What Is Purging Disorder? Symptoms, Causes, Effects, & Treatments

What Is Purging Disorder?

Purging disorder refers to intentional and recurrent purging without binge eating. People may purge through vomiting, but they might also use diuretics, laxatives, medications, exercise, and long forms of fasting.¹ Like other eating disorders, purging disorder also coincides with poor body image, obsessive thoughts about food and eating, and high levels of shame and secrecy.

Purging Disorder Vs. Bulimia

Purging disorder and bulimia nervosa have similarities, but people with bulimia purge in response to episodes of binge eating. Purging disorder, on the other hand, is defined by the purging itself, and not it being a compensatory behavior.

Purging Disorder Vs. Anorexia

Purging disorder is not anorexia nervosa because people with anorexia restrict their food and are clinically underweight. Neither weight nor restriction represents specific purging disorder criteria. However, people experiencing either condition often have a preoccupation with food, weight, body shape, and themes of control.

Symptoms of Purging Disorder

People with purging disorder experience both physical and emotional or psychological symptoms. Repetitive purging can be extremely taxing on the body, and it can exacerbate feelings of depression, anxiety, low self-esteem, and withdrawal from other relationships and hobbies. Unlike other eating disorders, the sole focus is on purging rather than how food is–or isn’t–consumed.

Physical symptoms of purging disorder include:²

• Weight loss
• Dental problems/tooth decay
• Gastrointestinal distress
• Dehydration
• Heart problems
• Scarred hands
• Inflamed throat
• Fatigue

Psychological symptoms of purging disorder include:

• Anxiety
• Depression
• Poor body image
• Body dysmorphia
• Low self-esteem
• Relationship problems
• Academic/work problems
• Feelings of worthlessness

What Causes Purging Disorder?

Anyone can develop an eating disorder, including purging disorder, and the exact cause of these conditions isn’t known. Like with all mental health conditions, genetic and environmental factors impact someone’s likelihood of developing this disorder.³

Purging disorder symptoms can emerge at any age. However, the onset typically starts in adolescence or young adult years. People experiencing certain mental or developmental conditions may be more susceptible to developing purging disorder.

Possible causes for purging disorder include: 

• Genetics: Eating disorders often run in families, and research shows that a genetic component may explain this strong familial transmission. Some research suggests that self-induced vomiting rates are roughly 46-72% inheritable.⁴
• Neurotransmitter imbalances: Research shows that people with eating disorders have neurotransmitter differences, specifically with serotonin and dopamine-related genes. These neurotransmitters are associated with mood regulation, pleasure, and emotion, all of which can affect eating disorders.⁴
• Significant stress at home: Purging may act as a way to relieve stress or avoid facing the actual stressors in real-time.
• History of sexual abuse: Sexual abuse can trigger immense body shame and physical discomfort. Some people purge as a way to punish themselves or to avoid feeling the emotional pain associated with their past trauma.
• Childhood trauma: Childhood trauma can profoundly impact all parts of development, and there’s a high comorbidity between childhood trauma and eating disorders.
• History of toxic dieting: Dieting is a risk factor for all eating disorders. Even mild periods of starvation can impact the brain and create complications with food and body image.
• Other eating disorders: It is common for people to experience ‘symptom switching’ in eating disorder recovery. For example, someone with anorexia may stop restricting and start bingeing and purging more often. Or someone might keep purging even if they no longer binge.⁵

Purging Disorder & Other Mental Health Conditions

Purging disorder often coexists with other mental health conditions. In many cases, an underlying mental health issue triggers the purging disorder. However, ongoing, recurrent purging can certainly exacerbate other mental health symptoms.

Mood disorders that frequently co-occur with purging disorder include:

• Anxiety disorders
• Substance use disorders 
• Personality disorders
• PTSD

What Are the Early Signs of Purging Disorder?

Purging disorder can be insidious, and people often take great lengths to conceal their patterns. The shame often feels intense, and the struggling individual doesn’t want their loved ones to know what’s happening. That said, it’s important for families to know potential red flags.

Early signs of purging disorder include:

• Swollen salivary glands
• Excessive exercise
• Fasting or excessive dieting talk
• Empty laxative wrappers or containers
• Frequent trips to the bathroom
• Finger calluses or scrapes
• Red or swollen eyes
• Unexplained smells of vomit
• Weight fluctuations
• Dry and cracked lips
• Bleeding gums

Side Effects of Purging Disorder

Purging can impact a person’s daily activities, relationships, and overall quality of life. In addition, it can significantly impact someone’s physical health, both in the short term and long term. These effects may start mildly, but they tend to worsen progressively over time.

Side effects of purging disorder include:

• Chronic dehydration
• Tooth decay
• Stomach ulcers
• Kidney failure
• Heart attacks
• Esophageal tears
• Pregnancy difficulties/birth defects (for pregnant women)
• Low blood pressure
• Anemia
• Burst blood vessels
• Hemorrhoids (due to diuretics or laxatives)
• Body injuries (resulting from compulsive exercise)

How is Purging Disorder Diagnosed?

Receiving a proper diagnosis can be a key part of starting and maintaining an effective treatment plan. Although diagnosing is sometimes controversial among healthcare providers, having a diagnosis may provide more treatment accessibility and options, particularly if you intend to use your health insurance.

Purging disorder isn’t a specific DSM-5 diagnosis, so people with this condition will likely be diagnosed with “other specified feeding or eating disorder” (OSFED). OSFED is just as serious as other eating disorders. The National Eating Disorders Association indicates that people with OSFED are just as likely to die from eating disorder behaviors/symptoms as they are from anorexia or bulimia.⁶

An evaluation for diagnosing purging disorder may include:

• A physical examination: A physical exam might be administered to identify signs of any other health issues underlying (or exacerbating) purging disorder symptoms.
• A psychiatric evaluation: A psychiatric evaluation can assess comorbidity with other mental health conditions, such as anxiety, depression, or substance use disorders.
• Blood tests: Blood tests provide baseline data about numerous conditions and can reveal vitamin deficiencies, cholesterol levels, and your general state of health.
• Self-reports: Some clients come into treatment with self-reports of their symptoms. A qualified healthcare provider will use this information to determine the next assessment steps.

How to Cope with Purging Disorder

Purging disorder may be challenging, but it is treatable, and you can recover. Having the right support and utilizing healthy coping skills can make a significant difference. Change may take time, and it often represents a trial-and-error process. It’s important to be patient and compassionate with yourself during this time.

Some tactics to cope with purging disorder include: 

• Mindfulness practices: Learning how to sit with triggers is an important part of recovery. Mindfulness exercises, such as deep breathing or meditation, can help you cope with distressing moments and maintain a more balanced perspective.
• Journaling: Journaling can help you better understand your triggers and even recognize progress over time. Consider following specific journal prompts or simply using your journal to write your thoughts freely.
• Limiting time on social media: There is a relationship between excessive social media use and eating disorders, particularly among younger people. Limiting time on these platforms can also encourage you to spend more time on hobbies and feel more engaged with real-life relationships.
• Acknowledging how you feel: Taking a moment to simply recognize an urge without acting on it can be extremely empowering. Urges do pass, and allowing yourself to ‘ride the wave’ reminds you that no emotional experience lasts forever.

Purging Disorder Treatment

Eating disorder treatment tends to be multifaceted, especially when the disorder is more chronic and long-term. There are no one-size-fits-all treatment methods, but it’s important to find a plan that feels reasonable and safe to follow (even if it, at times, feels uncomfortable). Depending on the severity of your purging disorder, you may need a higher level of care.

Treatment options for purging disorder include:

Psychotherapy Options

Working with a therapist is one of the best steps for treating your eating disorder. There are numerous evidence-based therapies, including cognitive behavioral therapy (CBT), family therapy, and dialectical behavior therapy (DBT), that are associated with reduced eating disorder symptoms. Some people with eating disorders also have trauma histories. Specific trauma-based therapies, such as eye movement desensitization and reprocessing (EMDR), internal family system therapy (IFS), or psychodynamic therapy, may also be beneficial for healing.

Both in-person and online therapy options can be helpful, depending on your preferences and needs. Some people also attend group therapy as a standalone or supplemental treatment option. Group therapies facilitated by trained mental health professionals offer peer support, accountability, and a sense of structure.

Medications

There are no FDA-approved medications specifically for treating purging disorder. However, some people are prescribed psychiatric medications, like SSRIs, to treat co-occurring depression or anxiety. Anticonvulsant medications, such as Topamax, may be prescribed when bulimia is present.

Hospitalization/Inpatient Treatment

In cases of moderate or severe purging disorder, someone may need hospitalization or inpatient treatment to stabilize the most acute symptoms. This can apply when there is significant malnutrition, electrolyte imbalances, or other health-related issues. It can also apply when there are severe mental health concerns, such as suicidal intent. These care settings provide the highest level of monitoring and support.

How to Find Treatment for Purging Disorder

Struggling in silence can be challenging, and the idea of speaking your truth can feel scary. But acknowledging the need for help and support is the first step toward recovery. Resources and help are always available. Having the right support team and finding the right therapist can be transformative.

To find the best provider, consider asking your doctor for a referral, talking to trusted friends or family, or looking through a therapist directory. Remember that not every therapist specializes in treating eating disorders, but it’s important to find a provider who can provide the treatment you need.

In My Experience

Although purging disorder isn’t talked about as much as other eating disorders, it’s just as serious and concerning. And because it’s not as understood, more people than we realize are likely dealing with these symptoms (which can make accessing treatment feel even more daunting). If you’re struggling, you deserve to reach out for support. In my experience, even when clients feel ambivalent about change, they find that therapy offers important insight and support in helping them live more meaningful lives.