02 October 2007

How purging yields clues

Whether or not a person with an eating disorder uses more than one method of purging may be an accurate indicator of the severity of the disorder, researchers say.

Whether or not a person with an eating disorder uses more than one method of purging may be a better indicator of the severity of the disorder than how frequently purging occurs, results of a study suggest.

But purging frequency was linked to other, related psychological problems, Dr Pamela K. Keel of the University of Iowa in Iowa City and her colleagues found. "Purging frequency was significantly associated with depression and anxiety," Keel told Reuters Health, "whereas multiple purging methods were significantly associated with eating disorder severity. So, each feature provided unique and clinically useful information."

Doctors treating people with bulimia nervosa and purging disorder typically rely on the frequency of purging to determine how ill a person is and whether their recovery is progressing, Keel pointed out. But there is evidence that using several different purging methods - for example, self-induced vomiting, laxatives and diuretics - may indicate worse disease.

Keel and her colleagues evaluated the independent significance of multiple purging method use in 76 women with purging disorder and 35 healthy controls. Twenty-eight of the purging disorder patients had used multiple purging methods in the previous three months, while 48 had not.

Body image disturbance
The individuals who used multiple purging methods exhibited greater body image disturbance, were more restraint in eating, and were more concerned about eating, the researchers found.

"Although they did not report greater frequency of binge eating, their greater body image concerns and dietary restraint may contribute to increased efforts to counteract the effects of eating on their weight by using different purging methods," Keel said.

Women who purged more frequently were more depressed and anxious, and were also more likely to have been diagnosed with a personality disorder, the researchers found.

"Using multiple purging methods as a marker of eating disorder severity could provide more meaningful distinctions among women who purge than our current diagnostic system," the researchers conclude, adding that further studies should look at the effect of multiple purging method use on response to treatment and remission.

SOURCE: International Journal of Eating Disorders, September 2007. – (Reuters Health)

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Eating disorders Centre

October 2007


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