In the context of eating disorders, the word purging is most often associated with bulimia, where it makes up one half of the binge-purge cycle. But purging behaviors can also exist on their own, and when this happens, it’s known as purging disorder. Read on to learn more about purging disorder, its health risks, what treatment looks like, and more.

What is purging disorder?

Purging disorder is characterized by recurrent episodes of purging behavior in the absence of binge eating. This pattern of behavior was first identified and described as an eating disorder in the early 2000s, but it didn’t become an official diagnosis until the publication of the DSM-5 in 2013. The decision to add purging disorder to the DSM was based on “considerable evidence to support the clinical significance of this disorder.”

In the DSM, purging disorder is described as “recurrent purging behaviors to influence weight or shape, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, in the absence of binge eating,” and it falls under the category of OSFED (Other Specified Feeding or Eating Disorder). Not having its own distinct category in the DSM doesn’t make purging disorder any less serious or common.

Symptoms and signs of purging disorder

Purging disorder involves recurrent episodes of purging in the absence of binge eating. Purging can take many different forms, including:

• Self-induced vomiting
• Misuse of laxatives, diuretics, or other medications
• Excessive exercise
• Fasting

It’s important to note that purging is almost always done in secret, so if you’re concerned a loved one may be purging, you’ll need to watch for other signs. Here are some red flags to look out for that might indicate purging behaviors:

• Disappearing or going to the bathroom after meals
• Frequent use of mints, gum, or other breath-freshening products
• Damage to teeth
• Constipation or other digestive problems
• Fatigue or weakness
• Fear of gaining weight or a preoccupation with losing weight
• Placing a lot of value on weight, body size and shape, and appearance
• Body checking behaviors

Purging disorder also shares many of the signs and symptoms of other eating disorders. Our eating disorder screener can help you identify if you or a loved one might be dealing with purging disorder or a different diagnosis.

How common is purging disorder?

Because purging disorder is such a new diagnosis, there’s not a lot of research about how common it is and who it tends to affect. What’s more, many people with purging disorder may have been incorrectly diagnosed with bulimia or left undiagnosed completely, skewing the numbers in the research that does exist. However, we do have some data that gives a sense of just how prevalent purging disorder is.

Estimates of lifetime prevalence for purging disorder (meaning the percent of people who will experience the disorder at some point in their life) range from 1.1% to 5.3%. Among populations of people in eating disorder treatment, up to 7% have purging disorder, according to Tana Luo, PhD, Director of Program Development at Equip.

Though purging disorder can occur at any age, it most commonly emerges in late adolescence and early adulthood (it affects about 2.5% of adolescents each year). The disorder occurs more commonly in girls and women than in boys and men, though 5-10% of those affected by purging disorder are men. Purging disorder typically affects people who are classified as normal weight or larger.

What causes purging disorder?

Frustrating as it might feel, eating disorders almost never have one clear cause. Instead, they emerge out of a confluence of different factors: genetic, physiological, environmental, social, psychological. However, there are some things that can increase a person’s chance of developing purging disorder.

“In terms of risk factors, people who struggle with body dissatisfaction and with dieting behaviors are at increased risk for developing purging disorder later in life,” explains Luo. “There’s also some evidence that those with purging disorder may experience excessive fullness and GI distress after mealtimes, compared to both people with bulimia and people without an eating disorder, which may increase risk of purging.”

Here’s a snapshot of the risk factors for purging disorder:

• A history of dieting
• Body dissatisfaction
• Nausea, stomachache, or other GI distress after eating
• Hormonal response (some research suggests that people with purging disorder might overproduce hormones that cause the feeling of fullness after eating)
• Family history of an eating disorder
• Trauma
• Co-occurring conditions like depression or anxiety

Bulimia vs. purging disorder: understanding the difference

Bulimia is defined by recurrent episodes of binge eating followed by purging behaviors, while purging disorder is defined by recurrent episodes of purging without binge eating beforehand. “The lack of objective binge eating is the main difference between purging disorder and bulimia,” says Luo. “There’s some evidence that purging disorder may be characterized by a loss of control while eating normal or small amounts of food.” In other words, since loss of control is one of the defining characteristics of a binge, someone with purging disorder might eat a totally normal amount of food (objectively not a binge), but because of the loss of control and excessive feelings of fullness they felt while eating, feel the need to purge afterward.

Here are some of the key differences between purging disorder and bulimia:

• Bulimia includes episodes of binge eating, while purging disorder does not.
• In bulimia, purging occurs after eating an objectively large amount of food. In purging disorder, purging occurs after eating a normal or small amount of food, though it may be subjectively perceived as a binge.
• Some evidence suggests that purging behaviors in purging disorder may be due to gastrointestinal distress or excessive fullness after eating, rather than a desire to change body weight or size.
• Bulimia is a distinct diagnosis in the DSM, while purging disorder falls under the OSFED category (this doesn’t make purging disorder less serious).

Purging disorder and bulimia also share a number of characteristics. Some of the similarities between the disorders include:

• “Getting rid” of food that’s been eaten through purging behaviors like self-induced vomiting, misuse of medication, or excessive exercise
• Weight fluctuations
• Physical symptoms like sore throat, tooth decay, and gastrointestinal issues
• Other serious health risks (outlined below)

The health risks of purging disorder

Purging disorder may be less well-known than other eating disorders, but that doesn’t make it less serious. Left untreated, purging disorder can cause a long list of physical and mental health problems, just like other eating disorders.

Because purging is extremely harmful to a person’s body, purging disorder poses serious risks to physical health, many of which overlap with the physical consequences of bulimia. Some of the physical health issues associated with purging disorder include:

• Electrolyte imbalances (which can be very serious and even cause death)
• Dehydration
• Kidney failure
• Dental erosion and tooth decay
• Gastrointestinal issues
• Heart problems
• Impaired bone health
• Tears in the esophagus

And while purging takes a significant toll on the body, purging disorder is ultimately a mental health issue, and can cause a variety of different psychological and emotional problems. Purging disorder carries many of the mental health risks of other eating disorders, including:

• Mood swings
• Depression
• Anxiety
• Suicidal ideation

What does purging disorder treatment look like

“There’s currently a lack of research on the treatment of purging disorder specifically,” says Luo. However, she says, CBT-E is an evidence-based treatment approach that has been shown to be effective across eating disorder diagnoses, so it’s likely to be effective for purging disorder.

Luo also points out that the purging behaviors associated with purging disorder might serve a different purpose than the purging in bulimia, and so this needs to be taken into account. “Treatment should take into consideration the specific triggers and functions of purging episodes in people with purging disorder,” she advises. “Given some of the research on satiety and GI distress following meals, people with purging disorder may also specifically benefit from tools to help them tolerate feelings of fullness and other GI symptoms after eating.”

As with treatment for any eating disorder, there are a lot of different options and decisions to make. There’s in-person treatment, virtual treatment, inpatient programs, outpatient programs, and seeing individual providers without a program, not to mention all the different potential treatment modalities (like CBT-E, FBT, DBT, and others). Eating disorder treatment isn’t one-size-fits all, so there’s not one “correct” way to reach recovery. However, here’s what to keep in mind when seeking treatment for purging disorder:

• It’s important to have a multidisciplinary care team. This is because eating disorders affect a whole person—their mind, their body, their social life, their family, their daily functioning—and so one provider can’t treat every aspect of it. A multidisciplinary care team should include, at the minimum, a medical provider, a registered dietitian, and a licensed therapist.
• Look for evidence-based practices. Not all eating disorder specialists and eating disorder programs use approaches that are backed up by evidence, so it’s important to ask about evidence-based modalities. Some of the evidence-based modalities for eating disorders include CBT, CBT-E, FBT, ERP, and TBTS.
• Loved ones should probably be involved. Eating disorders don’t only affect the person with the diagnosis—they also affect friends, family, and other loved ones. Involving these people in treatment helps them feel supported and engaged throughout the tough journey of recovery, and also helps educate them about eating disorders so that they can create a recovery-supportive environment outside of treatment. Involving loved ones can be a powerful step toward preventing relapse.
• Virtual treatment can be a smart choice for many. Research shows that virtual eating disorder treatment is just as effective as in-person care. Given that the average American lives over two hours from the closest eating disorder treatment center, and that in-person care tends to be financially inaccessible and often not covered by insurance, virtual treatment offers a more accessible alternative. Being able to recover at home is also an advantage, as it means patients don’t have to uproot their lives to get better, and allows them to tackle real-world triggers and challenges with the support of their treatment team.

The Equip takeaway: What to remember about purging disorder

Purging disorder is a lesser-known eating disorder that’s characterized by recurrent episodes of purging (i.e., engaging in behaviors to “get rid” of food that’s been consumed) without binge eating beforehand. Purging disorder was introduced into the DSM in 2013 under the category of OSFED, but not having its own category doesn’t make it any less serious than other eating disorders.

Because it’s a relatively new diagnosis, we don’t know all that much about how common it is or which treatment approaches work best, but as awareness increases, we’re hopeful this will change. Recognizing purging disorder as its own distinct and harmful diagnosis is an important first step toward getting everyone struggling the care they need and deserve.

If you’re worried that you or a loved one might be struggling with purging disorder, know that lasting recovery is possible. Don’t wait to seek help—eating disorders don’t go away on their own, and early intervention is associated with better outcomes. Talk with your doctor, mental health provider, or an eating disorder specialist, or reach out to our team for a no-obligation consultation.

FAQ about purging disorder

1. What is purging disorder and how is it different from bulimia?

Purging disorder is an eating disorder characterized by recurrent episodes of purging behavior (like self-induced vomiting, laxative misuse, or excessive exercise) without binge eating beforehand. Bulimia is an eating disorder characterized by recurrent episodes of binge eating followed by purging. The primary difference between the two is the absence of binge eating in purging disorder.

Purging disorder falls under the OSFED (other specified feeding or eating disorder) category in the DSM, while bulimia has its own entry. This doesn’t make purging disorder any less serious or harmful.

2. What are the common symptoms of purging disorder?

The primary symptom of purging disorder is recurrent episodes of purging behaviors to “get rid of” food that’s been eaten. These behaviors might include self-induced vomiting, laxative or diuretic misuse, or excessive exercise, among others. Purging is usually done in secret, so loved ones should look for other signs of purging disorder, like disappearing after meals, frequent use of breath-freshening products, damage to teeth, digestive problems, and body image distress.

3. How can purging disorder affect physical and mental health?

Like all eating disorders, purging disorder carries significant risks to mental and physical health. Physical health risks include electrolyte imbalance, kidney failure, heart issues, digestive problems, tooth decay, dehydration, and impaired bone health. Mental health risks include mood swings and increased risk of depression, anxiety, and suicidal ideation.

4. What are the causes and risk factors for developing purging disorder?

Like all eating disorders, purging disorder emerges out of a combination of different factors, which can be genetic, psychological, social, or environmental. Some things that might increase a person’s risk of developing purging disorder include a history of dieting, body dissatisfaction, gastrointestinal distress after eating, family history of an eating disorder, trauma, and co-occurring conditions like depression or anxiety.

5. What treatment options are available for purging disorder?

There’s not much research on treatment for purging disorder specifically (yet), but it’s likely that other evidence-based eating disorder treatment approaches can be effective options. Enhanced cognitive behavioral therapy (CBT-E) may be a good option for adults with purging disorder, and family-based treatment (FBT) may be a good option for young people with eating disorders.

As with all eating disorders, purging disorder can be treated via in-person or virtual treatment, as well as with inpatient or outpatient care. When considering treatment options for purging disorder, it’s important to look for a multidisciplinary care team, evidence-based treatment approaches, and the involvement of loved ones. For many people struggling, virtual treatment may be a more accessible (and equally effective) treatment choice than in-person care.