Purging: Definition, Types, & Treatments

What Is Purging?

Purging is a conscious attempt to eliminate or counteract calories from food. 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, leading to purging disorder.

Here are four common methods of purging:

Self-Induced Vomiting

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

Laxative Abuse

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

Excessive Exercise

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

Diuretic Misuse

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.

Insulin Misuse

Insulin misuse refers to the intentional improper use of insulin often for weight and/or body shape management, often called diabulimia. Insulin misuse is typically predominant in people with diabetes who self-administer insulin, either through injections or insulin pumps. Although this is not an official diagnosis and more research is needed to truly understand it, insulin misuse can be thought of as a non-dietary, purging-type behavior often seen in those with type 1 diabetes.⁶

Purging & Eating Disorders

Current eating disorder statistics show that eating disorders impact more than 28 million Americans, and they can 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:

Bulimia Nervosa & Purging

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 Binge Purge 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.

OSFED

OSFED stands for “other specified feeding or eating disorder,” which is a category within the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). OSFED is used to describe cases in which someone displays diverse presentations of disordered eating but doesn’t meet the full criteria for other eating disorders like anorexia nervosa, bulimia nervosa, or binge-eating disorder. Nonetheless, OSFED reflects the understanding that eating disorders can manifest in a variety of ways, and people can still experience serious mental and physical complications even if their symptoms don’t fit the full criteria for more specific eating disorders.⁷

Physical Effects 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:

• Dehydration
• Hyponatremia (not enough sodium in the blood)
• Low blood pressure
• Fatigue
• 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
• Esophagitis
• Fertility problems
• Low bone density
• Severe malnutrition
• Osteoporosis
• Hypertension
• Heart attacks
• Gastric rupture
• Premature death

Signs Someone Is Purging

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, such as not eating in the company of others, having bad breath, or using the bathroom for a long time after meals.

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.⁸ Societal expectations around thinness and body shape also likely play a role, as social media can influence eating disorders.

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.

When to Seek Emergency Help After Purging

Purging is a dangerous behavior that can affect every organ system in the body and cause severe health complications that may require emergency care. If you or someone you know is experiencing symptoms such as dizziness or fainting, chest pain, shortness of breath, heart palpitations, or abdominal pain, seeking immediate medical assistance is crucial because these may be indicative of something more serious or fatal. The earlier a person receives help, the greater the likelihood of preventing a possible life-threatening event to happen.⁹

Here are several signs that you should seek immediate help for purging behaviors:⁹

• Dizziness or fainting: Dizziness can occur for several reasons like severe dehydration, low blood sugar levels, heart rate levels dropping, and not enough blood pumping throughout the body—all resulting from purging.
• Chest pain, shortness of breath, or heart palpitations: Electrolyte imbalances due to purging typically affect the cardiovascular system. Chest pain, irregular heartbeats, or shortness of breath can be indicative of possible heart failure or another chronic heart-related issue.
• Severe dehydration: Purging leads to severe dehydration due to the body losing more fluids than it is taking in, leading to extreme thirst, dry mouth, dark urine, and more. Severe dehydration can also cause tremors, weakness, fainting, kidney damage, and, in extreme cases, death.
• Severe sore throat or acid reflux: Repetitive self-induced vomiting can wear down the esophagus, inducing automatic gag reflex and gastric acids to reach the throat after eating. Consequently, people may experience sore throat, heartburn, or hoarseness. In severe cases the esophagus can rupture, creating a life-threatening emergency
• Tremors, weakness, or blurry vision: Nutritional deficiencies, extreme dehydration, and other purging-related consequences can induce tremors, weakness, or blurry vision. Overall, these are signs of significant physiological stress and imbalance in the body.
• Abdominal pain: Severe abdominal pain may happen due to the esophagus being repetitively exposed to gastric acids, causing irritation and/or damage to the stomach lining. This may signify gastric related problems such as ulcers, gastritis, acid reflux among others.

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, and therapy is often the first step toward changing your behavioral responses. Therapies such as CBT-E,  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.

Eating disorder group therapy 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 binging and vomiting in people with bulimia.¹⁰

How to Get Help for Purging

If someone is struggling with purging behaviors, seeking help is crucial as this condition can worsen over time. A good starting point can be talking to your primary care doctor who can assess your overall health, provide initial support, and refer you to specialists or treatment programs if needed. They can also rule out any underlying medical conditions contributing to the purging behaviors. You may also consider going directly to a mental health professional who can thoroughly evaluate you and offer treatment. You can find a therapist through your primary care doctor or by using an online therapist directory, or you can use an online eating disorder recovery program, like Equip Health or Within Health.

Another option depending on the severity of the purging behaviors is to enter a specialized or inpatient eating disorder facility. These can provide you with more intensive and specific interventions to address the purging and associated concerns.

How to Stop Purging

Purging may begin to feel like an automatic response, but you can interfere with that process by developing healthy coping skills for your eating disorder. 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.

If you feel the need to purge, 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).