Bingeing and Purging
Bingeing (or binge eating) and purging are eating disorder behaviors that show up in bulimia nervosa, as well as other eating disorder diagnoses.
Diagnoses that involve bingeing and/or purging:
Bulimia
A person with bulimia experiences recurrent episodes of binge eating, or eating a large amount of food in a short period of time, followed by episodes of purging, or attempting to “get rid of” the food through various compensatory behaviors.
Binge eating disorder (BED)
A person with BED experiences recurrent binges without purging afterward
Purging disorder
A person with purging disorder (a type of OSFED) experiences recurrent episodes of purging, without binges
Anorexia binge-purge subtype (AN-BP)
A person with AN-BP experiences bingeing and purging alongside restricted eating.
Read on to learn more about bingeing and purging, the health risks they carry, and what to do if you or a loved one is engaging in these behaviors.
What is bingeing?
Bingeing, or binge eating, is when a person eats an objectively large amount of food in a short amount of time, usually accompanied by a feeling of being out of control and followed by distressing emotions. Eating an extra slice of cake or going back for a third serving of pasta isn’t a binge; binges are distinct psychological events with specific characteristics.
Someone who’s engaging in a binge may feel like they’re unable to control how much they’re eating, and even have the sense that they’re outside their body while the binge is occurring. During a binge, a person typically continues to eat after they feel full, often to the point of extreme physical discomfort. Episodes of binge eating are almost invariably followed by intense feelings of shame or guilt and significant emotional discomfort.The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) uses several criteria to help professionals diagnose binge-related eating disorders like bulimia and binge eating disorder.
The diagnostic criteria include:
- Episodes of binge eating that happen within two hours
- Eating more food during a two-hour period than most other people would typically eat during that time frame
- Feeling like one has lost control during a two-hour period of eating
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not feeling physically hungry
- Eating alone because of being embarrassed by how much one is eating
- Feeling disgusted with oneself, depressed, or very guilty after overeating
How does binge eating affect the body?
For people struggling with bulimia or binge eating disorder, binges can provide a temporary sense of relief, helping to numb tough feelings (as we often say, eating disorders are coping mechanisms gone awry). However, that relief is quickly and inevitably replaced by emotional and psychological distress, often in the form of shame, guilt, embarrassment, disgust, or other difficult emotions.
In addition to the mental health consequences, bingeing can also take a toll on your body.
Short- and long-term physical effects of binge eating include
- Abdominal bloating
- Abdominal cramping
- Nausea
- Vomiting
- Acid reflux
- Diarrhea
- Constipation
- Lethargy
- Insulin resistance
- Sleep apnea
- Metabolic syndrome
- Heart disease
- Type 2 diabetes
- High blood pressure
- Musculoskeletal problems
What is purging?
Purging is a term used to describe any compensatory behavior meant to “get rid of” or “make up for” food a person has eaten. In bulimia and anorexia binge-purge subtype, purging occurs after a binge, whereas in purging disorder, a person purges without having binged.
When people think of the purging associated with bulimia, they tend to think of vomiting. And while this is a common purging behavior, purging can also take several other forms, including excessively exercising, abusing laxatives or diuretics, or fasting. 
Levels of severity
The DSM-5 characterizes the severity of a person’s bulimia based on how frequently they purge. The levels of severity are as follows:
Mild
Purges occur one to three times per week
Moderate
Purges occur four to seven times per week
Severe
Purges occur eight to 13 times per week
Extreme
Purges occur 14 or more times per week
These different levels of severity can be helpful for clinicians looking to understand and treat someone who purges—but they by no means suggest who should and shouldn’t get treatment. Regardless of how frequently someone is purging, they’re at risk for serious mental and physical health complications. Plus, “mild” purging behaviors can easily and quickly escalate to “extreme” forms.
Getting help early is always the best approach, not only to prevent serious health issues, but also to set someone up for an easier recovery journey.
How does purging affect the body?
As with binge eating, purging is a coping behavior that can provide a sense of temporary relief to someone struggling with an eating disorder. But this relief, just like the relief associated with binge eating, is inevitably overshadowed by distressing emotions.
Purging also carries physical health risks, some of which can be extremely serious and potentially lethal. Some of the most common physical effects of purging include:
- Discoloration and decay of the teeth
- Sore throat and temporary loss of voice
- Bleeding from the mouth
- Low blood pressure
- Heart arrhythmia
- Low heart rate
- Feeling cold often
- Chronic acid reflux
- Chronic diarrhea
- Chronic pain in the stomach
- Chronic cough
- Kidney failure
- Infertility
- Hormone disruptions
- Electrolyte imbalance
Recovery is possible
Binge eating and purging are both dangerous behaviors. Whether done together or in isolation, once a week or several times a day, they carry serious and even life-threatening health risks. If you or someone you love is struggling with bingeing and purging behaviors, don’t wait to get help. Though full, lasting recovery is possible no matter how long someone has been stuck in the binge-purge cycle, earlier intervention can make the recovery process significantly easier.
Contact our team today for more information about Equip treatment for bingeing and purging or to schedule a free consultation.
References
1. “DSM.” Psychiatry.org—DSM. https://www.psychiatry.org/psychiatrists/practice/dsm. Accessed 26 Oct. 2023.