Purging disorder

Purging disorder is an eating disorder characterized by the DSM-5 as self-induced vomiting, or misuse of laxatives, diuretics, or enemas to forcefully evacuate matter from the body.[1] Purging disorder differs from bulimia nervosa (BN) because individuals do not consume a large amount of food before they purge.[2] In current diagnostic systems, purging disorder is a form of other specified feeding or eating disorder. Research indicates that purging disorder, while not rare, is not as commonly found as anorexia nervosa or bulimia nervosa.[3] This syndrome is associated with clinically significant levels of distress, and that it appears to be distinct from bulimia nervosa on measures of hunger and ability to control food intake. Some of the signs of purging disorder are frequent trips to the bathroom directly after a meal, frequent use of laxatives, and obsession over one's appearance and weight. Other signs include swollen cheeks, popped blood vessels in the eyes, and clear teeth which are all signs of excessive vomiting.[4][5]

Purging disorder is studied far less often than anorexia nervosa and bulimia nervosa as it is not considered an independent diagnosis in the DSM-5, published in 2013.[3] However, it has been argued that purging disorder should be considered a distinct eating disorder, separate from bulimia nervosa.[6][7][8][9] Because of this, little information is known about the risk factors for purging disorder, including how gender, race, and class could contribute to the risk for purging disorder. As with most eating disorders, it is suggested that purging disorder is gender specific because of cultural forces and social pressures. These social pressures are associated with a severe preoccupation with shape and weight, this puts women and transgender individuals at the most risk for eating disorders, including purging disorder.[3] In one study of the risk factors for purging disorder 77% of the participants who presented with symptoms of purging disorder were female.[10] Purging disorder progressing into bulimia nervosa has been observed, while it is extremely rare for the reverse situation, bulimia nervosa progressing into purging disorder. This was observed once in a transgender patient with a severe history of bulimia nervosa but presented with symptoms of purging disorder to an eating disorder treatment facility in New Zealand.[3]

Estimates of lifetime prevalence of purging disorder have been estimated from 1.1% to 5.3%.[11]

Signs and symptoms
  • Recurrent purging to influence body weight or shape[6]
  • Absence of binging episode(s)[6]
  • Purge behaviors occur at least once per week for at least 3 months[6]
  • Undue influence of body shape and weight[6]
  • Russell's sign[12]

Causes

Risk Factors

Genetic

The heritability of some eating disorders has been well established,[14] but to date there are no documented family studies of purging disorder to understand the familial nature of purging disorder.[15]

Diagnosis

The DSM-5 is used as a reference to diagnose Purging Disorder. A patient with Purging disorder will be diagnosed with other specified feeding or eating disorder.[11]

Complications

Purging behaviors, specifically self-induced vomiting and laxative use are associated with the following medical complications:

Treatment

Treatment for purging disorder can be multidisciplinary. One approach to treatment is cognitive behavioral therapy.[16]

Prognosis

Children and teenagers with purging disorder have been found to have poorer health-related quality of life than their healthy peers.[17] A small review of 11 cases of purging disorder where death occurred found that only 5 of the 11 deaths could be contributed to the purging disorder.[16] The remaining 6 deaths were a result of suicide.[16]

References
  1. Diagnostic and statistical manual of mental disorders : DSM-5. Internet Archive. Arlington, VA : American Psychiatric Association. 2013. ISBN 978-0-89042-554-1.{{cite book}}: CS1 maint: others (link)
  2. Keel, Pamela K. (2019). "Purging disorder: recent advances and future challenges". Current Opinion in Psychiatry. 32 (6): 518–524. doi:10.1097/YCO.0000000000000541. ISSN 0951-7367. PMC 6768735. PMID 31306252.
  3. Surgenor, Lois J.; Fear, Jennifer L. (December 1998). "Eating disorder in a transgendered patient: A case report". International Journal of Eating Disorders. 24 (4): 449–452. doi:10.1002/(sici)1098-108x(199812)24:4<449::aid-eat14>3.0.co;2-w. PMID 9813772. ProQuest 211126302.
  4. Carcieri, Elisha (2019). "Purging Disorder". Mirror-Mirror.
  5. "Little-known purging disorder is often missed". NBC News. Associated Press. 19 September 2007.
  6. Castillo, Marigold; Weiselberg, Eric (2017-04-01). "Bulimia Nervosa/Purging Disorder". Current Problems in Pediatric and Adolescent Health Care. 47 (4): 85–94. doi:10.1016/j.cppeds.2017.02.004. ISSN 1538-5442. PMID 28532966.
  7. Keel, Pamela K.; Striegel-Moore, Ruth H. (2009). Walsh, B. Timothy (ed.). "The validity and clinical utility of purging disorder". International Journal of Eating Disorders. 42 (8): 706–719. doi:10.1002/eat.20718. PMID 19642215.
  8. Keel, Pamela K. (2007). "Purging disorder: subthreshold variant or full-threshold eating disorder?". The International Journal of Eating Disorders. 40 Suppl: S89–94. doi:10.1002/eat.20453. ISSN 0276-3478. PMID 17868124.
  9. Koch, Sonja; Quadflieg, Norbert; Rief, Winfried; Fichter, Manfred (2013). "[Purging disorder--a distinct diagnosis? Review about the current state of research]". Psychotherapie, Psychosomatik, Medizinische Psychologie (in German). 63 (8): 305–317. doi:10.1055/s-0032-1331212. ISSN 1439-1058. PMID 23382033.
  10. Allen, Karina L.; Byrne, Susan M.; Crosby, Ross D. (19 September 2014). "Distinguishing Between Risk Factors for Bulimia Nervosa, Binge Eating Disorder, and Purging Disorder". Journal of Youth and Adolescence. 44 (8): 1580–1591. doi:10.1007/s10964-014-0186-8. PMID 25233874. S2CID 28204545.
  11. Smith, Kathryn E.; Crowther, Janis H.; Lavender, Jason M. (2018). "A review of purging disorder through meta-analysis". Journal of Abnormal Psychology. 126 (5): 565–592. doi:10.1037/abn0000243. ISSN 1939-1846. PMC 5741973. PMID 28691846.
  12. Forney, K. Jean; Buchman-Schmitt, Jennifer M.; Keel, Pamela K.; Frank, Guido K. W. (2016). "The medical complications associated with purging". The International Journal of Eating Disorders. 49 (3): 249–259. doi:10.1002/eat.22504. ISSN 1098-108X. PMC 4803618. PMID 26876429.
  13. Stice, Eric (2016). "Interactive and Mediational Etiologic Models of Eating Disorder Onset: Evidence from Prospective Studies". Annual Review of Clinical Psychology. 12: 359–381. doi:10.1146/annurev-clinpsy-021815-093317. ISSN 1548-5951. PMID 26651521.
  14. Rikani, Azadeh A.; Choudhry, Zia; Choudhry, Adnan M.; Ikram, Huma; Asghar, Muhammad W.; Kajal, Dilkash; Waheed, Abdul; Mobassarah, Nusrat J. (2013). "A critique of the literature on etiology of eating disorders". Annals of Neurosciences. 20 (4): 157–161. doi:10.5214/ans.0972.7531.200409. ISSN 0972-7531. PMC 4117136. PMID 25206042.
  15. Thornton, Laura M.; Mazzeo, Suzanne E.; Bulik, Cynthia M. (2011). "The Heritability of Eating Disorders: Methods and Current Findings". Current Topics in Behavioral Neurosciences. 6: 141–156. doi:10.1007/7854_2010_91. ISBN 978-3-642-15130-9. ISSN 1866-3370. PMC 3599773. PMID 21243474.
  16. Koch, Sonja; Quadflieg, Norbert; Fichter, Manfred (2014-03-01). "Purging disorder: a pathway to death? A review of 11 cases". Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. 19 (1): 21–29. doi:10.1007/s40519-013-0082-3. ISSN 1590-1262. PMID 24198060. S2CID 207497017.
  17. Wu, Xiu Yun; Yin, Wen Qiang; Sun, Hong Wei; Yang, Shu Xiang; Li, Xin Yang; Liu, Hong Qing (2019). "The association between disordered eating and health-related quality of life among children and adolescents: A systematic review of population-based studies". PLOS ONE. 14 (10): e0222777. Bibcode:2019PLoSO..1422777W. doi:10.1371/journal.pone.0222777. ISSN 1932-6203. PMC 6777752. PMID 31584956.
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