Purging refers to using compensatory measures such as vomiting, misusing laxatives, taking diet pills, or engaging in excessive exercise as a means of managing calorie intake. People with eating disorders may purge to try to avoid weight gain. Purging often occurs directly after an episode of binge-eating, but some may purge after eating any quantity of food.
What Is Purging?
Purging is a conscious attempt to eliminate or counteract food calories. People with eating disorders often use these behaviors as hazardous weight management tools. However, over time, purging rituals can quickly become compulsive and quitting them can be extremely challenging. In milder cases, someone may purge occasionally; in more severe situations, a person may purge several times a day.
Here are four common methods of purging:
Vomiting often coincides with binge eating, and people with bulimia are particularly prone to this type of purging.1 Someone typically vomits their food to undo overeating or binge eating. After a person eats, they feel they must “empty” themselves. Guilt, shame, and embarrassment may emerge, thus triggering more cravings to eat again. This pattern can become a vicious cycle.
The impacts of chronic vomiting can be life-threatening. Vomiting often coincides with electrolyte imbalances, and this imbalance can cause lethargy, irregular heartbeat, kidney failure, and heart attacks. It also impacts the stomach, and may cause ulcers and intense gastrointestinal distress. For these reasons, those living with bulimia are considered susceptible to acute and premature death.
Moreover, vomiting doesn’t work as an effective weight loss measure. The body absorbs food rapidly, and vomiting alone will not eliminate more than 50% of the consumed calories–usually much less.2
Some may abuse laxatives to lose weight, feel thin, or empty themselves after eating. The laxatives typically follow binge episodes–the person wants to “rush out” food calories before absorption. However, laxative effectiveness is a myth. Food is absorbed very quickly, and any artificial weight loss quickly returns after rehydration.3
Laxative misuse also causes electrolyte imbalances. This disruption can impact the heart, blood, and kidneys. Furthermore, overusing laxatives may cause dependency, and the colon will need a higher dose of them to produce bowel movements. Over time, this can cause significant internal organ damage and increase the risk of colon cancer.3
People may exercise excessively to lose or manage their weight, or to counteract the impact of calories consumed. While many often associate eating disorders with women, men are more likely to use exercise as a compensatory measure.4 This trend tends to be particularly pervasive in fitness communities.
While moderate physical activity is recommended for nearly everyone, overdoing it can be detrimental. Excessive exercise is associated with injuries, intense soreness, fatigue, hormonal dysregulation, and cardiovascular stress.5
Diuretics–also known as water pills–aim to remove water from the blood to reduce blood pressure. Some people abuse prescription diuretics to manage weight or induce weight loss. However, removing excess water from the body is not an effective weight-loss strategy. As soon as someone rehydrates, the water weight returns. That said, the consequences of misuse can be detrimental. Diuretic abuse is also associated with electrolyte imbalances and can affect the heart, organs, liver, blood, and kidneys.
Purging & Eating Disorders
Research shows that eating disorders impact more than 28 million Americans. These affect people of any age, sex, or socioeconomic status. That said, they’re often comorbid with other mental health issues, including anxiety, mood, and substance use disorders.
Purging is a common behavior in these eating disorders:
People with bulimia engage in binge-purge cycles in response to weight preoccupation or poor body image. They will eat large volumes of food in a short period of time (known as a binge), in which they experience a lack of control. Purging is often done to reduce the guilt or fear of eating.
It’s important to note that bulimia differs from binge eating. People with binge-eating disorder consume large quantities of food, but they do not typically compensate with purging behaviors.
Anorexia Nervosa Purging Subtype
Some people living with anorexia show similar cycles of bulimic behavior. For example, they may binge and purge to manage their weight, also referred to as anorexia nervosa binge/purge subtype. However, anorexia entails chronic food restriction, and that is not always the case with bulimia. In addition, people with anorexia have low body weights. People with anorexia may purge by vomiting; abusing laxatives; fasting (not eating for many days after a binge); or diuretic abuse.
Purging disorder refers to persistent patterns of purging behavior in the absence of binge eating. In the DSM, purging disorder currently falls under the category of Other Specified Feeding or Eating Disorder (OSFED). Excessive exercise often falls under this category, as someone might exercise compulsively without overeating.
Complications of Purging
Purging is inherently dangerous, and it can affect all areas of your physical and emotional well-being. It’s important to remember that symptoms may develop over time. Unfortunately, this progression can create false confidence. Some people may engage in purging behaviors for many years before experiencing serious consequences. But, at that point, they may have already caused significant damage to their minds and bodies.
Physical effects of purging may include:
- Low blood pressure
- Arrhythmia (irregular heartbeat)
- Tooth erosion
- Swollen glands
- Hormonal imbalances
- Altered glucose levels
Psychological effects of purging may include:
- Body dysmorphia
- Poor body image
- Increased risk of developing an anxiety disorder
- Feelings of worthlessness
- Heightened risk of suicide
- Increased risk of developing depression
- Relationship issues
- Poor work or school performance
- Intense feelings of guilt and shame
Long-term complications of purging may include:
- Gastrointestinal dysfunction
- Kidney failure
- Fertility problems
- Low bone density
- Severe malnutrition
- Heart attacks
- Gastric rupture
- Premature death
Purging Warning Signs
It can be challenging to discern if a loved one is purging. Feelings of shame and embarrassment often drive people to attempt to conceal their purges. However, loved ones may be able to notice slight physical and behavioral changes.
Below are some warning signs of purging behavior:
- Only eating when alone
- Eating large amounts of food quickly
- Empty laxative or diuretic packages
- Bad breath
- Unexplained weight fluctuations
- Heightened anxiety around mealtimes
- Engaging in various fad diets
- Swollen cheeks or jaw line
- Using the bathroom for long periods of time after eating
- Large quantities of food disappear without an explanation
- Intense, prolonged exercise sessions
What Causes Someone to Purge?
Various environmental or genetic variables may make someone more susceptible to purging. For example, research shows that low self-esteem, perfectionism, and tendencies towards impulsive behaviors are eating disorder risk factors.6
Societal expectations around thinness and body shape also likely play a role. Furthermore, stress can trigger someone to use unhealthy coping skills, such as purging to feel more “in control.” Finally, purging itself can become a behavioral addiction. Someone may feel a “high” when purging, only to experience a crash soon after.
Treatment for Purging Disorders
Purging can be life-threatening. Even in milder situations, this pattern can significantly impact your quality of life. Seeking professional help is important if you are struggling. Therapy is often the first step toward changing your behavioral responses. Therapies such as CBT, family therapy, and exposure therapy are all evidence-based treatments for purging. In therapy, you will learn more about managing your triggers and implementing healthier coping responses.
Support groups may also be beneficial in helping you feel validated and understood. There are numerous in-person and online therapy options available. Some groups are peer-led (self-run), and others are facilitated by trained eating disorder professionals. You may need to try a few different groups before finding the right fit.
Finally, some people respond well to pharmacological treatment. SSRIs and antiepileptics, for example, are associated with decreased binge-eating. Topiramate, in particular, seems to show promising results. Moreover, buspirone has been shown to reduce bingeing and vomiting in people with bulimia.7
Self-Coping Methods for Purging
Purging may begin to feel like an automatic response, but you can interfere with that process by developing healthy coping skills. At first, purging urges may seem very intense and even unbearable. But having several coping skills on hand can help you feel more empowered. Eventually, the more you practice these habits, the more natural they will feel.
You may be able to help improve your negative patterns of purging by:
- Meditating: Meditation can help you feel more connected to yourself. The next time you want to purge, try spending a few moments simply focusing on your breath and relaxing your body. Consider downloading a guided meditation script if you need support.
- Practicing mindfulness: Try to spend more time being in the present moment. Consider grounding yourself by focusing on your five senses. If you feel anxious, remind yourself that all emotions pass.
- Journaling: If you feel anxious or flooded by your emotions after eating, consider spending a few moments journaling. Write down how you feel and consider tracking your moods to develop more insight into potential behavioral patterns.
- Using your hands (painting your nails, knitting, drawing): Try to occupy your hands and attention for at least thirty minutes at a time. You may notice that the urge to purge significantly reduces after that time passes.
- Spending a few moments in nature: Nature can boost feel-good hormones, such as serotonin and dopamine. Consider sitting outside for a few minutes or taking a short talk.
- Cuddling with an animal: If you have a pet, spend some time playing or cuddling up against them. The oxytocin boost may help reduce your desire to purge.
- Taking a nap or going to bed early: Feeling tired can be a trigger for engaging in maladaptive behavior. Sometimes “sleeping it off” does the trick.
- Organizing or cleaning something: Sometimes, focusing on controlling an “external” part of your world can help you feel better. Set a timer and commit to completing a task you’ve been putting off (e.g., folding the laundry, organizing a drawer, wiping down the counters).
All forms and frequencies of purging can be dangerous. Likewise, these problems often worsen progressively over time. If you are struggling, it’s important to seek help. You’re not alone, and getting the right treatment can make an important difference in starting a meaningful recovery.