Signs and Symptoms of Purging Disorder

Purging disorder is a common and dangerous yet widely misunderstood eating disorder.

The disordered behaviors involved in the condition are similar to some aspects of bulimia nervosa (BN), leading many people to misread or misdiagnose what’s actually going on. Others may miss the condition all together, thanks to misconceptions and confusion around the eating disorder behaviors that constitute purging.

Still, there are some signs and symptoms to look out for that may indicate someone is struggling with this particular mental health condition. Learning these risk factors could be a crucial step toward ensuring someone finds the correct type of help as quickly as possible.

What Is Purging?

The first thing to understand about purging disorder is what purging can actually entail.

Many people mistakenly assume that purging is always achieved through self-induced vomiting. In fact, that’s only one method someone may use when they struggle with this serious eating disorder.

“Purging” can actually refer to any act that clears the stomach, evacuates the bowels, or otherwise works toward removing food from the body, including:

Self-induced vomiting: This can be achieved manually, with the use of spoons, or other tools, or through medications like ipecac.
Laxative misuse: Someone engaging in this purging behavior may take laxatives on a regular basis, or take larger quantities than are otherwise called for.
Excessive exercise: Long periods of vigorous exercise can be used to burn off calories from meals and snacks. Excessive exercise may persist, even in cases of exhaustion or injury.
Extreme fasting: This method could involve someone severely limiting their diet for hours or days in order to burn off “excess” food.

It’s possible someone may use additional tactics in order to remove the food from their body.

What is Purging Disorder?

Purging disorder is one of the most recently recognized types of eating disorders. It has yet to be studied widely enough to earn its own entry in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the official record of all recognized mental health conditions.

Rather, the condition is grouped under the umbrella term “other specified feeding or eating disorders.” Still, scientists agree on some broader aspects of the disorder.

As with nearly all other eating disorders, purging disorder often involves a fixation on body shape, weight, and size. People with this condition may have a fear of weight gain, and utilize purging tactics in order to avoid gaining weight, or to actively achieve a certain body shape.

It’s estimated that up to 4.8% of adolescent girls have a purging disorder of some type, including bulimia nervosa, purging disorder, or other conditions that involve this maladaptive coping mechanism. [1] But again, purging disorder is relatively new, and doctors may not always screen for it. It’s possible some patients have purging disorder and are misdiagnosed undiagnosed altogether.

Signs of Purging Disorder

Purging disorders in general may be difficult to spot. While often used for weight control, these conditions don’t lead to dramatic weight loss as frequently as other disorders, like anorexia nervosa. [3] Many people with purging disorders remain at relatively normal weights.

Yet, it may be possible to spot subtle changes or other signs that may indicate purging.

Some common signs include: [4]

Cuts and calluses across the knuckles and fingers due to self-induced vomiting, sometimes called Russell’s Sign
Swelling around salivary glands, sometimes called bulimia cheeks
Discolored or sensitive teeth, cavities, or eroded tooth enamel
Complaints of stomach cramps, constipation, or acid reflux
Noticeable fluctuations in weight
Dizziness or fainting

A more obvious sign is the frequent use of the restroom directly following a meal. While it isn’t always this case, this can often indicate purging behaviors.

Many people with purging disorder may also opt to skip out on mealtime altogether, frequently eat alone, or avoid social occasions that involve food.

Symptoms of Purging Disorder

Purging on a regular basis is dangerous in any form, and the practice becomes more damaging the longer it’s utilized. The sooner someone can find treatment for these issues, the less likely it is that they will have to deal with serious or long-term health consequences.

Physical Impact

Different forms of purging can have similar physical side effects. These include:

Dehydration
Electrolyte imbalance
Organ damage

Self-induced vomiting, in particular, can lead to:

Dental problems
Throat swelling
Broken blood vessels in the face and neck

Laxative misuse can result in:

Rectal bleeding
Chronic diarrhea
Constipation without the aid of laxatives

Psychological Impact

There are also a number of serious psychological side effects that can come from purging, including:

Irritability
Mood swings
Depression or anxiety
Fear of eating in public

Many people with purging disorder may also try to hide their condition. They may use gum, mints, or mouthwash on a regular basis, wear baggy clothes to hide the shape of their body, develop unusual rituals around food or eating, or eat alone or in secret.

Treating Purging Disorder

The lack of clarity on what constitutes purging disorder has caused some confusion among the scientific community about which behaviors may or may not constitute the condition.

And unfortunately, the murky designation can also make it difficult for people with purging disorder to find appropriate treatment.

The recent acknowledgement of the condition means few clinical trials have taken this condition into account, or sought out to more deeply examine it. Yet, it is likely that people with purging disorder would benefit from some forms of therapy, medications, or other common treatments for eating disorders.

For bulimia nervosa in particular, which is similar to purging disorder in a number of ways, cognitive behavioral therapy (CBT) is one of the most widely-practiced forms of treatment. The concept, which helps patients recognize, stop, and change the unhelpful thoughts related to their mental health condition, may also work to treat purging disorder, though much more research is needed on the subject.

What to Do After You Spot Signs That Someone Is Purging

If you think a loved one is struggling with purging disorder or another type of eating disorder, this can be distressing. You may want to help but at the same time feel helpless. It can be difficult to know what to do or what to say.

Yet, if your loved one is grappling with purging disorder, it’s a good idea to seek professional attention as soon as possible. Early intervention is the most effective treatment for eating disorders.

Try talking to the person about the purging signs you’ve seen. This conversations can be tricky, so try to keep in mind the following tips to help ensure your helpful intentions are understood and well-received: [5]

Use caring statements that begin with the word “I,” rather than blaming statements that start with “you.”
Let the person tell you what they want and need. Don’t rush to your next talking point.
Remind the person that you’re available to offer love and support. You’re not blaming them.

If your loved one agrees to go into a treatment program, offer to help. Take the person to appointments and offer to go to counseling sessions with them if it’s helpful. Check in with the person regularly to ensure that they feel supported.

Anyone can have an eating disorder. And anyone can help. By talking about what you’ve seen and how you can remain involved, you could be a vital help to someone in need.

References

Keel PK. (2019). Purging disorder: recent advances and future challenges. Current opinion in psychiatry; 32(6):518–524.
Caruso M. (2022, April 29). Ohio Researcher Looks Into Little Known Purging Disorder. Ohio University. Accessed July 2022.
Bulimia Nervosa. National Alliance on Mental Illness, Michigan. Accessed July 2022.
Bulimia Nervosa. National Eating Disorders Association. Accessed July 2022.
What to Say and Do. National Eating Disorders Collaboration. Accessed July 2022.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Last Updated on April 18, 2023
Published on EatingDisorderHope.com

Eating Disorder Hope Staff