Table of ContentsView AllTable of ContentsWhat Is Purging Disorder?Evolving DefinitionAffected PopulationsPurging Disorder vs. Other DisordersCo-Occurring DisorderRisksTreatment

Table of ContentsView All

View All

Table of Contents

What Is Purging Disorder?

Evolving Definition

Affected Populations

Purging Disorder vs. Other Disorders

Co-Occurring Disorder

Risks

Treatment

If you purge or exercise excessively, you might wonder whether you would be considered to havebulimia nervosa. But what if you purge but don’tbinge? This may mean that you have a different problem: purging disorder.

Purging disorder is an eating disorder that is diagnosed when a person purges to influence body shape or weight but does not binge. It can be thought of as bulimia nervosa without bingeing. Many who write about the disorder seem to assume that vomiting is the default form of purging, but laxative and diuretic misuse are also common. Some people also engage in other behaviors to compensate for eating, includingexcessive exerciseand extreme fasting.

Purging disorder is not listed as an official disorder in theDiagnostic and Statistical Manual of Mental Disorders(DSM-5). Instead, it is included as a described condition within the category ofOther Specified Feeding and Eating disorder (OSFED). This category includes individuals with clinically significant eating disorders who do not meet criteria for one of the primary eating disorders including anorexia nervosa, bulimia nervosa, orbinge eating disorder. Even though it lacks its own official category in the DSM-5, purging disorder can be just as serious as any of these other disorders.

An Unclear and Evolving Definition

Because purging disorder is not well-defined, researchers have not totally agreed on what it comprises. One of the challenges with our current diagnostic system is deciding into which basket a person with a certain group of symptoms should be placed.

For example, driven exercise has more recently been included as a potential purging behavior.Even though exercise is commonly considered a healthy and socially acceptable behavior—in a way that vomiting or laxative use is not—excessive exercise can be a serious problem.

Thus the research is ongoing, and as a result, it is unclear exactly how purging disorder will ultimately be defined.

Who Gets Purging Disorder?

Purging disorder most commonly emerges in late adolescence and early adulthood.It affects primarily women and people who are classified as normal weight or larger. Because of the current diagnostic system, which prioritizes the diagnosis of anorexia nervosa, purging disorder specifically cannot be diagnosed in people who are underweight. People who are underweight and engage in purging would instead be diagnosed with anorexia nervosa, binge/purge subtype.

As a proportion of those seeking treatment for an eating disorder, research indicates that purging disorder is the presenting problem in 5% to 10% of adult patients and 24% to 28% of adolescent patients.It might become a more common diagnosis if excessive exercise gets classified as part of purging disorder.

How Purging Disorder Is Different From Bulimia Nervosa and Anorexia Nervosa

By definition, people with purging disorder do not have the episodes of eating unusually large amounts of food that characterize bulimia nervosa (otherwise, they would meet criteria for bulimia nervosa). However, they may often feel that they have eaten “too much” when they have actually only eaten a normal amount of food. They may purge after meals. They may experience similar levels of guilt and shame to those who purge after eating large amounts of food.

Research shows that people who purge but do not binge have severe symptoms that include restrictive eating, a preoccupation with eating disorder thoughts, andbody imageconcerns.A primary difference between purging disorder and bulimia may be that people with bulimia nervosa report a greater loss of control over food. Some research suggests that purging disorder may be less severe than bulimia nervosa.

Patients with purging disorder often report feelings of gastrointestinal distress after eating and more distress than healthy people and patients with bulimia nervosa. Some patients with purging disorder may feel that their vomiting is automatic.

According to Keel and colleagues in “Clinical Handbook of Complex and Atypical Eating Disorders,” patients with purging disorder “often resemble patients with anorexia nervosa in temperament and interpersonal interactions more than they resemble patients with bulimia nervosa.”

Other Disorders That Occur Alongside Purging Disorder

Patients with purging disorder often have other psychological disorders:

Purging disorder is also associated with an elevated risk ofsuicideand intentional self-harm.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.For more mental health resources, see ourNational Helpline Database.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see ourNational Helpline Database.

Risks of Purging Disorder

Treatment for Purging Disorder

Unfortunately, as of the time of writing, no randomized controlled treatment trials have been conducted for individuals with purging disorder. There are no evidence-based treatments specifically for the disorder. There is some indication from the inclusion of patients with purging disorder in transdiagnostic treatment trials that they may benefit fromcognitive behavioral therapy (CBT-E), the most successful treatment for adults with bulimia nervosa. Modules that address mood intolerance and problem-solving may be particularly helpful. These strategies help patients to tolerate feelings of fullness and anxiety and help them to develop other coping skills.

According to Keel and colleagues, patients with purging disorder who purge after what they believe is out of control eating—a behavior similar to patients with bulimia nervosa—may respond better to treatment. This could be because the feeling of loss of control eating is so unpleasant. By contrast, patients who purge but do not experience any feelings of loss of control over eating may have less motivation for treatment because their behavior does not feel problematic to them. They may appear more like patients with anorexia nervosa who do not experience their restriction as a problem. This latter group may also be less willing to engage in treatment due to fear of weight gain if they stop purging.

A Word From Verywell

People who engage in purging and similar behaviors may be ashamed and reluctant to seek help. However, it is important toget professional attentionand the sooner the better. If you or a loved one is engaging in eating disorder behaviors such as vomiting, misuse of laxatives or diuretics, or excessive exercise, please seek help.

5 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Lydecker JA, Shea M, Grilo CM.Driven exercise in the absence of binge eating: implications for purging disorder.Int J Eat Disord.2018;(51)2:139-145. doi:10.1002/eat.22811Rohde P, Stice E, Marti CN.Development and predictive effects of eating disorder risk factors during adolescence: implications for prevention efforts.Int J Eat Disord. 2015;(48)2:187-98. doi:10.1002/eat.22270Keel PK, Forney KJ, Kennedy G. Purging disorder. In: Anderson LK, Murray SB, Kaye WH, eds.Clinical Handbook of Complex and Atypical Eating Disorders. New York: Oxford University Press; 2018:189–204.Smith KE, Crowther JH, Lavender JM.A review of purging disorder through meta-analysis.J Abnorm Psychol. 2017;(126)5:565-592. doi:10.1037/abn0000243Wile D.Diuretics: a review.Ann Clin Biochem. 2012;49(Pt 5):419-431. doi:10.1258/acb.2011.011281Additional ReadingKeel PK, Haedt A, Edler C.Purging disorder: an ominous variant of bulimia nervosa?.Int J Eat Disord. 2005;38(3):191-9. doi:10.1002/eat.20179

5 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Lydecker JA, Shea M, Grilo CM.Driven exercise in the absence of binge eating: implications for purging disorder.Int J Eat Disord.2018;(51)2:139-145. doi:10.1002/eat.22811Rohde P, Stice E, Marti CN.Development and predictive effects of eating disorder risk factors during adolescence: implications for prevention efforts.Int J Eat Disord. 2015;(48)2:187-98. doi:10.1002/eat.22270Keel PK, Forney KJ, Kennedy G. Purging disorder. In: Anderson LK, Murray SB, Kaye WH, eds.Clinical Handbook of Complex and Atypical Eating Disorders. New York: Oxford University Press; 2018:189–204.Smith KE, Crowther JH, Lavender JM.A review of purging disorder through meta-analysis.J Abnorm Psychol. 2017;(126)5:565-592. doi:10.1037/abn0000243Wile D.Diuretics: a review.Ann Clin Biochem. 2012;49(Pt 5):419-431. doi:10.1258/acb.2011.011281Additional ReadingKeel PK, Haedt A, Edler C.Purging disorder: an ominous variant of bulimia nervosa?.Int J Eat Disord. 2005;38(3):191-9. doi:10.1002/eat.20179

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Lydecker JA, Shea M, Grilo CM.Driven exercise in the absence of binge eating: implications for purging disorder.Int J Eat Disord.2018;(51)2:139-145. doi:10.1002/eat.22811Rohde P, Stice E, Marti CN.Development and predictive effects of eating disorder risk factors during adolescence: implications for prevention efforts.Int J Eat Disord. 2015;(48)2:187-98. doi:10.1002/eat.22270Keel PK, Forney KJ, Kennedy G. Purging disorder. In: Anderson LK, Murray SB, Kaye WH, eds.Clinical Handbook of Complex and Atypical Eating Disorders. New York: Oxford University Press; 2018:189–204.Smith KE, Crowther JH, Lavender JM.A review of purging disorder through meta-analysis.J Abnorm Psychol. 2017;(126)5:565-592. doi:10.1037/abn0000243Wile D.Diuretics: a review.Ann Clin Biochem. 2012;49(Pt 5):419-431. doi:10.1258/acb.2011.011281

Lydecker JA, Shea M, Grilo CM.Driven exercise in the absence of binge eating: implications for purging disorder.Int J Eat Disord.2018;(51)2:139-145. doi:10.1002/eat.22811

Rohde P, Stice E, Marti CN.Development and predictive effects of eating disorder risk factors during adolescence: implications for prevention efforts.Int J Eat Disord. 2015;(48)2:187-98. doi:10.1002/eat.22270

Keel PK, Forney KJ, Kennedy G. Purging disorder. In: Anderson LK, Murray SB, Kaye WH, eds.Clinical Handbook of Complex and Atypical Eating Disorders. New York: Oxford University Press; 2018:189–204.

Smith KE, Crowther JH, Lavender JM.A review of purging disorder through meta-analysis.J Abnorm Psychol. 2017;(126)5:565-592. doi:10.1037/abn0000243

Wile D.Diuretics: a review.Ann Clin Biochem. 2012;49(Pt 5):419-431. doi:10.1258/acb.2011.011281

Keel PK, Haedt A, Edler C.Purging disorder: an ominous variant of bulimia nervosa?.Int J Eat Disord. 2005;38(3):191-9. doi:10.1002/eat.20179

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