Co-morbidity and disorder-related distress and impairment in purging disorder

Abstract

PD is associated with elevated distress and impairment and should be considered for inclusion as a provisional disorder in nosological schemes such as the Diagnostic and Statistical Manual to facilitate much-needed research on this clinically significant syndrome.

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

“…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.…”

“…Compared with noneating disordered controls, women with either current 8 or lifetime PD 14,15 report significantly greater depression, 8,15 anxiety, 8,15 higher rates of Axis I and II disorders, 8,15 greater impairment in psychosocial function, 10,14 and higher suicidality. 15 Using the DSM-IV conceptualization of clinical significance, PD is a mental disorder based on present distress, impairment in one or more important areas of function, and increased risk of suffering death, pain, or disability.…”

“…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.…”

“…However, others have been struck by the relatively small and inconsistent differences between PD and BN concluding that PD is worthy of consideration in eating disorders classification. 7,8,[10][11][12] Table 2 presents effect sizes across studies that have utilized either the eating disorders examination (EDE) 19 or the EDE-questionnaire 20 to examine eating disorder severity in PD. Using Cohen's 21 characterization of effect sizes (e.g., Cohen's d 5 0.20 is small, d 5 0.50 is medium, and d 5 0.80 is large), large effect sizes are associated with comparisons between PD and controls on measures of eating disorder severity, and very small effect sizes are associated with comparisons between PD and BN on dietary restraint, and weight or shape concerns.…”

Personality pathology in purging disorder and bulimia nervosa

“…2,7 A more consistent pattern has emerged when looking at anxious personality traits, with studies finding greater trait anxiety in women with BN compared to women with PD. 7,10 Importantly, the relatively small number of participants in studies comparing BN and PD may have limited statistical power for detecting differences, particularly for analyses based on personality disorder diagnoses. Indeed, studies utilizing continuous measures of personality pathology have been more likely to yield significant differences between PD and BN.…”