The-F-Word.org

A University of Iowa professor is making a case for a new eating disorder she calls purging disorder.

Similar to bulimia nervosa in that both syndromes involve eating then trying to compensate for calories, purging disorder differs from its wicked stepsister in the amount of food consumed and the way people compensate for what they eat.

Women with purging disorder eat normal or even small amounts of food, and then purge, often by vomiting, said Pamela Keel, associate professor of psychology in the UI College of Liberal Arts and Sciences. By contrast, bulimia nervosa is characterized by large, out-of-control binge eating episodes followed by purging, fasting or excessive exercise.

In a paper published in the Archives of General Psychiatry, Keel shares the results of a study indicating that purging disorder is a significant problem in women that is distinct from bulimia. Read more about the study and the results here. Read more about Keel’s other related studies here.

Studying eating disordered behavior apart from the narrow and stifling two-category compartmentalization in place today is vastly important. All too often doctors rely almost completely on diagnostic manuals for a diagnosis of an eating disorder, trying to find one of the two to pigeonhole the patient within. Considering that awareness of eating disorders has only surfaced within the past decade or so, continued research into the disease is clearly needed.

A personal story: An anorexia diagnosis requires a loss of 15 percent body weight and a body weight of less than 85 percent of expected weight. In the throes of my eating disorder, I lost nearly 60 percent of my body weight, but my lowest weight of 125 was not sufficient to meet the anorexia diagnosis requirements. Yet while I veered occasionally into bulimia, I mostly fit the clinical definition of an anorectic – the symptoms were all there.

I was lumped therefore into the ED-NOS category, which encompasses basically any disordered behavior that doesn’t meet the requirements of an anorexia or bulimia diagnosis. ED-NOS can range from:
- Someone with binge-eating disorder (which has NOT been classified in the DSM as a mental disorder);
- Someone who chews and then spits out their food;
- Someone who meets the criteria for anorexia, but still menstruates;
- Someone who binges and purges, but less than the two times per-week average for bulimia;
- Someone who meets all the anorexia criteria, but despite substantial weight loss, whose body weight is still in the normal range

And so on. You see the gamut of disordered behavior lumped into ED-NOS, all of which is disordered, but each so very different in its approach to food and compensatory actions. Yet all of these types of people are as seriously ill as those with anorexia or bulimia and all need comprehensive treatment.

But when seeking insurance coverage, it may be more difficult to explain to the insurance company the need for treatment when the patient does not fit the current diagnostic criteria. Insurance coverage is difficult enough to attain when a patient is diagnosed as anorexic, and is compounded further by this vague and all-encompassing eating disordered catch-all.

What about your related experiences, whether it be in a diagnosis or with seeking insurance coverage?