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Purging is an attempt to compensate for the calories of a meal that has already been consumed. A purge doesn't always follow a binge. Some people fear fat even when they eat modestly. Here are 10 thiings to know about purging disorder.

When the topic is eating disorders, we're mostly likely to hear about anorexia, bulimia, or maybe an exotic condition like pica. The Diagnostic and Statistical Manual of Mental Disorders, however, also has a category for five “other specified feeding and eating disorders.” One of these "other" disorders is purging disorder.

Purging disorder is a condition that causes the people that have it to compensate for calorie intake to avoid weight gain even when they don't binge, when they eat normally. This compensation can be exercise, or the use of laxatives, or self-induced vomiting. Because purging disorder in the category of "eating disorder not otherwise specified" (ENDNOS), it would be easy to assume that it is a relatively rare disease. It's not. Purging disorder is more common than anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) harmless disease.

And because purging disorder is in its own poorly defined category, it would be easy to assume it is a relatively inconsequential disease. Again, it's not. Percentage-wise, more people die of purging disorder than die of the better-known bulimia.

Purging disorder is a condition that affects more people, and kills more people than other, better-known eating disorders. Here are 10 things you should not miss about purging disorder.

People who have purging disorder usually try to hide their purging behaviors

It can be hard for parents, friends, and family members to pick up the cues that point to a purging disorder. Maybe a teenager makes a habit of going to the bathroom immediately after eating. This may be a sign of a bowel issue like irritable bowel syndrome, or it may be a sign that they are getting rid of their stomach contents with self-induced vomiting.

Some other methods of purging calories are more subtle. Some purgers load up on caffeinated beverages to burn more calories or because they had heard that caffeine encourages weight loss. Some try to lose weight with enemas or diuretics. Some teenagers are completely unsuccessful with their weight loss efforts and actually wind up gaining weight due to the disturbances to their metabolism. 

Purging with laxatives can cause a variety of health issues

Stimulant laxatives that contain rhein, a plant compound found in Senkeot, or bisacodyl , a chemical compound found in generic bisacodyl,  Bisa-Lax, Ducodyl, Dulcolax, Fleet Bisacodyl, Fleet Laxative, The Magic Bullet, Women's Gentle Laxative (bisac), and Women's Laxative (bisacodyl), cause a number of problems when they are used for than a few days.

At first, users may have as many as 50 small bowel movements per day. They can become dehydrated. Potassium levels are depleted, so muscles are weak. Both rhein and bisacodyl interfere with the absorption of glucose and amino acids from digested food, so chronically low blood sugar levels may be become a problem, and there may be even be loss of muscle mass. With continued use, the stimulant power of these products is diminished, so that there may even be a problem with chronic constipation and resulting weight gain. However, even when laxatives cause weight gain, they continue to cause malnutrition.

Purging becomes addictive

Purging changes the production of serotonin in the digestive tract and in the brain. It may even trigger the release of endorphins so that purges want to induce vomiting or use laxatives over and over again.

A purging disorder can interfere with social life

People who purge may avoid parties and gatherings where food is served but they would not be able to find a place to induce vomiting or diarrhea in private.

People who have purging disorder are not usually obsessed with their shape

When psychiatrists talked with people living with a purging disorder, they heard concerns about eating, shape, and weight, but without the obsessiveness about shape and weight expressed by people who have bulimia.

People who have purging disorder usually don't have a history of yo-yo dieting

Purging disorder isn't usually a condition with a history of alternating weight loss and weight regain. People living with purging disorders usually have relatively stable weight.

People who have purging disorder usually have more inhibitions about food than people with other eating disorders

The problem in purging disorder isn't stuffing yourself. It's working too hard to get rid of the calories you take in.

People who have purging disorder aren't usually suffering major depression

Major depression is a lot more likely to be associated with bulimia or a binge-eating disorder. However, people living with a purging disorder are more likely to commit suicide than people who have bulimia, perhaps because they have a higher energy level that enables them to pursue self-harm, and perhaps because they aren't as likely to receive counseling.

Not everyone who has purging disorder uses laxatives or forces vomiting

Some people who live with purging disorder try to burn off calories with exercise. They usually have a better self-image and less severe depression than people who purge with laxatives and/or regurgitation.

No one can force a purger into recovery

People who purge will not seek help just because they are asked to. They don't respond well to shaming, either. Because the underlying psychological process in many purgers is a feeling of not having control over life outcomes, patient support is the only way to help.

  • Fink E, Smith A, Gordon K, Holm-Denoma J, Joiner T. Psychological correlates of purging disorder as compared with other eating disorders: An exploratory investigation. Int J Eat Disord. 2009. 42:31–39.
  • Lydecker JA, Shea M, Grilo CM.​ Driven exercise in the absence of binge eating: Implications for purging disorder. Int J Eat Disord. 2018 Feb
  • ​.​1(2):139-145. doi: 10.1002/eat.22811. Epub 2017 Dec 7.​ PMID: 29215743​.
  • ​ Roberto CA, Grilo CM, Masheb RM, White MA. Binge eating, purging, or both: Eating disorder psychopathology findings from an internet community survey. Int J Eat Disord. 2010. 43:724–31.
  • Photo courtesy of SteadyHealth

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