Anorexia nervosa binge-purge type explained

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In the binge-purge subtype of anorexia nervosa, a person greatly restricts the amount and type of food they consume.

They also engage in episodes of binge eating and purging. When this happens, a person eats a large amount of food in a short time and then aims to remove it from their body through various methods.

Purging methods may include:

• laxatives
• forced vomiting
• diuretics

Binge-purge type occurs in around 30–50% of people with anorexia nervosa.

Learn more about eating disorders.

Anorexia nervosa has two subtypes: binge-purge type and restricting type.

Restricting type

In restricting type, people severely limit the amount and type of food they eat, but they do not engage in bingeing and purging episodes.

Some people with this subtype may exercise excessively in addition to limiting their food consumption.

Learn more about restricting type.

Binge-purge type

The main difference between binge-purge type and restricting type is the use of purging. Along with food restriction, people with the binge-purge type have regular periods of binge eating followed by some sort of purging. People with restricting type do not usually engage in binge eating.

A person can experience an overlap in subtypes of anorexia nervosa. They may show signs of either type at different times after developing the condition.

Symptoms of anorexia nervosa include:

• extreme thinness (emaciation)
• excessively restricted eating
• intense fear of gaining weight
• unwillingness to maintain a typical weight for their height
• a significant influence of body weight and shape on self-esteem
• denial of the seriousness of low body weight
• distorted body image

Diagnosis

Diagnosis of either subtype of anorexia nervosa entails a medical history and physical examination to note symptoms and behaviors that indicate the condition.

Healthcare professionals may also perform blood tests to determine levels of certain substances, such as blood cell counts and hormones, and urine tests to detect prescription and recreational drugs. Heart tests may also be necessary.

The diagnostic criteria for anorexia nervosa binge-purge type, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision, include:

• restricting food and energy intake to a degree that leads to a significantly low body weight
• intensely fearing weight gain and engaging in behavior that interferes with gaining weight
• feeling disturbed by one’s body weight or shape
• regularly engaging in binge eating or purging during the past 3 months

Learn more about anorexia nervosa.

Bulimia nervosa entails recurring, frequent episodes of eating large amounts of food and feeling a lack of control over this habit. People with this condition typically follow the binges with one or more of the behaviors below:

• fasting
• excessive exercise
• forced vomiting
• excessive use of laxatives or diuretics

A major distinction between bulimia nervosa and the binge-purge subtype of anorexia nervosa involves weight. Unlike people with anorexia nervosa, who often have a low body weight, those with bulimia may be overweight, slightly underweight, or of typical weight.

The binge-purge type of anorexia nervosa also involves severe food restriction. Bulimia does not typically involve restriction. And if restriction occurs, it is typically not to the same extent.

Additionally, bulimia may include symptoms that are not typical in binge-purge anorexia, such as:

• long-term inflamed or sore throat
• acid reflux, which is the backward flow of acid from the stomach to the esophagus
• severe dehydration from purging fluids
• worn tooth enamel and increasingly sensitive teeth
• swollen salivary glands in the neck and jaw
• intestinal irritation from laxative misuse
• electrolyte imbalances, which can lead to a heart attack or stroke

Because a person with bulimia may not seem underweight and may hide their purging behaviors, other people in their life may be unaware of their condition. Signs of purging may include:

• frequent trips to the bathroom
• dizziness or fainting due to excessive purging
• recurrent, unexplained diarrhea
• the disappearance of large amounts of food

Read more about the differences between anorexia and bulimia.

Anorexia nervosa can be fatal, as people have a risk of death from medical complications related to starvation.

Over time, the following effects may develop:

• brittle nails and hair
• growth of fine hair all over the body
• low blood pressure
• mild anemia and muscle weakness
• severe constipation
• lethargy

Other possible complications include:

• absence of menstrual cycle
• delayed puberty
• thinning of bones
• yellowish tinge to the skin (jaundice)
• low blood sugar
• irregular or slow heart rate
• deficiency of red blood cells, white blood cells, and platelets (the component of the blood that contributes to clotting)
• damage to the nerves outside of the brain
• lower body temperature, which causes a person to frequently feel cold
• failure to thrive
• atypical enlargement of the heart
• infertility
• kidney failure

Treatment for anorexia nervosa includes:

• psychotherapy
• medications
• monitoring for refeeding syndrome

Psychotherapy

One option is family-based therapy, in which family members of a person with the condition assume responsibility for feeding them. This appears to be highly effective in promoting weight gain, enhanced mood, and better eating habits.

Another option is cognitive behavioral therapy (CBT). This type of therapy helps someone recognize unhelpful thinking patterns and identify and change inaccurate beliefs.

Read more about treatment for anorexia.

Medications

At first, healthcare and mental health professionals do not use medications for treatment. But if the condition worsens later or does not respond to psychotherapy, the first-line therapy is olanzapine (Zyprexa, Zyprexa Zydis). This is a medication for the treatment of certain mental health conditions.

Additionally, doctors may address any other mental health conditions a person may have, such as major depressive disorder and generalized anxiety disorder. Treatment may involve a combination of psychotherapy and selective serotonin reuptake inhibitors such as escitalopram (Lexapro).

Addressing refeeding syndrome

This syndrome, which may follow prolonged starvation, can involve atypical levels of electrolytes, such as low calcium and low phosphate levels. This may lead to heart problems and breathing difficulties. To prevent this, doctors closely monitor a person’s electrolyte levels.

A person may consider asking the following:

• Do I have anorexia nervosa, bulimia nervosa, or another eating disorder?
• Should I have psychotherapy? If so, which type and for how long?
• Do I need medications?
• Will my condition go away without treatment?
• How can treatment help, and how long might it take?
• What are the dangers of not getting treatment?

Learn more about the signs of eating disorders.

People with the binge-purge type of anorexia nervosa greatly restrict their food intake. They also engage in episodes of binge eating followed by purging through forced vomiting or the use of laxatives or diuretics.

Symptoms include extreme thinness and an unwillingness to maintain a typical weight.

The condition can lead to serious complications such as thinning of bones and infertility. It also can cause heart damage and other effects that can lead to death.

Treatment may include family therapy, CBT, medications, or a combination of these approaches.