Purging disorder

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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]

Contents

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, purging disorder appears to affect women disproportionately, presumably due to cultural forces and social pressures. In particular, preoccupation with shape and weight puts women at elevated 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

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]

Related Research Articles

An eating disorder is a mental disorder defined by abnormal eating behaviors that adversely affect a person's physical or mental health. Types of eating disorders include binge eating disorder, where the patient eats a large amount in a short period of time; anorexia nervosa, where the person has an intense fear of gaining weight and restricts food or overexercises to manage this fear; bulimia nervosa, where individuals eat a large quantity (binging) then try to rid themselves of the food (purging); pica, where the patient eats non-food items; rumination syndrome, where the patient regurgitates undigested or minimally digested food; avoidant/restrictive food intake disorder (ARFID), where people have a reduced or selective food intake due to some psychological reasons; and a group of other specified feeding or eating disorders. Anxiety disorders, depression and substance abuse are common among people with eating disorders. These disorders do not include obesity. People often experience comorbidity between an eating disorder and OCD. It is estimated 20–60% of patients with an ED have a history of OCD.

<span class="mw-page-title-main">Bulimia nervosa</span> Type of eating disorder

Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging or fasting, and excessive concern with body shape and weight. This activity aims to expel the body of calories eaten from the binging phase of the process. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives.

<span class="mw-page-title-main">Appetite</span> Desire to eat food

Appetite is the desire to eat food items, usually due to hunger. Appealing foods can stimulate appetite even when hunger is absent, although appetite can be greatly reduced by satiety. Appetite exists in all higher life-forms, and serves to regulate adequate energy intake to maintain metabolic needs. It is regulated by a close interplay between the digestive tract, adipose tissue and the brain. Appetite has a relationship with every individual's behavior. Appetitive behaviour also known as approach behaviour, and consummatory behaviour, are the only processes that involve energy intake, whereas all other behaviours affect the release of energy. When stressed, appetite levels may increase and result in an increase of food intake. Decreased desire to eat is termed anorexia, while polyphagia is increased eating. Dysregulation of appetite contributes to anorexia nervosa, bulimia nervosa, cachexia, overeating, and binge eating disorder.

Binge eating disorder (BED) is an eating disorder characterized by frequent and recurrent binge eating episodes with associated negative psychological and social problems, but without the compensatory behaviors common to bulimia nervosa, OSFED, or the binge-purge subtype of anorexia nervosa.

Binge eating is a pattern of disordered eating which consists of episodes of uncontrollable eating. It is a common symptom of eating disorders such as binge eating disorder and bulimia nervosa. During such binges, a person rapidly consumes an excessive quantity of food. A diagnosis of binge eating is associated with feelings of loss of control. Binge eating disorder is also linked with being overweight and obesity.

Unspecified feeding or eating disorder (UFED) is a DSM-5 category of eating disorders that, along with other specified feeding or eating disorder (OSFED), replaced eating disorder not otherwise specified (EDNOS) in the DSM-IV-TR.

The Eating Attitudes Test, created by David Garner, is a widely used 26-item, standardized self-reported questionnaire of symptoms and concerns characteristic of eating disorders. The EAT is useful in assessing "eating disorder risk" in high school, college and other special risk samples such as athletes. EAT has been extremely effective in screening for anorexia nervosa in many populations.

Avoidant/restrictive food intake disorder (ARFID) is a feeding or eating disorder in which people avoid eating certain foods, or restrict their diets to the point it ultimately results in nutritional deficiencies. This can be due to the sensory characteristics of food, such as its appearance, smell, texture, or taste; due to fear of negative consequences such as choking or vomiting; having little interest in eating or food, or a combination of these factors. People with ARFID may also be afraid of trying new foods, a fear known as food neophobia.

Diabulimia, also known as ED-DMT1 in the US or T1ED in the UK, is an eating disorder in which people with type 1 diabetes deliberately give themselves less insulin than they need or stop taking it altogether for the purpose of weight loss. Diabulimia is not recognized as a formal psychiatric diagnosis in the DSM-5. Because of this, some in the medical or psychiatric communities use the phrases "disturbed eating behavior" or "disordered eating behavior" and disordered eating (DE) are quite common in medical and psychiatric literature addressing patients who have type 1 diabetes and manipulate insulin doses to control weight along with exhibiting bulimic behavior.

The Eating Disorder Inventory (EDI) is a self-report questionnaire used to assess the presence of eating disorders, (a) anorexia nervosa both restricting and binge-eating/purging type; (b) bulimia nervosa; and (c) eating disorder not otherwise specified including binge eating disorder. The original questionnaire consisted of 64 questions, divided into eight subscales. It was created in 1984 by David M. Garner and others. There have been two subsequent revisions by Garner: the Eating Disorder Inventory-2 (EDI-2) and the Eating Disorder Inventory-3 (EDI-3).

The Eating Disorder Diagnostic Scale (EDDS) is a self-report questionnaire that assesses the presence of three eating disorders; anorexia nervosa, bulimia nervosa and binge eating disorder. It was adapted by Stice et al. in 2000 from the validated structured psychiatric interview: The Eating Disorder Examination (EDE) and the eating disorder module of the Structured Clinical Interview for DSM-IV (SCID)16.

<span class="mw-page-title-main">Anorexia nervosa</span> Type of eating disorder

Anorexia nervosa (AN), often referred to simply as anorexia, is an eating disorder characterized by food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin.

The differential diagnoses of anorexia nervosa (AN) includes various types of medical and psychological conditions, which may be misdiagnosed as AN. In some cases, these conditions may be comorbid with AN because the misdiagnosis of AN is not uncommon. For example, a case of achalasia was misdiagnosed as AN and the patient spent two months confined to a psychiatric hospital. A reason for the differential diagnoses that surround AN arise mainly because, like other disorders, it is primarily, albeit defensively and adaptive for, the individual concerned. Anorexia Nervosa is a psychological disorder characterized by extremely reduced intake of food. People with anorexia nervosa tend to have a low self-image and an inaccurate perception of their body.

Cognitive behavioral therapy (CBT) is derived from both the cognitive and behavioral schools of psychology and focuses on the alteration of thoughts and actions with the goal of treating various disorders. The cognitive behavioral treatment of eating disorders emphasizes on the minimization of negative thoughts about body image and the act of eating, and attempts to alter negative and harmful behaviors that are involved in and perpetuate eating disorders. It also encourages the ability to tolerate negative thoughts and feelings as well as the ability to think about food and body perception in a multi-dimensional way. The emphasis is not only placed on altering cognition, but also on tangible practices like making goals and being rewarded for meeting those goals. CBT is a "time-limited and focused approach" which means that it is important for the patients of this type of therapy to have particular issues that they want to address when they begin treatment. CBT has also proven to be one of the most effective treatments for eating disorders.

Drunkorexia is a colloquialism for anorexia or bulimia combined with an alcohol use disorder. The term is generally used to denote the utilization of extreme weight control methods to compensate for planned binge drinking. Research on the combination of an eating disorder and binge drinking has primarily focused on college-aged women, though the phenomenon has also been noted among young men. Studies suggest that individuals engage in this combination of self-imposed malnutrition and binge drinking to avoid weight gain from alcohol, to save money for purchasing alcohol, and to facilitate alcohol intoxication.

Christopher James Alfred Granville Fairburn is a British psychiatrist and researcher. He is Emeritus Professor of Psychiatry at the University of Oxford. He is known for his research on the development, evaluation and dissemination of psychological treatments, especially for eating disorders.

Chew and spit is a compensatory behavior associated with several eating disorders that involves chewing food and spitting it out before swallowing, often as an attempt to avoid ingesting unwanted or unnecessary calories. CS can be used as a way to taste food viewed as “forbidden” or unhealthy. Individuals who partake in CS typically have an increased desire for thinness, increased loss of control (LOC) and body dissatisfaction. CS can replace vomiting and/or binging behaviors, or serve as an additional behavior to many eating disorders.

Paul E. Garfinkel is a Canadian psychiatrist, researcher and an academic leader. He is a professor at the University of Toronto and a staff psychiatrist at Centre for Addiction and Mental Health (CAMH).

Body image disturbance (BID) is a common symptom in patients with eating disorders and is characterized by an altered perception of one's own body.

Atypical anorexia nervosa is an eating disorder in which individuals meet all the qualifications for anorexia nervosa, including a body image disturbance and a history of restrictive eating and weight loss, except that they are not currently underweight. Atypical anorexia qualifies as a mental health disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), under the category Other Specified Feeding and Eating Disorders (OSFED). The characteristics of people with atypical anorexia generally do not differ significantly from anorexia nervosa patients except for their current weight.

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. 1 2 3 4 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. 1 2 3 4 5 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. 1 2 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. 1 2 3 4 5 6 7 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. 1 2 3 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. 1 2 3 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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