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

Published online by Cambridge University Press:  15 January 2020

K. Jean Forney Open the ORCID record for K. Jean Forney [Opens in a new window] ,
Ross D. Crosby Open the ORCID record for Ross D. Crosby [Opens in a new window] ,
Tiffany A. Brown Open the ORCID record for Tiffany A. Brown [Opens in a new window] ,
Kelly M. Klein  and
Pamela K. Keel
K. Jean Forney*
Affiliation:
Department of Psychology, Ohio University, Athens, Ohio, USA
Ross D. Crosby
Affiliation:
Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
Tiffany A. Brown
Affiliation:
Department of Psychiatry, University of California San Diego, San Diego, California, USA
Kelly M. Klein
Affiliation:
VA Boston Healthcare System, Brockton Division, Brockton, MA, USA
Pamela K. Keel
Affiliation:
Department of Psychology, Florida State University, Tallahassee, Florida, USA
*
Author for correspondence: K. Jean Forney, E-mail: [email protected]
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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.

Keywords

Eating disorderfollow-uppurging disorderother specified feeding or eating disorderoutcome
Type
Original Articles
Information
Psychological Medicine , Volume 51 , Issue 6 , April 2021 , pp. 1020 - 1027
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Copyright
Copyright © Cambridge University Press 2020

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References

Allen, K. L., Byrne, S. M., Oddy, W. H., & Crosby, R. D. (2013). Early onset binge eating and purging eating disorders: Course and outcome in a population-based study of adolescents. Journal of Abnormal Child Psychology, 41(7), 1083–1096. https://doi.org/10.1007/s10802-013-9747-7.CrossRefGoogle Scholar
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.Google Scholar
Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies. Archives of General Psychiatry, 68(7), 724–731. https://doi.org/10.1001/archgenpsychiatry.2011.74.CrossRefGoogle ScholarPubMed
Bardone-Cone, A. M., Harney, M. B., Maldonado, C. R., Lawson, M. A., Robinson, D. P., Smith, R., & Tosh, A. (2010). Defining recovery from an eating disorder: Conceptualization, validation, and examination of psychosocial functioning and psychiatric comorbidity. Behaviour Research and Therapy, 48(3), 194–202. https://doi.org/10.1016/j.brat.2009.11.001.CrossRefGoogle ScholarPubMed
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.Google Scholar
Beck, A. T., Steer, R. A., & Carbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8(1), 77–100. https://doi.org/10.1016/0272-7358(88)90050-5.CrossRefGoogle Scholar
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4(6), 561–571. https://doi.org/10.1001/archpsyc.1961.01710120031004.CrossRefGoogle ScholarPubMed
Bohn, K., Doll, H. A., Cooper, Z., O'Connor, M., Palmer, R. L., & Fairburn, C. G. (2008). The measurement of impairment due to eating disorder psychopathology. Behaviour Research and Therapy, 46(10), 1105–1110. https://doi.org/10.1016/j.brat.2008.06.012.CrossRefGoogle ScholarPubMed
Bowman, R. L., & DeLucia, J. L. (1992). Accuracy of self-reported weight: A meta-analysis. Behavior Therapy, 23(4), 637–655. https://doi.org/10.1016/S0005-7894(05)80226-6.CrossRefGoogle Scholar
Cooper, P. J., Taylor, M. J., Cooper, Z., & Fairburn, C. G. (1987). The development and validation of the Body Shape Questionnaire. International Journal of Eating Disorders, 6(4), 485–494. https://doi.org/10.1002/1098-108X(198707)6:4<485::AID-EAT2260060405>3.0.CO;2-O.3.0.CO;2-O>CrossRefGoogle Scholar
Cooper, Z., & Fairburn, C. (1987). The Eating Disorder Examination: A semi-structured interview for the assessment of the specific psychopathology of eating disorders. International Journal of Eating Disorders, 6(1), 1–8. https://doi.org/10.1002/1098-108X(198701)6:1%3C1::AID-EAT2260060102%3E3.0.CO;2-9.3.0.CO;2-9>CrossRefGoogle Scholar
Crow, S. J., Peterson, C. B., Swanson, S. A., Raymond, N. C., Specker, S., Eckert, E. D., & Mitchell, J. E. (2009). Increased mortality in bulimia nervosa and other eating disorders. American Journal of Psychiatry, 166(12), 1342–1346. https://doi.org/10.1176/appi.ajp.2009.09020247.CrossRefGoogle ScholarPubMed
Dossat, A. M., Bodell, L. P., Williams, D. L., Eckel, L. A., & Keel, P. K. (2015). Preliminary examination of glucagon-like peptide-1 levels in women with purging disorder and bulimia nervosa. International Journal of Eating Disorders, 48(2), 199–205. https://doi.org/10.1002/eat.22264.CrossRefGoogle ScholarPubMed
Eddy, K. T., Dorer, D. J., Franko, D. L., Tahilani, K., Thompson-Brenner, H., & Herzog, D. B. (2007). Should bulimia nervosa be subtyped by history of anorexia nervosa? A longitudinal validation. International Journal of Eating Disorders, 40(S3), S67–S71. https://doi.org/10.1002/eat.20422.CrossRefGoogle ScholarPubMed
Eddy, K. T., Swanson, S. A., Crosby, R. D., Franko, D. L., Engel, S., & Herzog, D. B. (2010). How should DSM-V classify eating disorder not otherwise specified (EDNOS) presentations in women with lifetime anorexia or bulimia nervosa? Psychological Medicine, 40(10), 1735–1744. https://doi.org/10.1017/S0033291709992200.CrossRefGoogle ScholarPubMed
Fairburn, C. G., & Beglin, S. J. (1994). Assessment of eating disorders: Interview or self-report questionnaire? International Journal of Eating Disorders, 16(4), 363–370. https://doi.org/10.1002/1098-108X(199412)16:4<363::AID-EAT2260160405>3.0.CO;2-#.3.0.CO;2-#>CrossRefGoogle ScholarPubMed
Fairburn, C. G., Cooper, Z., Doll, H. A., O'Connor, M. E., Bohn, K., Hawker, D. M., … Palmer, R. L. (2009). Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: A two-site trial with 60-week follow-up. American Journal of Psychiatry, 166(3), 311–319. https://doi.org/10.1176/appi.ajp.2008.08040608.CrossRefGoogle ScholarPubMed
Fichter, M. M., Quadflieg, N., & Hedlund, S. (2006). Twelve-year course and outcome predictors of anorexia nervosa. International Journal of Eating Disorders, 39(2), 87–100. https://doi.org/10.1002/eat.20215.CrossRefGoogle ScholarPubMed
First, M., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1995). Structured Clinical Interview for DSM-IV Axis I Disorders. New York: New York State Psychiatric Institute.Google Scholar
Forney, K. J., Buchman-Schmitt, J. M., Keel, P. K., & Frank, G. K. W. (2016). The medical complications associated with purging. International Journal of Eating Disorders, 49(3), 249–259. https://doi.org/10.1002/eat.22504.CrossRefGoogle ScholarPubMed
Glazer, K. B., Sonneville, K. R., Micali, N., Swanson, S. A., Crosby, R., Horton, N. J., … Field, A. E. (2019). The course of eating disorders involving bingeing and purging among adolescent girls: Prevalence, stability, and transitions. Journal of Adolescent Health, 64(2), 165–171. https://doi.org/10.1016/j.jadohealth.2018.09.023.CrossRefGoogle ScholarPubMed
Hawthorne, G., Herrman, H., & Murphy, B. (2006). Interpreting the WHOQOL-Bref: Preliminary population norms and effect sizes. Social Indicators Research, 77(1), 37–59.CrossRefGoogle Scholar
Helverskov, J. L., Clausen, L., Mors, O., Frydenberg, M., Thomsen, P. H., & Rokkedal, K. (2010). Trans-diagnostic outcome of eating disorders: A 30-month follow-up study of 629 patients. European Eating Disorders Review, 18(6), 453–463. https://doi.org/10.1002/erv.1025.CrossRefGoogle ScholarPubMed
Keel, P. K., Eckel, L. A., Hildebrandt, B. A., Haedt-Matt, A. A., Appelbaum, J., & Jimerson, D. C. (2018). Disturbance of gut satiety peptide in purging disorder. International Journal of Eating Disorders, 51(1), 53–61. https://doi.org/10.1002/eat.22806.CrossRefGoogle ScholarPubMed
Keel, P. K., Haedt, A., & Edler, C. (2005). Purging disorder: An ominous variant of bulimia nervosa? International Journal of Eating Disorders, 38(3), 191–199. https://doi.org/10.1002/eat.20179.CrossRefGoogle ScholarPubMed
Keel, P. K., & Mitchell, J. E. (1997). Outcome in bulimia nervosa. American Journal of Psychiatry, 154(3), 313–321. https://doi.org/10.1176/ajp.154.3.313.Google ScholarPubMed
Keel, P. K., Mitchell, J. E., Miller, K. B., Davis, T. L., & Crow, S. J. (1999). Long-term outcome of bulimia nervosa. Archives of General Psychiatry, 56(1), 63–69. https://doi.org/10.1001/archpsyc.56.1.63.CrossRefGoogle ScholarPubMed
Keel, P. K., & Striegel-Moore, R. H. (2009). The validity and clinical utility of purging disorder. International Journal of Eating Disorders, 42(8), 706–719. https://doi.org/10.1002/eat.20718.CrossRefGoogle ScholarPubMed
Keel, P. K., Wolfe, B. E., Liddle, R. A., Young, K. P. D., & Jimerson, D. C. (2007). Clinical features and physiological response to a test meal in purging disorder and bulimia nervosa. Archives of General Psychiatry, 64(9), 1058–1066. https://doi.org/10.1001/archpsyc.64.9.1058.CrossRefGoogle ScholarPubMed
Keski-Rahkonen, A., Raevuori, A., Bulik, C. M., Hoek, H. W., Rissanen, A., & Kaprio, J. (2014). Factors associated with recovery from anorexia nervosa: A population-based study. International Journal of Eating Disorders, 47(2), 117–123. https://doi.org/10.1002/eat.22168.CrossRefGoogle ScholarPubMed
Kleinke, K. (2019). Package “countimp” (Version 2.0.7). Retrieved from https://github.com/kkleinke/countimp.Google Scholar
Knoph, C., Von Holle, A., Zerwas, S., Torgersen, L., Tambs, K., Stoltenberg, C., … Reichborn-Kjennerud, T. (2013). Course and predictors of maternal eating disorders in the postpartum period. International Journal of Eating Disorders, 46(4), 355–368. https://doi.org/10.1002/eat.22088.CrossRefGoogle ScholarPubMed
Koch, S., Quadflieg, N., & Fichter, M. (2013). Purging disorder: A comparison to established eating disorders with purging behaviour. European Eating Disorders Review, 21(4), 265–275. https://doi.org/10.1002/erv.2231.CrossRefGoogle ScholarPubMed
Kohl, M. (2019). Package “MKmisc” (Version 1.6). Retrieved from https://cran.r-project.org/web/packages/MKmisc/MKmisc.pdf.Google Scholar
Löwe, B., Zipfel, S., Buchholz, C., Dupont, Y., Reas, D. L., & Herzog, W. (2001). Long-term outcome of anorexia nervosa in a prospective 21-year follow-up study. Psychological Medicine, 31(5), 881–890. https://doi.org/10.1017/S003329170100407X.CrossRefGoogle Scholar
Mond, J. M., Hay, P. J., Rodgers, B., & Owen, C. (2006). Eating Disorder Examination Questionnaire (EDE-Q): Norms for young adult women. Behaviour Research and Therapy, 44(1), 53–62. https://doi.org/10.1016/j.brat.2004.12.003.CrossRefGoogle ScholarPubMed
Robitzsch, A., Grund, S., & Henke, T. (2019). Package “miceadds” (Version 3.5-14). Retrieved from https://cran.r-project.org/web/packages/miceadds/miceadds.pdf.Google Scholar
Rosen, J. C., Jones, A., Ramirez, E., & Waxman, S. (1996). Body Shape Questionnaire: Studies of validity and reliability. International Journal of Eating Disorders, 20(3), 315–319. https://doi.org/10.1002/(SICI)1098-108X(199611)20:3<315::AID-EAT11>3.0.CO;2-Z.3.0.CO;2-Z>CrossRefGoogle ScholarPubMed
Smith, K. E., Crowther, J. H., & Lavender, J. M. (2017). A review of purging disorder through meta-analysis. Journal of Abnormal Psychology, 126(5), 565–592. https://doi.org/10.1037/abn0000243.CrossRefGoogle ScholarPubMed
Speilberger, C. D., Gorusch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). The State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
Stice, E., Marti, C. N., & Rhode, P. (2013). Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal of Abnormal Psychology, 122(2), 445–457. https://doi.org/10.1037/a0030679.CrossRefGoogle Scholar
Stunkard, A. J., & Messick, S. (1985). The Three-Factor Eating Questionnaire to measure dietary restraint, disinhibition and hunger. Journal of Psychosomatic Research, 29(1), 71–83. https://doi.org/10.1016/0022-3999(85)90010-8.CrossRefGoogle ScholarPubMed
The WHOQoL Group, T. W. (1998). Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment. Psychological Medicine, 28(3), 551–558.CrossRefGoogle Scholar
van Buuren, S. (2019). Package “mice” (Version 3.6.0). Retrieved from https://cran.r-project.org/web/packages/mice/mice.pdf.Google Scholar
von Soest, T., & Wichstrøm, L. (2008). The impact of becoming a mother on eating problems. International Journal of Eating Disorders, 41(3), 215–223. https://doi.org/10.1002/eat.20493.CrossRefGoogle ScholarPubMed
Waller, G., Gray, E., Hinrichsen, H., Mountford, V., Lawson, R., & Patient, E. (2014). Cognitive-behavioral therapy for bulimia nervosa and atypical bulimic nervosa: Effectiveness in clinical settings. International Journal of Eating Disorders, 47(1), 13–17. https://doi.org/10.1002/eat.22181.CrossRefGoogle ScholarPubMed
Watson, H. J., Holle, A. V., Hamer, R. M., Berg, C. K., Torgersen, L., Magnus, P., … Bulik, C. M. (2013). Remission, continuation and incidence of eating disorders during early pregnancy: A validation study in a population-based birth cohort. Psychological Medicine, 43(8), 1723–1734. https://doi.org/10.1017/S0033291712002516.CrossRefGoogle Scholar