Purging Disorder

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Self-Induced Vomiting

Not everyone who binges also purges. Those with binge-eating disorderOpens in new window do not purge while suffering from this disorder, although some may have done so in the past. However, bulimia nervosaOpens in new window is characterized by binge eating followed by purging.

The most common method of purging is self-induced vomiting. To facilitate vomiting, many individuals consume large amounts of fluids with their binges. Usually, putting a finger or other object down the throat facilitates purging. After some time, purging may become automatic.

Another way patient induces vomiting is through the use of ipecac. This syrupy medication causes nausea and vomiting within about 20 minutes of ingestion. It is intended to be used in emergencies and should be administered only if someone has swallowed poison.

Ipecac is particularly dangerous because it causes systemic toxicity, which can cause weakness, tenderness and stiffness of muscles, cardiac disease and heart failure, coma, seizures, shock, blood pressure increases, possible hemorrhage, dehydration, aspiration pneumonia, and death.

Self-induced vomiting is not an effective way to rid the body of calories. One study conducted in a clinical research center examined the number of calories eaten and the number of calories purged in patients with bulimia nervosa.

Regardless of the size of their binges, patients retained approximately 1,000 calories after purging. This is equivalent to one or two meals and shows that the body is making up for having missed adequate meals earlier in the day. If the body did not retain these calories, bulimics would continue to lose weight. However, the vast majority of bulimics maintain a stable weight or even gain weight despite regularly purging.

Laxatives

The next most common form of purging is the use of stimulant laxatives. These work by stimulating the muscles of the lower bowel. When taken regularly and in large doses, laxatives cause the bowel muscles to stop working by themselves, leading to constipation. The use of laxatives is an even more inefficient way of removing calories from the body. Studies have found that, at most, about 10% of calories are removed, even with excessive laxative use. Moreover, as we have seen, removing calories simply leads to larger binges.

Diuretics

The third most common form of purging involves taking diuretics or water pills. Many bulimics use water pills because they give the illusion of a flatter stomach. One may feel better because of fluid loss, but water pills do nothing to remove calories from the body. All forms of purging are inefficient methods of controlling caloric intake; in other words, they do not work.

Over-Exercising

Another method many bulimics use to control caloric intake is to increase energy expenditure through exercise. Indeed, there is a non-purging form of bulimia nervosa associated with excessive exercise or fasting, in which individuals do not consume solid foods and subsist only on fluids such as water, coffee, or tea for longer than 24 hours at a time and often up to several days. Such fasting is then followed by a return to binge eating.

Many bulimics purge and exercise. In the case of exercise, we are not talking about exercise to improve health. Many individuals with an eating disorder engage in vigorous exercise for two or more hours every day. Such exercise often takes over their lives so that it must be performed even if they are injured or unwell, or if it interferes with their social life.

After this sort of strenuous exercise, individuals are often exhausted, but they persist day after day. Sometimes it seems to them that exercise is their only pleasure in life.