Eating disorders are some of the deadliest mental illnesses around today — with anorexia nervosa and bulimia nervosa being the most recognizable. Researchers are now arguing in favor of recognizing purging disorder as distinct from bulimia nervosa — while both are characterized by purging behaviors, bulimia is distinguished by a prior episode of binge-eating. The distinction is important because treatment options are often geared toward the eating aspect of EDs; whereas the purging is relatively ignored.

Published in the International Journal of Eating Disorders, the study conducted by researchers from Ohio University advocates for recognizing purging disorder as its own category and not as an offshoot of bulimia nervosa. Purging is only one behavioral aspect they share in common, the study suggests, and so the prognosis and treatment for the two must differ so as to effectively address them.

“While purging disorder is classified as an ‘other specified’ eating disorder, individuals who experience this disorder have comparable negative long-term outcomes as those with bulimia nervosa,” the paper states.

“Most of our eating disorder treatments focus on treating binge-eating. What we really need are treatments that do a better job treating symptoms when binge eating isn’t present and we don’t really have that right now,” said K. Jean Forney, from the College of Arts and Sciences at Ohio University who specializes in eating disorders.

Related on The Swaddle:

What It’s Like To Live With: An Undiagnosed Eating Disorder

Purging behaviors can include induced vomiting and laxative use. The critical insight of the research is that purging disorder and bulimia nervosa both have comparable and similar outcomes in terms of severity; but only the latter is more widely recognized and treatable.

Bulimia nervosa is classified under the DSM-5 as a “full threshold” mental disorder, but purging disorder is relegated to the category of “residual” disorders. “People tend to think conditions in the residual category are less dangerous, but that isn’t true… There is plenty of cross-sectional data that suggest that the purging disorder is just as serious as bulimia nervosa,” Forney added.

Moreover, the “clinical presentation” or the symptoms leading up to a diagnosis for both conditions differ enough to warrant a separate diagnosis for purging disorder. “This highlights the importance of screening for and treating purging disorder as a full-threshold eating disorder,” the research concludes.

The underlying factors contributing to eating disorders are complex: they go beyond individual psyches and are often triggered by an unhealthy socio-cultural fixation around weight, food, and beauty. “You know how people talk about the weather to engage in small talk? Well, in India, it’s weight,” Myesha, a person with an eating disorder, told The Swaddle in 2017. Calorie-counting in the name of health is another recent phenomenon, fulled by health-tracking apps, that paves another pipeline toward eating disorders.

Unrecognized eating disorders can be particularly dangerous for how they don’t have specialized treatments, but share similar outcomes in terms of severity and morbidity with the “recognized” ones. But this is slowly changing. Recent research identified “chewing and spitting” and orthorexia nervosa — and obsessive need for healthy eating — as distinct disorders, arguing for their inclusion in the DSM.

“Studies have proved that these disorders have very high mortality rates, which means that paying greater attention to initial signs that could point towards an eating disorder could save lives,” wrote Aditi Murti for The Swaddle. The study thus has urgent implications — it could pave the way for early detection, which is crucial for treating eating disorders before they can get too serious, even fatal.