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Title/Topic: When Normal Women Purge
Posted On: 1/2/2008
Iowa, Jan 2 2008 (Des Moines Register) – An Iowa researcher is hoping to bring more attention to a new eating disorder she’s coined as “purging disorder.”

Purging disorder is similar to bulimia nervosa in that both conditions involve eating, then trying to compensate for the calories consumed. But women with purging disorder don’t have the large, binge eating episodes that bulimics experience.

Instead, these normal-weight individuals eat small to normal amounts of food, then purge, often by vomiting, said Pamela Keel, an associate professor of psychology at the University of Iowa.

She hopes that her research will lead to better and more effective diagnosis and treatments for individuals suffering from the condition. At this point, the condition doesn’t officially have a name and more research is needed to determine all its characteristics.

Keel’s most recent research was published in the September issue of the Archives of General Psychiatry. Keel, who worked with researchers from Iowa, Harvard University Medical School and others, led the study. Researchers found distinct differences between women with purging disorder, bulimic women and women without eating disorders.

Purging disorder is a problem that has been going on for years but has just recently received more attention, Keel said.

“It’s new in terms of it’s not been officially recognized,” said Keel, who has analyzed the disorder for almost a decade and conducted three studies on the subject. “There was no name for it before I suggested purging disorder as a term.”

About 11 million men and women in the United States – or approximately 4 percent of the population – have bulimia or anorexia nervosa, according to the National Eating Disorders Association. Millions more suffer from binge eating disorder, a condition with characteristics that include recurrent episodes of eating large amounts of food in short periods of time and feeling out of control during binges.

Clinicians use criteria in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders when making a diagnosis of an eating disorder.

Individuals who don’t fit the criteria for bulimia, anorexia nervosa or binge eating disorder fall into a broad category called “eating disorder not otherwise specified.” This is the same category that people with purging disorder currently fall in.

“Studies have suggested that about 66 percent of people with eating disorders have an eating disorder not otherwise specified,” Keel said.

In the fourth edition of the Diagnostic and Statistical Manual, binge eating disorder was given a “provisional” designation.

That means the condition was given its own name and criteria, but that more research is needed on the disorder, Keel said. The result was “an explosion of research on binge eating disorder – including studies on treatment and prevention.”

She hopes purging disorder receives the same type of designation when the fifth edition of the diagnostic manual is scheduled to come out in 2012.

Lack of good epidemiological studies in the United States make it difficult to say how many Americans have purging condition, Keel said. But studies done in Australia and Italy have found that between 1 percent and 5 percent of individuals have had purging disorder in their lifetime.

Right now, there is no standard treatment for purging disorder. Keel said her work is “absolutely headed in that direction.”

“A clinician trying to help someone with purging disorder is kind of left to their own devices, experience and training to try and figure out what’s going to be most helpful,” she said.

Why purge?

Keel is currently recruiting participants for a follow-up study to better understand the factors surrounding why women with purging disorders purge.

Eating disorders specialist Lynne Vestal said some of her patients would fall into the purging disorder category.

“I certainly see people who are like that who are in the normal weight range and they’re purging,” said Vestal, a licensed mental health counselor in Windsor Heights with 25 years of experience in the field of eating disorders.

Vestal said one thing she’d like to know more about regarding Keel’s work is the issue of women with purging disorder being of “normal” weight, and how that is being defined.

That’s because some individuals may appear to be of normal weight, but have actually lost a significant amount of weight by being extremely restrictive, she said. In a situation like that, the person may actually be anorexic.

Vestal stressed that research like Keel’s is valuable in helping clinicians better screen and treat patients, which includes what drugs are used for treatment and insurance-related issues.

“The more we can have additional information that describes this disorder, it just gives us more information about how to treat this disorder,” Vestal said.


Reporter Dawn Sagario can be reached at (515) 284-8351 or

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