Abstract
Purging disorder is an eating disorder subtype characterized by purging behaviors to control weight (i.e., self-induced vomiting or misuse of laxatives, diuretics, and/or other medications). It was recognized for the first time in the DSM-5 (2013) within the other specified feeding or eating disorder category. The lifetime prevalence of purging disorder is comparable to both anorexia nervosa and bulimia nervosa, placing it as a significant eating disorder phenotype. Purging disorder is symptomatologically similar to bulimia nervosa, except for the absence of binge eating episodes. However, despite the common features with other eating disorders, purging disorder appears as a clinically significant and potentially distinctive disorder. Therefore, the present chapter reviews and discusses the clinical and distinctiveness features of this disorder, as well as the treatments of first choice (i.e., cognitive-behavioral therapy). This chapter also highlights that studies on PD treatment outcomes are currently limited, available results are inconsistent, and evidence-based treatments are lacking.
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Abbreviations
- AN:
-
Anorexia nervosa
- BED:
-
Binge eating disorder
- BMI:
-
Body mass index
- BN:
-
Bulimia nervosa
- CBT:
-
Cognitive-behavioral therapy
- CBT-E:
-
Enhanced cognitive-behavioral therapy
- CCK:
-
Cholecystokinin
- DSM-5:
-
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
- ED:
-
Eating disorder
- GLP-1:
-
Glucagon-like peptide type 1
- OSFED:
-
Other specified feeding or eating disorder
- PD:
-
Purging disorder
- PYY:
-
Peptide YY
- RCT:
-
Randomized controlled trial
References
Allen KL, Byrne SM, Crosby RD (2015) Distinguishing between risk factors for bulimia nervosa, binge eating disorder, and purging disorder. J Youth Adolesc 44:1580–1591. https://doi.org/10.1007/S10964-014-0186-8
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders: DSM-5, 5th edn. American Psychiatric Association, Washington, DC
Balasundaram P, Santhanam P (2022) Eating disorders. In StatPearls. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK567717/
Binford RB, le Grange D (2005) Adolescents with bulimia nervosa and eating disorder not otherwise specified-purging only. Int J Eat Disord 38:157–161
Brown TA, Haedt-Matt AA, Keel PK (2011) Personality pathology in purging disorder and bulimia nervosa. Int J Eat Disord 44:735–740. https://doi.org/10.1002/EAT.20904
Dalle Grave R, Calugi S (2007) Eating disorder not otherwise specified in an inpatient unit: the impact of altering the DSM-IV criteria for anorexia and bulimia nervosa. Eur Eat Disord Rev 15:340–349. https://doi.org/10.1002/ERV.805/FORMAT/PDF
Davis HA, Smith GT, Keel PK (2020) An examination of negative urgency and other impulsigenic traits in purging disorder. Eat Behav 36. https://doi.org/10.1016/J.EATBEH.2020.101365
Dossat AM, Bodell LP, Williams DL et al (2015) Preliminary examination of glucagon-like peptide-1 levels in women with purging disorder and bulimia nervosa. Int J Eat Disord 48:199–205. https://doi.org/10.1002/EAT.22264
Ekeroth K, Clinton D, Norring C, Birgegård A (2013) Clinical characteristics and distinctiveness of DSM-5 eating disorder diagnoses: findings from a large naturalistic clinical database. J Eat Disord 1:1–11. https://doi.org/10.1186/2050-2974-1-31/TABLES/6
Fairburn C (2008) Cognitive behavior therapy and eating disorders. Guilford Press, New York
Fairburn CG, Cooper Z, Doll HA et al (2000) The natural course of bulimia nervosa and binge eating disorder in young women. Arch Gen Psychiatry 57:659–665
Fernández-Aranda F, Treasure J, Paslakis G et al (2021) The impact of duration of illness on treatment nonresponse and drop-out: exploring the relevance of enduring eating disorder concept. Eur Eat Disord Rev 29. https://doi.org/10.1002/erv.2822
Forney KJ, Buchman-Schmitt JM, Keel PK, Frank GKW (2016) The medical complications associated with purging. Int J Eat Disord 49:249–259. https://doi.org/10.1002/EAT.22504
Forney KJ, Crosby RD, Brown TA et al (2021) A naturalistic, long-term follow-up of purging disorder. Psychol Med 51:1020–1027. https://doi.org/10.1017/S0033291719003982
Goldschmidt AB, Accurso EC, O’Brien S et al (2016) The importance of loss of control while eating in adolescents with purging disorder. Int J Eat Disord 49:801–804. https://doi.org/10.1002/EAT.22525
Haedt AA, Keel PK (2010) Comparing definitions of purging disorder on point prevalence and associations with external validators. Int J Eat Disord 43:433–439. https://doi.org/10.1002/EAT.20712/FORMAT/PDF
Haedt-Matt AA, Keel PK (2015) Affect regulation and purging: an ecological momentary assessment study in purging disorder. J Abnorm Psychol 124:399–411. https://doi.org/10.1037/A0038815
Haines J, Neumark-Sztainer D, Hannan P, Robinson-O’Brien R (2008) Child versus parent report of parental influences on Children’s weight-related attitudes and behaviors. J Pediatr Psychol 33:783. https://doi.org/10.1093/JPEPSY/JSN016
Hammerle F, Huss M, Ernst V, Bürger A (2016) Thinking dimensional: prevalence of DSM-5 early adolescent full syndrome, partial and subthreshold eating disorders in a cross-sectional survey in German schools. BMJ Open 6. https://doi.org/10.1136/BMJOPEN-2015-010843
Hübel C, Leppä V, Breen G, Bulik CM (2018) Rigor and reproducibility in genetic research on eating disorders. Int J Eat Disord 51:593–607. https://doi.org/10.1002/EAT.22896
Jimerson DC, Wolfe BE, Carroll DP, Keel PK (2010) Psychobiology of purging disorder: reduction in circulating leptin levels in purging disorder in comparison with controls. Int J Eat Disord 43:584–588. https://doi.org/10.1002/EAT.20738
Keel PK (2019) Purging disorder: recent advances and future challenges. Curr Opin Psychiatry 32:518–524. https://doi.org/10.1097/YCO.0000000000000541
Keel PK (2007) Purging disorder: subthreshold variant or full-threshold eating disorder? Int J. Eat Disord 40(Suppl). https://doi.org/10.1002/EAT.20453
Keel PK, Eckel LA, Hildebrandt BA et al (2018) Disturbance of gut satiety peptide in purging disorder. Int J Eat Disord 51:53–61. https://doi.org/10.1002/eat.22806
Keel PK, Haedt A, Edler C (2005) Purging disorder: an ominous variant of bulimia nervosa? Int J Eat Disord 38:191–199
Keel PK, Holm-Denoma JM, Crosby RD (2011) Clinical significance and distinctiveness of purging disorder and binge eating disorder. Int J Eat Disord 44:311–316. https://doi.org/10.1002/EAT.20821
Keel PK, Wolfe BE, Gravener JA, Jimerson DC (2008) Co-morbidity and disorder-related distress and impairment in purging disorder. Psychol Med 38:1435–1442. https://doi.org/10.1017/S0033291707001390
Keel PK, Wolfe BE, Liddle RA et al (2007) Clinical features and physiological response to a test meal in purging disorder and bulimia nervosa. Arch Gen Psychiatry 64:1058–1066. https://doi.org/10.1001/ARCHPSYC.64.9.1058
Koch S, Quadflieg N, Fichter M (2014) Purging disorder: a pathway to death? A review of 11 cases. Eat Weight Disord 19:21–29. https://doi.org/10.1007/S40519-013-0082-3/TABLES/2
Koch S, Quadflieg N, Fichter M (2013) Purging disorder: a comparison to established eating disorders with purging behaviour. Eur Eat Disord Rev J Eat Disord Assoc 21:265–275. https://doi.org/10.1002/ERV.2231
Krug I, Granero R, Giles S et al (2020) A cluster analysis of purging disorder: validation analyses with eating disorder symptoms, general psychopathology and personality. Eur Eat Disord Rev 28:643–656. https://doi.org/10.1002/ERV.2769
Krug I, Sarah Giles E et al (2021) Where does purging disorder lie on the symptomatologic and personality continuum when compared to other eating disorder subtypes? Implications for the DSM. Eur Eat Disord Rev. https://doi.org/10.1002/ERV.2872
Lydecker JA, Shea M, Grilo CM (2018) Driven exercise in the absence of binge eating: implications for purging disorder. Int J Eat Disord 51:139–145. https://doi.org/10.1002/eat.22811
MacDonald DE, McFarlane TL, Dionne MM et al (2017a) Rapid response to intensive treatment for bulimia nervosa and purging disorder: a randomized controlled trial of a CBT intervention to facilitate early behavior change. J Consult Clin Psychol 85:896–908. https://doi.org/10.1037/CCP0000221
MacDonald DE, Trottier K (2019) Rapid improvements in emotion regulation predict eating disorder psychopathology and functional impairment at 6-month follow-up in individuals with bulimia nervosa and purging disorder. Int J Eat Disord 52:962–967. https://doi.org/10.1002/EAT.23117
MacDonald DE, Trottier K, Olmsted MP (2017b) Rapid improvements in emotion regulation predict intensive treatment outcome for patients with bulimia nervosa and purging disorder. Int J Eat Disord 50:1152–1161. https://doi.org/10.1002/eat.22766
Maske CB, Williams DL, Keel PK (2020) Preliminary examination of insulin and amylin levels in women with purging disorder. Int J Eat Disord 53:997–1001. https://doi.org/10.1002/EAT.23230
Munn-Chernoff MA, Keel PK, Klump KL et al (2015) Prevalence of and familial influences on purging disorder in a community sample of female twins. Int J Eat Disord 48:601. https://doi.org/10.1002/EAT.22378
Murray SB, Anderson LK (2015) Deconstructing atypical eating disorders: an overview of emerging eating disorder phenotypes. Curr Psychiatry Rep 17:86. https://doi.org/10.1007/s11920-015-0624-7
Neumark-Sztainer D, Bauer KW, Friend S et al (2010) Family weight talk and dieting: how much do they matter for body dissatisfaction and disordered eating behaviors in adolescent girls? J Adolesc Health 47:270–276. https://doi.org/10.1016/J.JADOHEALTH.2010.02.001
Riesco N, Agüera Z, Granero R et al (2018) Other specified feeding or eating disorders (OSFED): clinical heterogeneity and cognitive-behavioral therapy outcome. Eur Psychiatry 54:109–116. https://doi.org/10.1016/j.eurpsy.2018.08.001
Smith KE, Crowther JH, Lavender JM (2017) A review of purging disorder through meta-analysis. J Abnorm Psychol 126:565. https://doi.org/10.1037/ABN0000243
Steiger H, Bruce KR (2007) Phenotypes, endophenotypes, and genotypes in bulimia spectrum eating disorders. Can J Psychiatr 52:220–227
Stice E (2001) A prospective test of the dual-pathway model of bulimic pathology: mediating effects of dieting and negative affect. J Abnorm Psychol 110:124–135. https://doi.org/10.1037//0021-843X.110.1.124
Stice E, Desjardins CD, Rohde P, Shaw H (2021) Sequencing of symptom emergence in anorexia nervosa, bulimia nervosa, binge eating disorder, and purging disorder and relations of prodromal symptoms to future onset of these disorders. J Abnorm Psychol 130:377–387. https://doi.org/10.1037/ABN0000666
Stice E, Marti CN, Shaw H, Jaconis M (2009) An 8-year longitudinal study of the natural history of threshold, subthreshold, and partial eating disorders from a community sample of adolescents. J Abnorm Psychol 118:587–597. https://doi.org/10.1037/a0016481
Stice E, Nathan Marti C, Rohde P (2013) Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. J Abnorm Psychol 122:445–457. https://doi.org/10.1037/A0030679
Tasca GA, Maxwell H, Bone M et al (2012) Purging disorder: psychopathology and treatment outcomes. Int J Eat Disord 45:36–42. https://doi.org/10.1002/EAT.20893
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Agüera, Z., Baenas-Soto, I., Fernández-Aranda, F. (2023). Cognitive-Behavioral Therapy and Purging Disorder. In: Patel, V.B., Preedy, V.R. (eds) Eating Disorders. Springer, Cham. https://doi.org/10.1007/978-3-031-16691-4_68
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