The bingeless purge

A psychologist makes the case for a new classification of eating disorder.

By Lynn Harris
Published September 5, 2007 5:30PM (UTC)
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Binge-and-purge disorder, only without the binge: Does that still count as bulimia? Based on new research, the answer appears to be no.

Pamela Keel, associate professor of psychology at the University of Iowa, has spent several years studying "purging disorder" (P.D.), wherein a patient may eat a "normal" amount of food -- or even just a cookie -- and then experience the urge to purge. P.D. is currently classified as an "eating disorder not otherwise specified," but patients may be treated as if they have bulimia. In an article in this month's Archives of General Psychiatry, Keel suggests that P.D. should be classified as a disorder unto itself.


Skeptics may wonder if this position represents another case of disorder-itis in the medical community. Is P.D. really just bulimia lite?

Doesn't seem to be. First of all, though we can probably count on some media outlets to trumpet a "new" eating disorder (cue images of flushing toilets, gloomy women in silhouette, etc. etc.), Keel is hardly claiming to have "discovered" P.D., or that it has only recently emerged as a consequence of the latest Fashion Week. "Purging disorder is new in the sense that it has not been officially recognized as a unique condition in the classification of eating disorders," she said in a misleadingly headlined statement released by the University of Iowa. "But it's not a new problem. Women were struggling with purging disorder long before we began studying it."

Second, what's shown in her most recent research -- in which she compared the psychological and physiological responses to eating among women with P.D., women with bulimia and women with no eating disorder -- is that women with P.D., as opposed to bulimia, have a different mechanism that influences food intake; in effect, they feel fuller faster. Her earlier research has also determined that women with P.D. respond to what they eat, not how much.


In short, women with P.D. are not just underachieving bulimics. What's important, therefore, is to find ways to pluck patients out of the gray area and ensure that they're properly screened and treated. "Because we tend to only study formally defined disorders, this creates a gap between the problems people have and what we know about those problems," Keel said. "Identifying this disorder would stimulate research on its causes, treatment and prevention, which could alleviate the distress and impairment women with the illness suffer." Keel even suggests that there may be more women with P.D. than with anorexia and bulimia combined.

Next up for Keel: a follow-up study on why women with P.D. feel the urge to purge after what others might consider a normal, even small amount of food.

Lynn Harris

Award-winning journalist Lynn Harris is author of the comic novel "Death by Chick Lit" and co-creator of She also writes for the New York Times, Glamour, and many others.

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