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Purging disorder

recent advances and future challenges

Keel, Pamela K.

doi: 10.1097/YCO.0000000000000541
EATING DISORDERS: Edited by Hans W. Hoek and Anna Keski-Rahkonen

Purpose of review The present review aims to help specialists remain up-to-date on research from the past 2 years on epidemiology, risk factors, biological correlates, treatment, and outcomes for purging disorder, a DSM-5 other specified feeding and eating disorder.

Recent findings Purging disorder affects 2.5–4.8% of adolescent females in population-based samples, but purging disorder remains relatively rare in treatment settings. Higher premorbid body mass index, body dissatisfaction, and dieting prospectively predict purging disorder onset. In studies of biological correlates, women with purging disorder demonstrated significantly greater postprandial increases in the satiety peptide, peptide tyrosine tyrosine, compared to women with bulimia nervosa and controls, and these differences predicted greater gastrointestinal distress in purging disorder. Less than half of those with purging disorder are free from an eating disorder at the end of treatment and at one or more years of follow-up, supporting the need for improved interventions.

Summary Purging disorder may occupy a space that falls between anorexia and bulimia nervosa, making it ‘not quite’ anorexia and ‘not quite’ bulimia and difficult to reliably distinguish from each. Improved recognition and understanding of purging disorder requires more research specifically designed to test models of risk and maintenance factors to advance interventions for those who purge without binge eating.

Department of Psychology, Florida State University, Tallahassee, Florida, USA

Correspondence to Pamela K. Keel, PhD, 1107 West Call Street, Tallahassee, FL 32306, USA. Tel: +1 850 645 9140; fax: +1 850 644 7739; e-mail:

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