Abstract:Background
The DSM-5 introduced purging disorder (PD) as an other specified feeding or eating disorder characterized by recurrent purging in the absence of binge eating. The current study sought to describe the long-term outcome of PD and to examine predictors of outcome.
Methods
Women (N = 84) who met research criteria for PD completed a comprehensive battery of baseline interview and questionnaire assessments. At an average of 10.24 (3.81) years follow-up, available records indicated a… Show more
“…Consistent with prior work (Forney et al, 2021), three outcome definitions were tested. An eating disorder was diagnosed as present if an individual met DSM-5 criteria for anorexia nervosa, bulimia nervosa, binge-eating disorder, purging disorder, or another OSFED.…”
Section: Outcome Definitionsmentioning
confidence: 99%
“…We recently published results describing the naturalistic outcome of purging disorder at an average of 10‐year follow‐up (Forney et al, 2021). Despite experiencing a significant decrease in eating pathology, women with purging disorder reported a relatively poor outcome; 58% continued to meet criteria for an eating disorder, and only 30% met criteria for full recovery.…”
Section: Introductionmentioning
confidence: 99%
“…Based on the prior meta-analysis (Smith et al, 2017), we hypothesized that purging disorder would be associated with a more favorable outcome than bulimia nervosa. Data describing outcome in purging disorder were previously published (Forney et al, 2021); however, this is the first report of long-term outcomes in participants with a baseline bulimia nervosa diagnosis and the first comparison of long-term outcomes between purging disorder and bulimia nervosa.…”
Objective
The current study sought to examine the predictive validity of the purging disorder diagnosis at long‐term follow‐up by comparing naturalistic outcomes with bulimia nervosa.
Method
Women with purging disorder (N = 84) or bulimia nervosa (N = 133) who had completed comprehensive baseline assessments as part of one of three studies between 2000 and 2012 were sought for follow‐up assessment. Nearly all (94.5%) responded to recruitment materials and 150 (69% of sought sample; 83.3% non‐Hispanic white; 33.40 [7.63] years old) participated at an average of 10.59 (3.71) years follow‐up. Participants completed the Eating Disorder Examination, the Structured Clinical Interview for DSM‐IV, and a questionnaire battery. Diagnostic groups were compared on eating disorder (illness status, recovery status, and eating pathology) and related outcomes. Group differences in predictors of outcome were explored.
Results
There were no significant differences in eating disorder presence (p = .70), recovery status (p = .87), and level of eating pathology (p = .17) between diagnostic groups at follow‐up. Post hoc equivalence tests indicated group differences were smaller than a medium effect size (p's ≤ .005). Groups differed in diagnosis at follow‐up (p = .002); diagnostic stability was more likely than cross‐over to bulimia nervosa for women with baseline purging disorder (p = .004).
Discussion
Although purging disorder and bulimia nervosa do not differ in long‐term outcomes, the relative stability in clinical presentation suggests baseline group differences in clinical presentation may be useful in augmenting treatments for purging disorder.
Public Significance Statement
While purging disorder is classified as an “other specified” eating disorder, individuals who experience this disorder have comparable negative long‐term outcomes as those with bulimia nervosa. This highlights the importance of screening for and treating purging disorder as a full‐threshold eating disorder.
“…Consistent with prior work (Forney et al, 2021), three outcome definitions were tested. An eating disorder was diagnosed as present if an individual met DSM-5 criteria for anorexia nervosa, bulimia nervosa, binge-eating disorder, purging disorder, or another OSFED.…”
Section: Outcome Definitionsmentioning
confidence: 99%
“…We recently published results describing the naturalistic outcome of purging disorder at an average of 10‐year follow‐up (Forney et al, 2021). Despite experiencing a significant decrease in eating pathology, women with purging disorder reported a relatively poor outcome; 58% continued to meet criteria for an eating disorder, and only 30% met criteria for full recovery.…”
Section: Introductionmentioning
confidence: 99%
“…Based on the prior meta-analysis (Smith et al, 2017), we hypothesized that purging disorder would be associated with a more favorable outcome than bulimia nervosa. Data describing outcome in purging disorder were previously published (Forney et al, 2021); however, this is the first report of long-term outcomes in participants with a baseline bulimia nervosa diagnosis and the first comparison of long-term outcomes between purging disorder and bulimia nervosa.…”
Objective
The current study sought to examine the predictive validity of the purging disorder diagnosis at long‐term follow‐up by comparing naturalistic outcomes with bulimia nervosa.
Method
Women with purging disorder (N = 84) or bulimia nervosa (N = 133) who had completed comprehensive baseline assessments as part of one of three studies between 2000 and 2012 were sought for follow‐up assessment. Nearly all (94.5%) responded to recruitment materials and 150 (69% of sought sample; 83.3% non‐Hispanic white; 33.40 [7.63] years old) participated at an average of 10.59 (3.71) years follow‐up. Participants completed the Eating Disorder Examination, the Structured Clinical Interview for DSM‐IV, and a questionnaire battery. Diagnostic groups were compared on eating disorder (illness status, recovery status, and eating pathology) and related outcomes. Group differences in predictors of outcome were explored.
Results
There were no significant differences in eating disorder presence (p = .70), recovery status (p = .87), and level of eating pathology (p = .17) between diagnostic groups at follow‐up. Post hoc equivalence tests indicated group differences were smaller than a medium effect size (p's ≤ .005). Groups differed in diagnosis at follow‐up (p = .002); diagnostic stability was more likely than cross‐over to bulimia nervosa for women with baseline purging disorder (p = .004).
Discussion
Although purging disorder and bulimia nervosa do not differ in long‐term outcomes, the relative stability in clinical presentation suggests baseline group differences in clinical presentation may be useful in augmenting treatments for purging disorder.
Public Significance Statement
While purging disorder is classified as an “other specified” eating disorder, individuals who experience this disorder have comparable negative long‐term outcomes as those with bulimia nervosa. This highlights the importance of screening for and treating purging disorder as a full‐threshold eating disorder.
“…Results indicated that peer-led Body Project groups produced a statistically significant 46% reduction in onset of subthreshold/threshold BN and a statistically significant 62% reduction in onset of PD relative to controls during the follow-up period. These prevention effects are critical, given that <50% of individuals who experience BN or PD achieve full recovery (Forney, Crosby, Brown, Klein, & Keel, 2021 ; Steinhausen & Weber, 2009 ). In addition to high rates of comorbidity and physical consequences, BN has been independently associated with suicidality above and beyond risk predicted by comorbid disorders (Bodell, Joiner, & Keel, 2013 ).…”
Background
This study tested whether the dissonance-based Body Project eating disorder prevention program reduced onset of subthreshold/threshold anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD) over long-term follow-up.
Methods
Data were combined from three prevention trials that targeted young women at high-risk for eating disorders (N = 1092; M age = 19.3). Participants were randomized to Body Project groups led by peer educators or expressive writing/educational controls and completed masked diagnostic interviews over 2- to 4-year follow-ups. Logistic regressions tested whether onset of each eating disorder over follow-up differed between Body Project and control participants.
Results
Peer-led Body Project groups produced a 46% reduction in onset of subthreshold/threshold BN and a 62% reduction in onset of PD relative to controls over follow-up. Rates of onset of subthreshold/threshold AN and BED did not significantly differ between peer-led Body Project participants and control participants.
Conclusions
Results support the dissemination of the peer-led Body Project for reducing future onset of BN and PD. This study and recent research suggest that thin-ideal internalization, the risk factor for eating disorders targeted in the Body Project, may be more relevant for predicting onset of BN and PD compared to AN and BED. Findings support the development of a version of the Body Project aimed to reduce risk factors that have predicted future onset of all four types of eating disorders (e.g. overvaluation of weight/shape, fear of weight gain), which may more effectively prevent all eating disorder types.
“…Data from participants in the current study were included in prior analyses to examine whether postprandial peptide YY (PYY) and ghrelin responses contributed to differences in subjective responses to a fixed test meal (Keel et al, 2018a ) and whether a behavioral measure of satiation using an ad lib meal confirmed self-reported responses to a fixed meal (Keel et al, 2018b ). Data from these participants were also included in secondary analyses unrelated to the aims of the parent project (Davis, Smith, & Keel, 2020 ; Forney, Crosby, Brown, Klein, & Keel, 2021 ; Keel, Bodell, Haedt-Matt, Williams, & Appelbaum, 2017 ; Maske, Williams, & Keel, 2020 ). This is the first report of gastric emptying and of responses to the fixed meal in the medicated condition from this sample.…”
Background
Prior work supports delayed gastric emptying in anorexia nervosa and bulimia nervosa (BN) but not binge-eating disorder, suggesting that neither low body weight nor binge eating fully accounts for slowed gastric motility. Specifying a link between delayed gastric emptying and self-induced vomiting could offer new insights into the pathophysiology of purging disorder (PD).
Methods
Women (N = 95) recruited from the community meeting criteria for DSM-5 BN who purged (n = 26), BN with nonpurging compensatory behaviors (n = 18), PD (n = 25), or healthy control women (n = 26) completed assessments of gastric emptying, gut peptides, and subjective responses over the course of a standardized test meal under two conditions administered in a double-blind, crossover sequence: placebo and 10 mg of metoclopramide.
Results
Delayed gastric emptying was associated with purging with no main or moderating effects of binge eating in the placebo condition. Medication eliminated group differences in gastric emptying but did not alter group differences in reported gastrointestinal distress. Exploratory analyses revealed that medication caused increased postprandial PYY release, which predicted elevated gastrointestinal distress.
Conclusions
Delayed gastric emptying demonstrates a specific association with purging behaviors. However, correcting disruptions in gastric emptying may exacerbate disruptions in gut peptide responses specifically linked to the presence of purging after normal amounts of food.
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