Loss of Control Eating and Purging Disorder

The DSM-5 places purging disorder (PD) in the “Other Specified Feeding or Eating Disorder” category. It further defines PD as “Recurrent purging to influence weight or shape in the absence of low body weight and binge eating.” Individuals with PD do not report binge eating, or discrete episodes of loss of control (LOC) eating, which usually involves eating an unusually large amount of food in less than 2 hours.

According to Jean Forney and colleagues at Florida State University, Tallahassee, and the Illinois Institute of Technology, Chicago, LOC eating is in fact an important feature of PD and should be considered in research studies of purging (Int J Eat Disord. 2014; 3:244). The researchers used data from 101 women in 4 studies of PD. In order to participate, the women had to have experienced recurrent purging at least 4 times a month over the past 3 months, and to have an undue influence of shape or weight on self-evolution, normal body weight (body mass index, or BMI, of 18.5 to < 27.0 kg/m² ), and absence of large binge eating episodes.

Women selected for the study were 18 to 42 years of age (mean: 22 years of age), and were predominately Caucasian, never married, and had completed some college. Only 29% were currently seeking treatment. Sixty-one percent reported LOC eating at least once a week. More than 90% reported using self-induced vomiting as a purging method; smaller percentages reported using laxatives (17.8%) or diuretics (7.9%). The women reported using purging behavior nearly 6 times a week.

The authors suggest that the purging noted in PD may be more closely associated with anxiety, whereas LOC eating and LOC eating are connected with negative affect. LOC eating was associated with negative urgency, as well as to hunger, distress, depression, and disinhibition. The authors pointed out that in addition to showing a measure of severity within purging disorder, “LOC eating may reflect a severity across bulimic syndromes.”