The Diverse Presentations of Eating Disorders
K. Jean Forney, M.S.
Typically, when people hear “eating disorder,” they think of anorexia nervosa, the eating disorder characterized by low weight. People sometimes think of bulimia nervosa, which is characterized by binge eating (eating a large amount of food while feeling out of control) and compensatory behaviors, like self-induced vomiting or intense exercise. Awareness is growing about binge eating disorder, the eating disorder characterized by recurrent binge eating without any sort of compensatory behavior.
It turns out a significant portion of people with eating disorders don’t meet criteria for these disorders, but still have clinically significant eating disorders. These clinically significant eating disorders cause distress, impairment, and medical complications. These individuals typically fall into the “eating disorder not otherwise specified” or “Other specified feeding or eating disorder” group. This is problematic, because that group is pretty heterogeneous. Some of those people engage in binge eating, some people eat most of their food at night, others only exercise excessively but aren’t underweight or binge eating. Because it’s heterogeneous, it’s hard to generalize any research findings on this “other specified” group. Things that are true of someone who excessively exercises without binge eating probably aren’t true of people who eat most of their food at night. Without naming and separating these conditions, it’s hard to study and develop treatments, because they are too diverse.
Another member of this “other specified” group is purging disorder. Purging disorder is characterized by purging behaviors, such as self-induced vomiting or laxative abuse, in people who do not experience binge-eating episodes. Estimates range from .5% to about 5% of women experience purging disorder in their lifetime, and there are few estimates available for men. The research available right now suggests that individuals with purging disorder have a higher mortality rate than the general population. It’s a serious condition to have.
Problematically, because purging disorder isn’t a “full” diagnosis like anorexia nervosa or binge eating disorder, no one has studied treatments for it. We are starting to collect evidence about how purging disorder is different from other disorders, but we need to know more about the prognosis and course of the illness, and factors that influence prognosis, in order to better develop treatments.
That’s why I am raising funds to study the long-term outcome of purging disorder and to compare it to the outcome of bulimia nervosa. I will identify what factors (attitudes about shape and weight, feeling out of control while eating, and hormones related to eating) predict outcome, providing clues as to where we can intervene. Please consider taking a moment to share my project and consider donating.