Clinical Features and Physiological Response to a Test Meal in Purging Disorder and Bulimia Nervosa

Abstract

Purging disorder is a clinically significant disorder of eating that appears to be distinct from bulimia nervosa on subjective and physiological responses to a test meal. Findings support further consideration of purging disorder for inclusion in the classification of eating disorders. Future studies on the psychobiology of purging disorder are needed to understand the propensity to purge in the absence of binge eating.

Purging disorder: Subthreshold variant or full-threshold eating disorder?

“…8,11,17 In addition, PD has been associated with lower scores on the TFEQ Hunger and Disinhibition scales. 8,9 Differences in hunger and disinhibition between PD and BN were maintained at 6-month follow-up as was diagnostic status, supporting the longitudinal stability of distinctions between PD and BN. 8 Finally, recent findings indicate that PD and BN demonstrate distinct subjective and physiological responses to a standardized test meal.…”

“…However, women with PD reported lower eating concerns, had lower scores on the Three Factor Eating Questionnaire Hunger and Disinhibition scales, and had lower depression and trait anxiety as well as lower rates of current mood disorders compared to women with BN. 8 These findings have been largely replicated in a third study by Keel et al 9,10 In addition, Keel et al 10 found comparable impairment in BN and PD and higher rates of current anxiety disorders in PD compared with BN in their third study. In a sample of treatment-seeking adolescents, Binford and le Grange 11 found no significant differences between PD and BN on measures of dietary restraint, depression, or lifetime diagnoses of depressive disorder, anxiety disorder, or substance use.…”

“…Studies that examined purging solely in the context of AN or BN were not reviewed in detail. A total of 14 articles were identified, [5][6][7][8][9][10][11][12][13][14][15][16][17][18] reflecting 10 separate samples of PD. A challenge in reviewing the literature of a condition which has not been formally named or defined is heterogeneity of names and definitions used for the syndrome.…”

“…In a treatment setting, Tobin et al 6 reported no significant differences between PD and BN on measures of eating disorder severity or severity of related psychopathology. Similarly, in a community-based study, Keel et al 7 found no significant differences between PD and BN on measures of body image disturbance, dietary restraint, depression, or anxiety but reported that BN was 7 Subjective bulimia nervosa Recurrent purging (self-induced vomiting, laxative, or diuretic misuse) 2/week for 3 months Subjective binge episodes 2/week for 3 months Undue influence of weight/shape on self-evaluation No history of objectively large binge episodes Normal weight (body mass index (BMI) between 19 and 24 kg/m 2 ) 8 Keel et al 8,9 Purging disorder Recurrent purging (self-induced vomiting, laxatives, or diuretics) 2/week for 3 months Undue influence of weight/shape on self-evaluation No objectively large binge episodes, no lifetime history of bulimia nervosa Normal/healthy weight (BMI between 19 and 25 kg/m 2 8 and 18.5 and 26.5 kg/m 2 ) 9 Binford and le Grange 11a…”

“…8 Finally, recent findings indicate that PD and BN demonstrate distinct subjective and physiological responses to a standardized test meal. 9 Compared to women with BN and controls, women with PD reported significantly greater postprandial fullness and gastrointestinal distress, and women with PD demonstrated significantly greater postprandial cholecystokinin (CCK) release compared to women with BN. 9 This latter finding is particularly interesting because it is the first to establish an objective physiological difference between PD and BN.…”