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Disorders Associated with Purging Behavior

Purging is a self-inflicted behavior regularly practiced by individuals who have eating disorders such as anorexia and bulimia nervosa. Purging refers to ridding the body of food and/or calories consumed in order to lose weight or prevent weight gain. Self-induced vomiting, laxative abuse, diuretic abuse, enemas and excessive exercise are well-known purging behaviors. Purging disorder is not recognized by the American Psychological Association nor the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V) and is therefore not a recognized disorder however purging behavior is necessary in order to diagnose bulimia nervosa and a specific subtype of anorexia nervosa known as the binge-eating/purging type. Usually purging is performed after a binge however this does not always hold true. Oftentimes individuals may purge after they eat a moderate size meal or even small appetizers. It is a behavior associated with self-control rather than excessive amounts of food. Individuals with purging disorders are not necessarily underweight but many of them are of normal weight or overweight however individuals who practice purging behaviors have an obsession with body image. They either have an intense fear of gaining weight, a strong desire to lose weight, or a significant impairment in their body image, which is often noted by low self-esteem.

Laxative and enema abuse

Laxatives are medications used to treat or prevent constipation and are often inappropriately used to rid the body of calories of food. Methylcellulose, psyllium, magnesium hydroxide, mineral oil, senna, and glycerin are all examples of laxatives that are commonly used. Laxatives work on the large intestine or colon to stimulate water and electrolyte absorption to create a bowel movement. Laxatives do not play a role in the digestion of food. The process of digestion ends in the small intestine and therefore by the time food reaches the large intestine all of the calories and nutrients have already been absorbed in the body. Laxatives result in weight loss simply by eliminating water weight, which can cause dehydration. This water weight is not considered true weight loss as it can easily be gained back by drinking fluids. In addition, electrolyte imbalances also occur which can affect every organ in the body.

Enemas act similar to laxative however they are placed in the rectum to induce a bowel movement whereas laxatives are oral medications. Enemas work by absorbing water and electrolytes and play no role in eliminating calories.

Diuretic abuse

Diuretics also commonly known as “water pills” are used to excrete water from the body to prevent fluid overload in the setting of heart disease, liver disease and kidney disease. Furosemide, hydrochlorothiazide, spironolactone and amiloride are well known diuretics that act on the kidneys to eliminate fluid from the body. Diuretics like laxatives and enemas do not cause true weight but rather result in only water loss, which can easily be gained back by drinking fluids.

Self-induced vomiting

Self-induce vomiting to rid the body of food and calories is extremely dangerous. Not only does this purging behavior result in water loss and electrolyte depletion resulting in dehydration and deranged chemical imbalances in the body, self-induced vomiting results in severe gastrointestinal damage. Self-induced vomiting can cause tears in the esophagus and stomach resulting in severe pain and vomiting blood. Gastric reflux, swollen parotid glands, excoriations on the back of the knuckles, and dental cavities are also common complications directly associated with self-induced vomiting.

Treatment for purging disorders

Treatment for purging behaviors seen in eating disorders such as anorexia nervosa and bulimia nervosa consist of a combination of psychotherapy and medication management. Recognizing the underlying causes for these purging behaviors is important in order to treat the disorder successfully. Often times individuals will have emotional trauma, low self esteem, mental health disorders, a history of self-harm or substance abuse disorders that are driving them to engage in self-induced purging.

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