Anorexia Nervosa Binge Eating and Purging Subtype – Symptoms and Treatments

Subtypes of Anorexia Nervosa

Restricting Type

The Restricting Type of Anorexia Nervosa is defined by behaviors that focus on extreme restriction of food intake without regular episodes of binge-eating or purging.

Key Features:

• No recurrent episodes of binge-eating or purging (e.g., self-induced vomiting, misuse of laxatives, diuretics).
• Weight loss is primarily achieved through severe dieting, fasting, or excessive exercise.
• These individuals are obsessive about limiting food intake, closely monitoring calories, and often engaging in rigid, ritualistic eating behaviors.

Behavioral Pattern:

• Weight control in the Restricting Type is maintained by caloric restriction and exercise, without the use of purging methods.
• This subtype typically involves a gradual reduction in food intake, leading to significant weight loss over time.

Example: An individual with this subtype might eat significantly less than required, often skipping meals or eating only minimal portions, and may engage in extreme physical activity to avoid weight gain.

Binge-Eating/Purging Type

The Binge-Eating/Purging Type of Anorexia Nervosa is characterized by recurrent episodes of binge-eating followed by compensatory purging behaviors.

Key Features:

• Recurrent episodes of binge-eating: Consuming an excessive amount of food within a short period, often accompanied by a sense of loss of control.
• Recurrent purging behaviors: To counteract the effects of binge-eating, individuals engage in self-induced vomiting, laxative abuse, diuretic use, or enemas.
• Individuals with this subtype may also engage in restrictive eating behaviors, but the defining characteristic is the cycle of binge-eating and purging.

Behavioral Pattern:

• Individuals may go through periods of restricting food intake, followed by episodes of binge-eating, which are then followed by purging to eliminate calories.
• The purging behavior is repetitive and occurs regularly, often at least once a week for three months.

Example: An individual with the binge-eating/purging subtype might severely restrict their eating for several days but then engage in a binge episode, followed by self-induced vomiting or laxative use to rid their body of the ingested calories.

What are the Treatments for the Anorexia Nervosa Binge Eating and Purging Subtype?

Treating Anorexia Nervosa, Binge-Eating/Purging Subtype requires a multidisciplinary approach that addresses the physical, psychological, and behavioral aspects of the disorder. The primary goals of treatment include restoring a healthy weight, improving eating habits, and addressing the underlying psychological issues related to binge-eating and purging behaviors. Below are the key treatment approaches:

Medical Stabilization

• Nutritional Rehabilitation: Restoring nutritional health is the first and most urgent step, especially for individuals with severe weight loss and malnutrition. This often requires the supervision of a dietitian to create a structured meal plan aimed at gradual and safe weight gain.
• Management of Medical Complications: Due to the physical risks associated with purging behaviors (e.g., electrolyte imbalances, dehydration, gastrointestinal damage), medical monitoring is essential. Physicians will address acute complications such as hypokalemia (low potassium), which can lead to cardiac issues.
• In severe cases, hospitalization or inpatient treatment may be necessary to stabilize vital signs and prevent life-threatening complications.

Psychotherapy

Psychotherapy plays a central role in treating the binge-eating/purging subtype of anorexia nervosa. The following types of therapy have shown effectiveness:

• Cognitive-Behavioral Therapy (CBT):
• CBT-E (Enhanced CBT) is the most researched and commonly used form of therapy for eating disorders. It focuses on addressing distorted beliefs about weight, food, and body image, as well as changing unhealthy eating patterns. For the binge-purge subtype, CBT helps manage the cycle of binge-eating and purging by developing healthier coping mechanisms for stress and emotions.
• CBT targets maladaptive thoughts that drive disordered behaviors and provides tools to resist urges to binge or purge.
• Dialectical Behavior Therapy (DBT):
• DBT can be useful for individuals with anorexia who struggle with emotional regulation, impulsivity, or self-harming behaviors, which are often linked to binge-eating and purging. It teaches skills like mindfulness, emotional regulation, and distress tolerance, which can reduce the drive to binge and purge as a way to cope with negative emotions.
• Family-Based Therapy (FBT):
• Also known as the Maudsley Approach, this therapy involves family members in the treatment process. It is particularly effective for adolescents with anorexia, where the family takes an active role in helping the individual regain healthy eating habits and address purging behaviors.

Pharmacotherapy (Medications)

While medications are not the first-line treatment for anorexia nervosa, they can be helpful in managing co-occurring psychological symptoms or complications related to binge-eating and purging.

• Antidepressants (SSRIs):
• Selective Serotonin Reuptake Inhibitors (SSRIs), such as fluoxetine (Prozac), are often used to treat the underlying anxiety, depression, or obsessive-compulsive behaviors that commonly co-occur with anorexia nervosa. For the binge-eating/purging subtype, SSRIs can help reduce the frequency of binge episodes and improve mood regulation.
• Fluoxetine is FDA-approved for bulimia nervosa, but may be used off-label for anorexia nervosa, binge-eating/purging subtype.
• Antipsychotics:
• Second-generation antipsychotics like olanzapine may be prescribed to address distorted thinking and promote weight gain by reducing anxiety around food.

Nutritional Counseling

Nutritional rehabilitation is essential for restoring physical health and addressing disordered eating habits:

• Individualized Meal Planning: A registered dietitian works closely with the individual to create a tailored meal plan that gradually increases caloric intake and introduces healthy eating patterns.
• Education on Healthy Eating Habits: Nutritional counseling involves educating individuals about the importance of balanced nutrition, addressing fears around food, and preventing the development of further restrictive or binge-purge behaviors.

Support Groups and Peer Support

• Eating Disorder Support Groups: These provide a safe space for individuals to share their experiences, gain emotional support, and learn from others who have recovered or are in the process of recovery.
• Family and Friends Involvement: Involving close family members and friends in support can strengthen the recovery process, providing a network of encouragement and accountability.

Long-Term Monitoring and Relapse Prevention

• Ongoing Therapy: Given the chronic nature of anorexia nervosa, long-term psychological therapy is often necessary to prevent relapse. Therapy focuses on maintaining healthy behaviors, managing stress, and addressing any lingering body image issues.
• Relapse Prevention Programs: Structured aftercare or outpatient programs help individuals continue their progress after intensive treatment, ensuring that they have the support and resources to maintain recovery.

Because a person with anorexia nervosa binge-eating purging disorder often does not recognize they have the condition, it can be very difficult to get them to seek diagnosis and treatment. Unfortunately, they are also at risk for mental health disorders, including depression and anxiety.3 They also experience higher rates of suicide than a person who does not have anorexia nervosa.

Learning how to recognize anorexia nervosa via the DSM-5-TR symptoms can help medical professionals identify those who need to seek help. Treatments for anorexia nervosa include medical care and monitoring as well as therapy, nutritional counseling, and taking medications to treat underlying medical conditions.

While the process for treating eating disorders like anorexia nervosa can be difficult on the part of the individual and their family, treatment can work and a person can live a healthier, happier life.

To gain a further depth of knowledge about anorexia nervosa binge-eating purging disorder, subscribe to our film library.

References:

1Mustelin, L., Silen, Y., Raevuori, A., Hoek, H.W., Kaprio, J., & Keski-Rahkonin, A. (2016). The DSM-5 diagnostic criteria for anorexia nervosa may change its population prevalence and prognostic value. Journal of Psychiatric Research. 77, 85-91. doi: 10.1016/j.jpsychires.2016.03.003

2Gibson, D., Workman, C., & Mehler, P.S. (2019). Medical complications of anorexia nervosa and bulimia nervosa. Medical complications of anorexia nervosa and bulimia nervosa. The Psychiatric Clinics of North America. 42(2): 263-274. doi: 10.1016/j.psc.2019.01.00

3Moskowitz, L., & Weiselberg, E. (2017). Anorexia nervosa/atypical anorexia nervosa. Current Problems in Pediatric and Adolescent Health Care. 47(4): 70-84. doi: 10.1016/j.cppeds.2017.02.003

National Institute of Mental Health. (2024, January). Eating Disorders. Www.nimh.nih.gov; National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/eating-disorders

Anorexia Nervosa Subtypes: Understanding Restricting Type and Binge-Eating/Purging Type. (2023, September 14). Eating Recovery Center. https://www.eatingrecoverycenter.com/resources/anorexia-subtypes

Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2014.

Treasure J, Duarte TA, Schmidt U. Eating disorders. Lancet. 2020;395(10227):899-911.

Klein DA, Sylvester JE, Schvey NA. Eating Disorders in Primary Care: Diagnosis and Management. Am Fam Physician. 2021 Jan 1;103(1):22-32. Erratum in: Am Fam Physician. 2021 Mar 1;103(5):263. PMID: 33382560.