Four reasons we purge: what parents need to know about purge behavior

Purging behavior includes the use of self-induced vomiting, the use of laxatives, diuretics and weight-loss medication, and exercise. While the majority of purging begins with a simple goal of controlling weight, it is important to understand that purging can serve a variety of purposes in our lives. We are putting this information forward to help parents better understand that purging behavior is often not as “abhorrent” or “disgusting” as it may seem. Most of the time purging serves a very real purpose in a person’s life, and it is only when we understand the behavior that we are able to replace it with more adaptive ones.

It’s important to know that purging behavior is not limited to Bulimia Nervosa. It is engaged in by people who are diagnosed with Anorexia Nervosa, Binge Eating Disorder, OSFED and many subclinical eating disorders. Purging behavior can even be a stand-alone disorder. Purging of all types, at any level, has been correlated with other risky behaviors including smoking, binge drinking, and drug use. [3] One recent finding showed that 13% of North American girls reported purging behaviors in mid-adolescence. [4]

Hopefully, these descriptions will help you see why purging behavior arises and takes hold in some of us. It is our belief that when parents can approach a child who purges with understanding and compassion, they will have better success in supporting their child’s recovery from an eating disorder.

1. Socialized purges

Socialized purges are socially-accepted purge behaviors that are openly discussed in society. The most common example takes place at large meals like Thanksgiving. Many people will talk about engaging in vigorous exercise before or after Thanksgiving dinner in an attempt to “work off” the calories from the meal.

Many family tables involve one or more parents mentioning that they will take a little less food because they didn’t exercise that day or taking a little more because they “were good” in terms of exercising or restricting food earlier in the day. This is called “compensatory behavior” and is a form of calculation in which food is “earned” with the appropriate behavior.

People regularly say things like:

  • I’m going to have to put in some extra miles tomorrow after all these cookies
  • I shouldn’t be eating this, but I’ll go to the gym to make up for it
  • I skipped breakfast so that I could indulge tonight
  • I’ll have to skip breakfast tomorrow to make up for this meal
  • I can eat this cupcake because I burned 500 calories on the treadmill today
  • I’m off to burn 500 calories in spinning class so that I can enjoy dessert tonight.

This is socially normalized behavior, but it is also eating disorder behavior. Parents should be aware that when we normalize socialized purges, we open the door to eating disorders. We should eliminate socialized purges and any form of food or exercise compensatory behavior from our children’s lives. Food should never be “earned” or “worked off.” It should be enjoyed and appreciated as a critical element of life.

2. Bonding purges

It is not uncommon for teens and young adults to engage in bonding with friends by purging. This may involve group vomiting, drinking laxative teas, skipping meals, and exercising after eating a meal. Friendships are often the places where we first engage in these behaviors, and they become normalized and attractive as a result. Through our friendships, we feel a sense of critical belonging and understanding, and when purging becomes a part of a friendship it can become a “sticky” behavior that we do together and even spread to other friendships or done alone.

The most common social example of this is sororities, where large groups of girls will share purge behaviors and “secrets” about how to purge. While many will move on from these purge behaviors once they leave the social circle, the baseline behavior has been normalized and reinforced, leaving the person vulnerable to future mental health conditions including depression and anxiety. [2] Additionally, any level of purging, even if it is “mild,” has been correlated with high-risk behaviors including binge drinking, smoking, and drug use. [3]

If a person is engaging in bonding purges, they may not have a diagnosable eating disorder, but their purging behavior is still a significant concern, since a percentage of people who engage in bonding purges may develop additional eating disorder symptoms and behaviors. Early intervention can make a significant impact, so parents are encouraged to talk to kids about purging and seek professional support if they believe their child is engaging in purge behaviors.

3. Weight-loss purges

We live in a society that has normalized and encourages dieting, even though dieting has been linked with higher lifetime body weight and significant health complications. [5, 6] The desire to achieve a lower body weight is pervasive, and is especially pernicious among teenage girls, the population most vulnerable to developing eating disorders. Dieting is the most powerful predictor of an eating disorder. [7]

Our diet culture promotes low body weight at any cost, and there are countless diet programs available to support people who want to pursue intentional weight loss. But our bodies are finely tuned to maintain their own healthy body weight, regardless of what we would like that weight to be, and any restriction causes a healthy and intense hunger response, which often results in binge eating, or eating beyond the point of physical comfort.

Often when a person is binge eating, they are driven by extreme bodily needs and are in a state of emotional disconnection. It’s as if the body turns the mind off so that it can take over and get what it needs. While binge eating, we are typically not aware of how much we are eating, nor are we able to stop ourselves. Once a person has “succumbed” to their natural biology and eaten food in response to their hunger, they may turn to purge behaviors to compensate for their perceived failure to adhere to a diet.

Even people who maintain very restricted diets and eat very little food may engage in purging because they believe it is necessary to maintain their diet and/or low weight. In this way, purging can become a part of maintaining a diet even for people who do not experience binge-eating episodes. For example, in a person who has Anorexia Nervosa or someone who is on a calorie-restricted diet, a person may eat very little but still attempt to purge any calories that they believe put them over their daily goal. Someone who is on a carb-restricted diet may attempt to purge a carb-laden meal but will not do so after a no-carb meal.

Purging for weight loss can seem like a “smart” way to manage the pressures of maintaining a low body weight. It appears to solve problems for the strict dieter who occasionally or often goes beyond the boundaries of their diet. However, purge behaviors can become dangerously compulsive, can co-exist with Binge Eating Disorder, Anorexia Nervosa or OSFED, or become chronic in the form of Bulimia Nervosa.

When a person is engaging in purge behavior for the purpose of weight loss or weight maintenance, they need intensive care from providers who understand the dangers of diet culture and work from a Health at Every Size (HAES) perspective. Providers who are weight-conscious or promise that a person will not gain weight or can even lose weight with treatment should be avoided, as they can deepen the underlying diet beliefs that drive weight-loss purges.

4. Soothing purges

Surprising as it may sound, many who develop chronic purging behaviors experience a positive soothing quality to the action of purging. Eating disorders, especially Bulimia Nervosa, can be described as Maladaptive Coping Mechanisms, which are subconscious mechanisms to soothe anxious feelings. Bulimia has been linked to underlying problems with impulsivity, which can be defined as urgency, sensations seeking, lack of premeditation, and lack of perseverance. [8]

People who develop Bulimia tend to lack the ability to self-soothe. To compensate for their inability to self-soothe their emotional state, they seek external behaviors such as purging, substance use, and self-harm. These behaviors are sought on a subconscious and incredibly urgent basis. This is why purging behavior can sometimes be described as “addictive,” since it engages a response similar to addictive substances.

People who have Bulimia are more likely to engage in self-harm behavior, with rates between 25 and 75 percent reported in various studies. [9] Just like Bulimia, self-harm may seem like a bizarre way to soothe oneself, but they are both surprisingly consistent as coping behaviors. Like Bulimia, self-harm is a powerful form of non-verbal communication, a very valid call for help when the person suffering lacks adaptive methods of seeking support.

When a person engages in soothing purges, they need intensive psychological intervention to support them in building adaptive coping mechanisms. These adaptive methods will help them process pain, anxiety, and fear in new ways that don’t involve putting anything in their bodies (e.g. food, alcohol, drugs) or removing anything from their bodies (e.g. purging, bleeding).

Treatment for soothing purges should come from a place of compassion and acceptance so that the person feels free to fully explore the urges that drive their behavior. Therapists tell us that it is only when a person gets in touch with the pain they are trying to soothe with purging that they are able to begin the process of replacing their purge behavior with more adaptive coping methods. Since soothing purges typically begin as weight-loss purges, providers should come from a Health at Every Size perspective to avoid perpetuating dangerous diet culture beliefs about body size.


References: 

[1] Micali, et al, The incidence of eating disorders in the uk in 2000-2009, BMJ, 2013

[2] Field, et al, Prospective association of common eating disorders and adverse outcomes, Pediatrics, 2012

[3] Solmi, et al, Prevalence of purging at age 16 and associations with negative outcomes among girls in three community-based cohorts, Journal of Child Psychology and Psychiatry, 2015

[4] Neumark-Sztainer, et al, Dieting and Disordered Eating Behaviors from Adolescence to Young Adulthood: Findings from a 10-Year Longitudinal Study, Journal of the American Dietetic Association, 2011

[5] Mann, Secrets From the Eating Lab: The Science of Weight Loss, the Myth of Willpower, and Why You Should Never Diet Again

[6] Strohacker K, Carpenter, K, McFarlin B, Consequences of Weight Cycling: An Increase in Disease Risk?, International Journal of Exercise Science, 2009

[7] GC Patton, R Selzer, et al, Onset of adolescent eating disorders: population cohort study over 3 years, BMJ, 1999

[8] Anestis, et al, The role of urgency in maladaptive behaviors, Behaviour Research and Therapy, 2007

[9] Marilee Strong, A Bright Red Scream: Self-Mutilation and the Language of Pain, 1998

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