Purging disorder: considerations for clinical presentation, epidemiology, risk factors and interventions

Purging disorder (PD), a DSM-5 other specified feeding or eating disorder, involves purging in the absence of binge eating among individuals who are not underweight. Epidemiological studies indicate that PD is more common in women than men and affects 1.3% to 4.8% of girls. Clinical presentation includes elevated body image concerns, mood disturbance and perfectionism, similar to other eating disorders. However, PD is characterised by greater somatic complaints compared to other eating disorders, including greater postprandial gastrointestinal distress compared to bulimia nervosa (BN).Prospective risk factors for PD onset differ from those for anorexia nervosa onset and include higher premorbid body mass index, body dissatisfaction and dieting. Relative to its prevalence in the general population, PD is rare in eating disorder treatment settings. Treatment dropout is high in PD, with more than a third of patients discontinuing treatment early. Less than half of those with PD are free from an eating disorder at the end of treatment and at one or more years of follow-up. Recommendations for tailoring cognitive behavioural therapy include applying techniques for mood intolerance to address emotional and gastrointestinal distress that maintains purging in the absence of binge eating. Such efforts may benefit patients with PD as well as those who purge across eating disorder diagnoses.