who can guide you towards a healthier, happier life. Your courage in seeking help is the first step toward a brighter future.
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