Study looks at little-known bleeding disorder

Summary: Although purging may be a hallmark of bulimia nervosa, a new study reports that another type of eating disorder may also be responsible for purging behaviors.

Source: Ohio University

Although purging is often a condition associated with bulimia nervosa, new research at Ohio University suggests that another type of eating disorder may also be responsible.

The study, published in the International Journal of Eating Disorders, sought to differentiate the little-understood “purge disorder” from the more well-documented bulimia nervosa, with which it is often confused.

The research was led by K. Jean Forney, an assistant professor of psychology at Ohio University’s College of Arts and Sciences, who specializes in eating disorders.

Purging disorder and bulimia nervosa are eating disorders characterized by self-induced vomiting and other types of purging. However, a central feature of bulimia is large, uncontrollable eating episodes, whereas purging disorder is not defined by binge eating.

Additionally, purging is an essential attribute of purging disorder, whereas bulimia nervosa may include non-purgative behaviors like fasting or excessive exercise.

“In both conditions, people go to extreme lengths to control their weight,” Forney said.

Because bulimia nervosa is well understood, it is easily diagnosed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is used to diagnose mental health disorders. Purge disorder, however, has not been well studied and therefore falls into the more ambiguous “residual” categories of the DSM.

“People tend to think that residual category conditions are less dangerous, but that’s not true,” Forney said. “There is a lot of cross-sectional data that suggests purging disorder is just as serious as bulimia nervosa.”

Due to its relative obscurity in the psychiatric world, until it is better understood, people with bleeding disorders do not have psychiatric or psychological treatments that have been tested for their specific presentation of symptoms. Forney hopes the current study can provide a starting point for future research related to the intervention.

“Most of our eating disorder treatments focus on treating binge eating. What we really need are treatments that better address symptoms when binge eating isn’t present and we don’t really have that right now,” she said.

Purge disorder was first researched and identified in 2005 by Florida State University psychology professor Pamela Keel. Forney wanted to continue Keel’s original research so that the prognosis of bleeding disorder could be better understood. To do this, Forney followed 217 women who participated in Keel’s original study.

The participants, who had to meet the clinical criteria for purging disorder or bulimia nervosa, all took part in one of three studies conducted between 2000 and 2012.

Forney sought to predict the future behavior of people with bleeding disorder by comparing long-term outcomes to those with bulimia nervosa. The study found no significant differences in the presence of eating disorders, recovery status, and level of eating pathology between the diagnostic groups.

However, he concluded that there are significant enough differences between bulimia nervosa and purging disorder to require specific treatments for purging disorder. To do this, it’s important to treat purging disorder as a full-threshold eating disorder, according to research.

Purging disorder and bulimia nervosa are eating disorders characterized by self-induced vomiting and other types of purging. Image is in public domain

He also found sufficiently significant differences between bulimia nervosa and bleeding disorder that the interpretation of the symptoms that lead to a diagnosis, known as the clinical presentation, could be uniquely classified. Only a small proportion of women with bleeding disorders have developed bulimia nervosa, indicating that they are separate eating disorders.

“They are equal in severity and chronicity, but there are still differences in clinical presentation,” Forney said.

However, the study was not without limitations. “We found nothing that predicted the outcome,” Forney said, which she described as “disheartening.” “That means we need to do more work to figure out what’s keeping the eating disorder going – those are the factors we want to target in treatment.”

Despite the setbacks, Forney hopes his research will revive interest in bleeding disorder and that future research will eventually lead to a more effective treatment.

See also

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For people with eating disorders, the National Eating Disorder Association runs a helpline, as well as many other services and resources.

About this research on eating disorders

Author: Samantha Pelham
Source: Ohio University
Contact: Samantha Pelham – Ohio University
Picture: Image is in public domain

Original research: Free access.
“Assessment of the predictive validity of purging disorder in relation to bulimia nervosa at long-term follow-up” by K. Jean Forney et al. International Journal of Eating Disorders


Assessing the predictive validity of purging disorder versus bulimia nervosa at long-term follow-up


The present study aimed to examine the predictive validity of the diagnosis of bleeding disorder at long-term follow-up by comparing naturalistic findings with bulimia nervosa.


Women with bleeding disorders (NOT = 84) or bulimia nervosa (NOT = 133) who had completed comprehensive baseline assessments in any of the three studies between 2000 and 2012 were sought for follow-up assessment. Almost all (94.5%) responded to recruitment materials and 150 (69% of research sample; 83.3% non-Hispanic white; 33.40 [7.63] years) participated in a mean follow-up of 10.59 (3.71) years. Participants completed the Eating Disorders Screening, the DSM-IV Structured Clinical Interview and a battery of questionnaires. Diagnostic groups were compared on the basis of eating disorders (disease status, recovery status, and eating pathology) and associated outcomes. Group differences in outcome predictors were explored.


There were no significant differences in the presence of eating disorders (p = .70), recovery status (p = 0.87) and level of food pathology (p = 0.17) between diagnostic groups at follow-up. Post hoc equivalence tests indicated that the differences between the groups were less than an average effect size (p’s ≤ .005). The groups differed in diagnosis at follow-up (p = 0.002 ); diagnostic stability was more likely than transition to bulimia nervosa in women with bleeding disorder at baseline (p = 0.004).


Although purging disorder and bulimia do not differ in long-term outcomes, the relative stability of clinical presentation suggests that baseline group differences in clinical presentation may be useful in augmenting treatments for bleeding disorder. purge.

Statement of Public Significance

Although purging disorder is classified as an “other specified eating disorder,” people who suffer from this disorder have long-term negative outcomes comparable to those who suffer from bulimia nervosa. This underscores the importance of screening for and treating purging disorder as a full-threshold eating disorder.

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