A naturalistic, long-term follow-up of purging disorder

Abstract

Background The DSM-5 introduced purging disorder (PD) as an other specified feeding or eating disorder characterized by recurrent purging in the absence of binge eating. The current study sought to describe the long-term outcome of PD and to examine predictors of outcome. Methods Women (N = 84) who met research criteria for PD completed a comprehensive battery of baseline interview and questionnaire assessments. At an average of 10.24 (3.81) years follow-up, available records indicated all women were living, and over 95% were successfully located (n = 80) while over two-thirds (n = 58) completed follow-up assessments. Eating disorder status, full recovery status, and level of eating pathology were examined as outcomes. Severity and comorbidity indicators were tested as predictors of outcome. Results Although women experienced a clinically significant reduction in global eating pathology, 58% continued to meet criteria for a DSM-5 eating disorder at follow-up. Only 30% met established criteria for a full recovery. Women reported significant decreases in purging frequency, weight and shape concerns, and cognitive restraint, but did not report significant decreases in depressive and anxiety symptoms. Quality of life was impaired in the physical, psychological, and social domains. More severe weight and shape concerns at baseline predicted meeting criteria for an eating disorder at follow-up. Other baseline severity indicators and comorbidity did not predict the outcome. Conclusions Results highlight the severity and chronicity of PD as a clinically significant eating disorder. Future work should examine maintenance factors to better adapt treatments for PD.

Evaluating the predictive validity of purging disorder by comparison to bulimia nervosa at long‐term follow‐up

“…Consistent with prior work (Forney et al, 2021), three outcome definitions were tested. An eating disorder was diagnosed as present if an individual met DSM-5 criteria for anorexia nervosa, bulimia nervosa, binge-eating disorder, purging disorder, or another OSFED.…”

“…We recently published results describing the naturalistic outcome of purging disorder at an average of 10‐year follow‐up (Forney et al, 2021). Despite experiencing a significant decrease in eating pathology, women with purging disorder reported a relatively poor outcome; 58% continued to meet criteria for an eating disorder, and only 30% met criteria for full recovery.…”

“…Based on the prior meta-analysis (Smith et al, 2017), we hypothesized that purging disorder would be associated with a more favorable outcome than bulimia nervosa. Data describing outcome in purging disorder were previously published (Forney et al, 2021); however, this is the first report of long-term outcomes in participants with a baseline bulimia nervosa diagnosis and the first comparison of long-term outcomes between purging disorder and bulimia nervosa.…”

Evaluating whether a peer-led dissonance-based eating disorder prevention program prevents onset of each eating disorder type

“…Results indicated that peer-led Body Project groups produced a statistically significant 46% reduction in onset of subthreshold/threshold BN and a statistically significant 62% reduction in onset of PD relative to controls during the follow-up period. These prevention effects are critical, given that <50% of individuals who experience BN or PD achieve full recovery (Forney, Crosby, Brown, Klein, & Keel, 2021 ; Steinhausen & Weber, 2009 ). In addition to high rates of comorbidity and physical consequences, BN has been independently associated with suicidality above and beyond risk predicted by comorbid disorders (Bodell, Joiner, & Keel, 2013 ).…”

Disentangling the links between gastric emptying and binge eating v. purging in eating disorders using a case-control design

“…Data from participants in the current study were included in prior analyses to examine whether postprandial peptide YY (PYY) and ghrelin responses contributed to differences in subjective responses to a fixed test meal (Keel et al, 2018a ) and whether a behavioral measure of satiation using an ad lib meal confirmed self-reported responses to a fixed meal (Keel et al, 2018b ). Data from these participants were also included in secondary analyses unrelated to the aims of the parent project (Davis, Smith, & Keel, 2020 ; Forney, Crosby, Brown, Klein, & Keel, 2021 ; Keel, Bodell, Haedt-Matt, Williams, & Appelbaum, 2017 ; Maske, Williams, & Keel, 2020 ). This is the first report of gastric emptying and of responses to the fixed meal in the medicated condition from this sample.…”