# Purging disorder

Purging disorder is an eating disorder characterized by the DSM-5 as self-induced vomiting, or misuse of laxatives, diuretics, or enemas to forcefully evacuate matter from the body. Purging disorder differs from bulimia nervosa (BN) because individuals do not consume a large amount of food before they purge. In current diagnostic systems, purging disorder is a form of other specified feeding or eating disorder. Research indicates that purging disorder, while not rare, is not as commonly found as anorexia nervosa or bulimia nervosa. This syndrome is associated with clinically significant levels of distress, and that it appears to be distinct from bulimia nervosa on measures of hunger and ability to control food intake. Some of the signs of purging disorder are frequent trips to the bathroom directly after a meal, frequent use of laxatives, and obsession over one's appearance and weight. Other signs include swollen cheeks, popped blood vessels in the eyes, and clear teeth which are all signs of excessive vomiting.
Purging disorder is studied far less often than anorexia nervosa and bulimia nervosa as it is not considered an independent diagnosis in the DSM-5, published in 2013. However, it has been argued that purging disorder should be considered a distinct eating disorder, separate from bulimia nervosa. Because of this, little information is known about the risk factors for purging disorder, including how gender, race, and class could contribute to the risk for purging disorder. As with most eating disorders, purging disorder appears to affect women disproportionately, presumably due to cultural forces and social pressures. In particular, preoccupation with shape and weight puts women at elevated risk for eating disorders, including purging disorder. In one study of the risk factors for purging disorder, 77% of the participants who presented with symptoms of purging disorder were female. Purging disorder progressing into bulimia nervosa has been observed, while it is extremely rare for the reverse situation, bulimia nervosa progressing into purging disorder. This was observed once in a transgender patient with a severe history of bulimia nervosa but presented with symptoms of purging disorder to an eating disorder treatment facility in New Zealand.
Estimates of lifetime prevalence of purging disorder have been estimated from 1.1% to 5.3%.

## Signs and symptoms

* Recurrent purging to influence body weight or shape
* Absence of binging episode(s)
* Purge behaviors occur at least once per week for at least 3 months
* Inappropriate influence of body shape and weight
* Russell's sign

## Causes
### Risk factors

* Dieting
* Thin-ideal internalization
* Body dissatisfaction

### Genetic

The heritability of some eating disorders has been well established, but to date there are no documented family studies of purging disorder to understand the familial nature of purging disorder.

## Diagnosis

The DSM-5 is used as a reference to diagnose Purging Disorder. A patient with Purging disorder will be diagnosed with other specified feeding or eating disorder.

### Complications

Purging behaviors, specifically self-induced vomiting and laxative use are associated with the following medical complications:
* Subconjunctival hemorrhages (small bleeds in the eyes)
* Cuts or scars on the top of the hands (Russell's sign)
* Dental abnormalities such as enamel erosion
* Swelling of the parotid gland
* Mild esophagitis, heartburn, or acid reflux
* Renal (kidney) inflammation

## Treatment

Treatment for purging disorder can be multidisciplinary. One approach to treatment is cognitive behavioral therapy.

## Prognosis

Children and teenagers with purging disorder have been found to have poorer health-related quality of life than their healthy peers. A small review of 11 cases of purging disorder where death occurred found that only 5 of the 11 deaths could be attributed to the purging disorder. The remaining 6 deaths were a result of suicide.