Abstract
Purging disorder (PD) is a potentially debilitating eating disorder that is characterized by recurrent purging behaviors including self-induced vomiting or misuse of laxatives, diuretics, or other medications to influence shape or weight in the absence of objective binge eating. Evidence is mixed as to whether PD is more, less, or equally severe relative to other eating disorders that involve purging. Some researchers have questioned whether PD should be considered a unique diagnosis at all given the mixed evidence on the specificity of PD compared to other eating disorders. Yet, PD is common with lifetime prevalence rates ranging from 4 to 6%, and up to 7% of patients who present for treatment for an eating disorder having a diagnosis of PD. PD is also associated with a number of medical and psychiatric issues. Both psychological (emotion regulation, body dissatisfaction, trait anxiety, and cognitive restraint) and biological (satiety) factors have been identified as potential mechanisms in the development and maintenance of PD. In comparison to bulimia nervosa (BN) in which purging is used specifically to compensate for food eaten during an objective binge episode, in PD, purging may represent a persistent weight control strategy. Little has been written about whether or how treatment should differ for PD based on this functional distinction. Specific treatments for PD have not been developed and compared to existing evidence-based treatments making it difficult to know if treatment outcomes could be optimized by prioritizing the specific mechanisms (e.g., cognitive restraint, trait anxiety, satiety) that drive purging in PD.
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Abbreviations
- AN:
-
Anorexia nervosa
- AN-BP:
-
Anorexia nervosa, binge eating/purging subtype
- AN-R:
-
Anorexia nervosa, restricting subtype
- BED:
-
Binge eating disorder
- BMI:
-
Body mass index (kg/m2)
- BN:
-
Bulimia nervosa
- BN-P:
-
Bulimia nervosa, purging subtype
- DSM:
-
Diagnostic and Statistical Manual of Mental Disorders
- OSFED:
-
Other Specified Feeding and Eating Disorder
- PD:
-
Purging disorder
References
Allen KL, Byrne SM, Oddy WH et al (2013) Early onset binge eating and purging eating disorders: course and outcome in a population-based study of adolescents. J Abnorm Child Psychol 41(7):1083–1096. https://doi.org/10.1007/s10802-013-9747-7
American Psychiatric Association [APA] (2013) Diagnostic and statistical manual of mental disorders, 5th edn. https://doi.org/10.1176/appi.books.9780890425596
Binford RB, Le Grange D (2005) Adolescents with bulimia nervosa and eating disorder not otherwise specified-purging only. Int J Eat Disord 38(2):157–161. https://doi.org/10.1002/eat.20167
Brown TA, Haedt-Matt AA, Keel PK (2011) Personality pathology in purging disorder and bulimia nervosa. Int J Eat Disorder 44(8):735–740. https://doi.org/10.1002/eat.20904
Cooper Z, Fairburn CG (2011) The evolution of “enhanced” cognitive behavioural therapy for eating disorders: learning from treatment nonresponse. Cogn Behav Pract 18(3):394–402
Davis HA, Smith GT, Keel PK (2020) An examination of negative urgency and other impulsigenic traits in purging disorder. Eat Behav 36:101365. https://doi.org/10.1016/j.eatbeh.2020.101365
Dossat AM, Bodell LP, Williams DL et al (2015) Preliminary examination of glucagon-like peptide-1 levels in women with purging disorder and bulimia nervosa. Int J Eat Disord 48:199–205. https://doi.org/10.1002/eat.22264
Eddy KT, Swanson SA, Crosby RD et al (2010) How should DSM-V classify eating disorder not otherwise specified (EDNOS) presentations in women with lifetime anorexia or bulimia nervosa? Psychol Med 40(10):1735–1744. https://doi.org/10.1017/S0033291709992200
Ekeroth K, Clinton D, Norring C et al (2013) Clinical characteristics and distinctiveness of DSM-5 eating disorder diagnoses: findings from a large naturalistic clinical database. J Eat Disord 1(1):1–11. https://doi.org/10.1186/2050-2974-1-31
Engel SG, Wonderlich SA, Crosby RD, Mitchell JE, Crow S, Peterson CB, Gordon KH (2013) The role of affect in the maintenance of anorexia nervosa: evidence from a naturalistic assessment of momentary behaviors and emotion. J Abnorm Psychol 122:709–719. https://doi.org/10.1037/a0034010
Fairburn CG (2008) Cognitive behavior therapy and eating disorders. Guilford Press, New York
Fairburn CG, Cooper Z, Shafran R (2003) Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behav Res Ther 41(5):509–528. https://doi.org/10.1016/S0005-7967(02)00088-8
Fairburn CG, Cooper Z, Shafran R, Bohn K, Hawker DM, Murphy R, Straebler S (2008) Enhanced cognitive behavior therapy for eating disorders: the core protocol. In: Fairburn CG (ed) Cognitive behavior therapy and eating disorders. The Guilford Press, New York, pp 47–193
Favaro A, Ferrara S, Santonastaso P (2003) The spectrum of eating disorders in young women: a prevalence study in a general population sample. Psychosom Med 65:701–708. https://doi.org/10.1097/01.PSY.0000073871.67679.D8
Fink EL, Smith AR, Gordon KH et al (2009) Psychological correlates of purging disorder as compared with other eating disorders: an exploratory investigation. Int J Eat Disorder 42(1):31–39. https://doi.org/10.1002/eat.20556
Forney KJ, Haedt-Matt AA, Keel PK (2014) The role of loss of control eating in purging disorder. Int J Eat Disorder 47(3):244–251. https://doi.org/10.1002/eat.22212
Forney KJ, Buchman-Schmitt JM, Keel PK et al (2016) The medical complications associated with purging. Int J Eat Disorder 49(3):249–259. https://doi.org/10.1002/eat.22504
Forney KJ, Crosby RD, Brown TA et al (2021) A naturalistic, long-term follow-up of purging disorder. Psychol Med 51(6):1–1027. https://doi.org/10.1017/S0033291719003982
Glazer KB, Sonneville KR, Micali N et al (2019) The course of eating disorders involving bingeing and purging among adolescent girls: prevalence, stability, and transitions. J Adolescent Health 64(2):165–171. https://doi.org/10.1016/j.jadohealth.2018.09.023
Haedt AA, Keel PK (2010) Comparing definitions of purging disorder on point prevalence and associations with external validators. Int J Eat Disord 43(5):433–439. https://doi.org/10.1002/eat.20712
Haedt-Matt AA, Keel PK (2011) Revisiting the affect regulation model of binge eating: a meta-analysis of studies using ecological momentary assessment. Psychol Bull 137(4):660–681. https://doi.org/10.1037/a0023660
Haedt-Matt AA, Keel PK (2015) Affect regulation and purging: an ecological momentary assessment study in purging disorder. J Abnorm Psychol 124(2):399–411
Keel PK (2019) Purging disorder: recent advances and future challenges. Curr Opin Psychiatry 32(6):518–524. https://doi.org/10.1097/YCO.0000000000000541
Keel PK, Striegel-Moore RH (2009) The validity and clinical utility of purging disorder. Int J Eat Disord 42(8):706–719. https://doi.org/10.1002/eat.20718
Keel PK, Haedt A, Edler C (2005) Purging disorder: An ominous variant of bulimia nervosa? Int J Eat Disorder 38(3):191–199. https://doi.org/10.1002/eat.20179
Keel PK, Wolfe BE, Gravener JA et al (2008) Co-morbidity and disorder-related distress and impairment in purging disorder. Psychol Med 38(10):1435–1442. https://doi.org/10.1017/S0033291707001390
Keel PK, Haedt-Matt AA, Hildebrandt B et al (2018) Satiation deficits and binge eating: probing differences between bulimia nervosa and purging disorder using an ad lib test meal. Appetite 127:119–125. https://doi.org/10.1016/j.appet.2018.04.009
Koch S, Quadflieg N, Fichter M (2013) Purging disorder: a comparison to established eating disorders with purging behaviour. Eur Eat Disord Rev 21:265–275. https://doi.org/10.1002/erv.2231
Koch S, Quadflieg N, Fichter M (2014) Purging disorder: a pathway to death? A review of 11 cases. Eat Weight Disord-St 19(1):21–29. https://doi.org/10.1007/s40519-013-0082-3
Krug I, Granero R, Giles S et al (2020) A cluster analysis of purging disorder: validation analyses with eating disorder symptoms, general psychopathology and personality. Eur Eat Disord Rev 28(6):643–656. https://doi.org/10.1002/erv.2769
Krug I, Giles SE, Granero R et al (2021) Where does purging disorder lie on the symptomatologic and personality continuum when compared to other eating disorder subtypes? Implications for the DSM. Eur Disord Rev 30(1):36–49. https://doi.org/10.1002/erv.2872
Liebman RE, Coniglio KA, Becker KR et al (2019) Behavioral inhibition moderates the association between overvaluation of shape and weight and noncompensatory purging in eating disorders. Int J Eat Disord 53(1):143–148. https://doi.org/10.1002/eat.23195
MacDonald D, Solomon-Krakus S, Jewett R, Liebman RE, Trottier K (2022) Emotion regulation in bulimia nervosa and purging disorder. In: Preedy V, Patel V (eds) Eating disorders. Springer, New York
Machado PP, Machado BC, Gonçalves S et al (2007) The prevalence of eating disorders not otherwise specified. Int J Eat Disord 40(3):212–217. https://doi.org/10.1002/eat.20358
Mitchison D, Mond J, Bussey K et al (2020) DSM-5 full syndrome, other specified, and unspecified eating disorders in Australian adolescents: prevalence and clinical significance. Psychol Med 50(6):981–990. https://doi.org/10.1017/S0033291719000898
Munn-Chernoff MA, Keel PK, Klump KL et al (2015) Prevalence of and familial influences on purging disorder in a community sample of female twins. Int J Eat Disord 48(6):601–606. https://doi.org/10.1002/eat.22378
Nakai Y, Nin K, Noma S et al (2018) Changing profile of eating disorders between 1963 and 2004 in a Japanese sample. Int J Eat Disord 51(8):953–958. https://doi.org/10.1002/eat.22935
Riesco N, Agüera Z, Granero R et al (2018) Other specified feeding or eating disorders (OSFED): clinical heterogeneity and cognitive-behavioral therapy outcome. Eur Psychiatry 54:109–116. https://doi.org/10.1016/j.eurpsy.2018.08.001
Roberto CA, Grilo CM, Masheb RM et al (2010) Binge eating, purging, or both: eating disorder psychopathology findings from an internet community survey. Int J Eat Disord 43(8):724–731. https://doi.org/10.1002/eat.20770
Smith KE, Crowther JH, Lavender JM (2017) A review of purging disorder through meta-analysis. J Abnorm Psychol 126(5):565–592. https://doi.org/10.1037/abn0000243
Smyth JM, Wonderlich SA, Heron KE et al (2007) Daily and momentary mood and stress are associated with binge eating and vomiting in bulimia nervosa patients in the natural environment. J Consult Clin Psychol 75:629–638. https://doi.org/10.1037/0022-006X.75.4.629
Stice E (2002) Risk and maintenance factors for eating pathology: a meta-analytic review. Psychol Bull 128(5):825–848. https://doi.org/10.1037/0033-2909.128.5.825
Stice E, Gau JM, Rohde P et al (2017) Risk factors that predict future onset of each DSM–5 eating disorder: predictive specificity in high-risk adolescent females. J Abnorm Psychol 126(1):38. https://doi.org/10.1037/abn0000219
Tabri N, Murray HB, Thomas JJ et al (2015) Overvaluation of body shape/weight and engagement in non-compensatory weight-control behaviors in eating disorders: is there a reciprocal relationship? Psychol Med 45(14):2951–2958. https://doi.org/10.1017/S0033291715000896
Tasca GA, Maxwell H, Bone M et al (2012) Purging disorder: psychopathology and treatment outcomes. Int J Eat Disorder 45:36–42. https://doi.org/10.1002/eat.20893
Vo M, Accurso EC, Goldschmidt AB et al (2017) The impact of DSM-5 on eating disorder diagnoses. Int J Eat Disord 50(5):578–581. https://doi.org/10.1002/eat.22628
Wade TD (2007) A retrospective comparison of purging type disorders: eating disorder not otherwise specified and bulimia nervosa. Int J Eat Disorder 40(1):1–6. https://doi.org/10.1002/eat.20314
Yilmaz Z, Gottfredson NC, Zerwas SC et al (2019) Developmental premorbid body mass index trajectories of adolescents with eating disorders in a longitudinal population cohort. J Am Acad Child Psychiatry 58(2):191–199. https://doi.org/10.1016/j.jaac.2018.11.008
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Liebman, R.E., Santiago, V.A., Mccomb, S., MacDonald, D.E., Trottier, K. (2022). Purging Disorder. In: Patel, V., Preedy, V. (eds) Eating Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-67929-3_70-1
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