Purging Disorder: Symptoms, Causes, Effects, & Treatments

What Is Purging Disorder?

Purging disorder is one type of “other specified feeding or eating disorder” (OSFED) that involves 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.

How Common Is Purging Disorder?

Exact statistics on purging disorder are unknown, and this is likely because it’s underrepresented and underreported in both research and clinical settings. One study found that purging disorder affects approximately 2.5-4.8% of adolescent girls.² Because of the shame that often coincides with eating disorders, people may be less outspoken about their purging behavior. Similarly, healthcare professionals may not adequately screen for this condition.

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 related to bulimia.

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.

Types of Purging

Although people generally associate purging with self-induced vomiting, purging refers to any attempt to release food or burn calories. Some people engage in just one type of purging, whereas others may utilize multiple methods. It’s not uncommon for people to switch from one type of purging to another.

Types of purging include:

• Self-induced vomiting: Self-induced vomiting refers to intentionally vomiting after eating. Over time, this can lead people to involuntarily vomit.
• Laxative misuse: Laxative misuse refers to taking excessive amounts of laxative on a regular basis.
• Excessive exercise: Excessive exercise refers to exercising in a way that’s compulsive or extreme. Some people will exercise regardless of having injuries or being physically exhausted in order to burn calories.
• Extreme fasting: Extreme fasting may include going several days without eating. In other forms, it may also coincide with extremely restrictive behavior around food.

Outward 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.

Here are several potential signs someone is purging:

• 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

Purging Disorder Symptoms

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 symptoms of other eating disorders, the sole focus is on purging rather than how food is—or isn’t—consumed.

Physical symptoms of purging disorder include:³

• 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.⁴

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.⁵
• 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.⁵
• 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 binging and purging more often. Or someone might keep purging even if they no longer binge.⁶

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

Purging as a Form of Self-Harm

Purging can be a type of self-harm. Some people engage in self-harm to physically release their emotional pain. This can mimic that of other compulsive or addictive behaviors, as the individual may experience a rush just before and during the purging routine. However, like other forms of self-harm, there’s often a high level of secrecy, shame, and self-loathing that coincides with the act.

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.

Purging side effects can 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.⁷

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.

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 for Purging

Working with a therapist is one of the best steps for treating your eating disorder. Both in-person and online therapy options can be helpful, depending on your preferences and needs.

There are numerous evidence-based therapies, including:

• CBT-E
• Family-based treatment
• DBT for eating disorders
• Specific trauma-based therapies, such as EMDR, IFS, or psychodynamic therapy may also be beneficial for healing.

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.

Medication for Purging

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.

Nutrition Counseling

Nutrition counseling can help you understand your nutritional needs and eating behaviors. A registered dietitian can provide you with support about how to nourish your body appropriately. They may also help clear up any misconceptions you have about food. Nutrition counseling is often part of multidisciplinary treatment, and dietitians regularly collaborate with therapists and psychiatrists to best coordinate care.

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.

How to Stop Purging

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.

Along with professional treatment, here are some ways to cope with purging disorder:

• Acknowledge 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.
• Don’t try to recover by yourself: It’s important to seek support if you’re struggling with an eating disorder. Treatment can provide you with guidance and compassion as you recover.
• Don’t blame yourself or others: While it’s important to be mindful of the factors contributing to your eating disorder, blaming anyone or yourself rarely fixes the problem. Instead, simply be aware of how the triggers affect you and what you can do to best move through them.
• 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.

Outlook for Purging Disorder

The right treatment can help people reduce or eliminate purging disorder symptoms. It is possible to establish a full recovery. The timeline for treatment varies based on several factors, including your current mental health, support system, physical health, and the presence of other co-occurring issues. Keep in mind that progress is not necessarily linear, and it’s typical for people to experience slips throughout their recovery.