Purging Disorder: Does this mean a revision to DSM-IV?

Eating disorders are not new to the American public, nor are they new to the medical community. Doctors around the country have dealt with bulimia and anorexia for decades, however there appears to be a new kind of eating disorder emerging. Pamela Keel, a psychology professor at the University of Iowa, led the research study and found that this is in fact a new disorder. “Purging disorder” is the term being used to describe this new phenomena and it is much harder to detect than either bulimia or anorexia. The reason purging disorder is so difficult to identify is that it does not fall within the already established parameters of known eating disorders. Purging disorder shares some characteristics with bulimia and some with anorexia, however it does not share all traits with either. Medical doctors who are encountering this disorder are unsure of what category to place purging disorder into and so are left scratching their heads as to the course of treatment.

The DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, is the ruling authority within the medical community. Unfortunately, medical professionals are unable to consult DSM-IV because it does not have a category that would include purging disorder. Bulimia and anorexia have their own realm within diagnoses and are quite distinguishable from each other. However, the rising rates of purging disorder begs us to examine whether or not it warrants a revision to the DSM-IV in which it can be seen as similar to but separate from both bulimia and anorexia.

Bulimia is an eating disorder in which people, most often women (women are ten times more likely to suffer from an eating disorder than men), will binge eat to the point where people have complained of pain in their chest and abdomen. The person will then induce vomiting and expel the massive amounts of food consumed just moments prior. Purging disorder is similar in that it contains the vomiting component of bulimia; however the consumption of food is no where near that of bulimia. People with purging disorder often eat a regular amount of food or very little food. The fact that there is no binge eating coupled with the purging clearly takes purging disorder away from the diagnosis of bulimia.

Anorexia is an eating disorder that is broken down into two subdivisions; Anorexia Restricting subtype and Anorexia Binge-and-Purge subtype. Anorexia restricting subtype is where the person restricts their diet so as to limit the amount of food consumed even to the point of refusing to eat any food at all. However, there is no purging component to this type of anorexia. So while purging disorder contains the element of eating little to no food, it also contains the element of purging, which excludes it from this diagnosis.
Anorexia binge-and-purge subtype is just as it sounds; the person will binge-eat and then induce vomiting. We must keep in mind that to a person suffering from anorexia the term “binge-eat” will vary greatly than in terms of a person suffering from bulimia. A person suffering from this second subtype of anorexia will likely go from eating nothing to eating what would amount to a normal meal and to them it is considered a huge amount of food and they immediately engage in purging.

The chief element to a person suffering from anorexia of either subtype is that the person is noticeably under weight. A person with a normal weight cannot be anorexic because in either subtype of anorexia there is always an aspect of restricting; this is a crucial dividing line between bulimia and anorexia. Taking notice of the areas in which these two disorders come close to but never crossover with one another is how the DSM-IV has defined the separate diagnoses of Anorexia and Bulimia. But now there is a new disorder on the rise and no one is sure about where it fits in. Purging disorder is characterized by a person of normal weight who eats either very little or enough that amounts to a small meal and who purges immediately after eating. The defining characteristics of Anorexia and Bulimia are exclusive of one another and so the fact that purging disorder contains both of these exclusive elements suggests that a revision to the current definitions set forth by DSM-IV is absolutely needed.

*It is important to note that the use of the term “purging” in this post is seen for the most part as vomiting, however other forms of purging include taking laxatives, excessive exercise and other compensatory behaviors, in which the goal is to purge calories from the body.