Purging Disorder vs Bulimia: Key Differences

Bulimia Nervosa

Understanding and identifying the uncanny similarities and stark difference between Purging Disorder and Bulimia Nervosa

Purging is a behaviour commonly associated strictly with bulimia nervosa. However, purging disorder and bulimia nervosa are both very real and very serious eating disorders, independent of each other. Those suffering from either are deserving and worthy of unique treatment plans suited to their physical and emotional needs.

A defining tenet of bulimia nervosa is purging after a binge, with as much focus on the binge as on the purge. Purging disorder is not defined by a binge-purge cycle. It involves purging after eating, often after a normal or small amount of food.

Bulimia nervosa is its own diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), while purging disorder is diagnosed under Other Specified Feeding or Eating Disorder (OSFED). Both disorders, however, are serious, challenging, and complicated, and both demand respect and compassion.

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Purging Disorder vs Bulimia at a Glance

	Purging Disorder	Bulimia Nervosa
Diagnosis	Named presentation of OSFED (DSM-5)	Its own diagnosis (DSM-5)
Binge eating	No objectively large binges	Recurrent binge episodes
Purging	Recurrent purging after eating, often normal or small amounts	Compensatory behaviours after binges
Loss of control	May feel out of control after small amounts of food	Loss of control during binges is a core feature
Frequency threshold	Recurrent, no set frequency	At least once a week for three months
Seriousness	Serious medical and psychological risks	Serious medical and psychological risks

What Is Purging Disorder?

Purging disorder is an eating disorder characterised by recurrent purging to influence body weight or shape, without binge eating. It falls under the OSFED category, which stands for Other Specified Feeding or Eating Disorder. When an eating disorder falls under OSFED, it means it does not meet the full criteria for anorexia, bulimia, or binge eating disorder. You can read more about how that category works in our post on the difference between EDNOS and OSFED.

All eating disorders under the OSFED label should not be treated as one. Each has its own idiosyncrasies, deserving of unique attention and treatment. Purging disorder is adjacent to bulimia but is not a subset of it, because those who struggle with purging disorder feel compelled to purge regardless of how much they have eaten. For a closer look at the behaviour itself and its effects on the body, see The Other Side of Eating Disorders: Purging.

What Is Bulimia Nervosa?

Bulimia nervosa is an eating disorder defined by a cycle of binge eating followed by compensatory behaviours such as purging. A binge means eating an objectively large amount of food in a short period while feeling a loss of control.

To meet the DSM-5 criteria, binges and compensatory behaviours happen at least once a week for three months, and the person’s sense of self-worth is heavily influenced by body shape and weight. Learn more about the health risks of bulimia nervosa or our approach to bulimia treatment.

What Are the Signs of Purging Disorder?

Those who suffer from bulimia often describe feeling out of control around food, which leads to a binge and then a purge. Purging disorder looks different. Most people with purging disorder do not binge, but that does not mean food feels calm or neutral. Many feel intense distress, fullness, or a loss of control after eating even a normal or small amount, and purging becomes a way to relieve that feeling. It is less about the amount eaten and more about the urge to remove food from the body afterwards.

Signs of purging disorder can include:

Going to the bathroom right after meals, often consistently
Intense anxiety, guilt, or physical discomfort after eating ordinary amounts
Rigid rules about what, when, or how much to eat
Exercising excessively to make up for eating
Swollen cheeks or jaw, sore throat, or dental changes
Dizziness, fatigue, or feeling faint
A preoccupation with body weight or shape

Because purging disorder often occurs at a clinically normal weight, it can go unnoticed for a long time. The signs and symptoms of OSFED overlap closely and are worth reading too.

How Is Purging Disorder Diagnosed?

Purging disorder, like all other eating disorders, is diagnosed by a trained professional after a psychological intake or evaluation. Eating disorders greatly impact the physical body, but they are not identified by physical tests such as scans, blood work, or imaging. Those tests are still important, though. Blood work helps a doctor check electrolytes and heart health, which purging can affect.

Under the DSM-5, purging disorder is diagnosed when a person purges regularly to influence their weight or shape, without binge eating, and the behaviour causes significant distress or affects daily life. Often, the person feels distressed at the thought of not purging and actively finds ways to purge regardless of their surroundings. Anyone who is purging is worthy of and in need of support. A formal diagnosis is not required to seek help and begin treatment.

What Causes Purging Disorder?

Like all other eating disorders, purging disorder has no single, definitive cause. What there is, however, are shared experiences, emotions, and situations among those who live with eating disorders. They include, but are not limited to:

Nature (your genetics)
Nurture (your lived experiences)
Self-worth and self-confidence
Pre-existing mental health conditions such as anxiety, depression, or obsessive-compulsive disorder
Trauma
A history of dieting or exposure to diet culture

For a deeper look, read our post on what causes eating disorders.

Treatment for Purging Disorder and Bulimia

Eating disorder treatment can loosely follow the same structure regardless of the diagnosis. It is important to acknowledge that eating disorders are psychological disorders with cascading impacts on the mind and body, meaning it is critical to treat the psyche first and foremost. Engaging in therapy is a necessary step and practice for both purging disorder and bulimia.

Coupled with therapy, nutrition counselling with a registered dietitian is a helpful tool. It can increase understanding of food and its importance to our bodies, dispel inaccurate food beliefs, and help rebuild regular eating so the urge to purge loses its grip. Where the two differ is focus: bulimia treatment also works to break the binge-purge cycle, while purging disorder treatment centres on the distress that follows eating and the urge to compensate. Medical monitoring is important for both, since purging can affect electrolytes and heart health.

At EatWell, we offer purging disorder treatment and bulimia treatment as part of our eating disorder treatment programme.

How Do You Cope with Purging Disorder?

Coping with an eating disorder is, without a doubt, exhausting. It can consume the body and mind all day, every day. However, with support from family, friends, and a professional ally, it is possible to not only cope with an eating disorder but to actively reject it, reach full recovery, and regain complete control of your life. These strategies for how to cope with OSFED can help between sessions.

Purging Disorder Treatment in Toronto and Across Canada

EatWell Health Centre offers outpatient treatment for purging disorder and bulimia with no waitlist and no referral needed. Our therapists and registered dietitians see clients in person in Toronto and virtually across Canada. If you are waiting for a hospital programme, our hospital waitlist support can help bridge the gap.

Frequently Asked Questions

Is purging disorder the same as bulimia nervosa?

No. Purging disorder and bulimia nervosa are independent of each other. They share a similar tenet in the act of purging, but those with bulimia binge before purging, whereas those with purging disorder do not.

Does bulimia nervosa include purging?

Often, yes. Bulimia is defined by recurrent binge episodes followed by compensatory behaviours, and purging is one of the most common. This cycle is the defining feature of bulimia nervosa.

Is purging disorder an eating disorder?

Yes. Purging disorder is recognised in the DSM-5 as a named presentation of OSFED (Other Specified Feeding or Eating Disorder). It carries serious medical and psychological risks and deserves the same care as any other eating disorder.

What are the warning signs of purging disorder?

Common warning signs include going to the bathroom right after meals, visible distress after eating ordinary amounts of food, excessive exercise, swelling in the cheeks or jaw, dental changes, and fatigue or dizziness. Because many people with purging disorder are at a clinically normal weight, these signs are easy to miss.

What happens when you stop purging?

Our bodies are constantly seeking homeostasis, where everything is functioning on time and on track. Purging throws that balance off. When purging stops, many effects begin to ease, including dehydration, headaches, fatigue, and swollen salivary glands.

Recovery is not always smooth at first, though. It is common to feel bloated or uncomfortable while digestion readjusts, and people stopping laxative use may have temporary constipation or fluid retention. Some damage, like tooth enamel erosion, does not reverse on its own. Stopping purging can also shift electrolyte levels, which is why it is safest to do with medical support. If you feel faint, have chest pain, or notice an irregular heartbeat, seek medical care right away.

Can you recover from purging disorder?

Yes! Full recovery from purging disorder is possible with the right support, and earlier care tends to lead to better outcomes. You can reach out to our team directly to talk through next steps.

Purging Disorder and Bulimia Treatment in Toronto

Whether you are purging after binges, purging after ordinary meals, or are not sure which describes you, you deserve care that fits. Our team works through the distress around eating, the urge to compensate, and the beliefs about food and body that keep purging going.

EatWell Health Centre offers eating disorder treatment with no waitlist and no referral needed. Virtual care is available across Canada, and in-person care is available in Toronto.

Book a free consultation with our team

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