The medical complications associated with purging

Abstract

Objective Purging behaviors, including self-induced vomiting, laxative abuse, and diuretic abuse, are present across many of the eating disorders. Here we review the major medical complications of these behaviors. Method Although we identified over 100 scholarly articles describing medical complications associated with purging, most papers involved case studies or small, uncontrolled samples. Given the limited evidence base, we conducted a qualitative (rather than systematic) review to identify medical complications that have been attributed to purging behaviors. Results Medical conditions affecting the teeth, esophagus, gastrointestinal system, kidneys, skin, cardiovascular system, and musculoskeletal system were identified, with self-induced vomiting causing the most medical complications. Conclusions Purging behavior can be associated with severe medical complications across all body systems. Mental health professionals should refer patients with purging behaviors to medical providers for screening and treatment as needed. The medical work-up for individuals with eating disorders should include a comprehensive metabolic panel, complete blood count, and a full body exam including the teeth to prevent severe complications. Medical providers should screen patients for purging behaviors and associated medical complications, even in the absence of an eating disorder diagnosis, to increase the detection of eating disorders. Recognizing the link between purging and medical complications can aid in identifying potential eating disorders, particularly those that often elude detection such as purging disorder.

Characteristics of seeking treatment among U.S. adolescents with eating disorders

“…One possible reason for these associations is that restriction and purging are behaviors associated with weight loss and may be perceived as less stigmatized than behaviors associated with weight gain (e.g., binge eating; Hart et al, ). Another explanation is that restriction and some types of purging (i.e., self‐induced vomiting) often have visible physical signs (e.g., weight loss, Russell's sign [Strumia, ]) and dangerous sequelae (e.g., arrhythmia, hypotension; Casiero & Frishman, ; Fichter & Quadflieg, ; Forney, Buchman‐Schmitt, Keel, & Frank, ). These behaviors' visible markers and physiological consequences may make them more likely to be identified by adolescents themselves, peers, parents, teachers, and/or caretakers as serious and in need of treatment (Peebles et al, ).…”

Driven exercise in the absence of binge eating: Implications for purging disorder

“…Likewise, it also warrants investigation whether DE precedes other purging/compensatory behaviors in longitudinal studies; determining the order of onset for DE and other behaviors could inform targeted prevention and early treatment efforts. Additionally, our findings about the similarity between exercise and vomiting/laxatives on eating-disorder psychopathology suggest the need to perform more comprehensive and multimodal research with individuals who purge by different methods, such as has been done with non-exercise purging (40). For example, physical comorbidities may vary.…”

Acute medical stabilisation of adults with anorexia nervosa: experience of a defined interdisciplinary model of care

“…24 From a biochemical perspective, alanine aminotransferase elevation, while present, was less frequent than in similar descriptive studies. 26 The aetiology for cases of hypoalbuminaemia and low bicarbonate in our cohort was not statistically elucidated, but possibly due to concomitant acute medical pathology. This differs from comparative studies, whereby albumin is often within normal range, irrespective of AN severity.…”