Psychological Medicine

Original Articles

Co-morbidity and disorder-related distress and impairment in purging disorder

P. K. Keela1 c1, B. E. Wolfea2, J. A. Gravenera1 and D. C. Jimersona3

a1 Department of Psychology, The University of Iowa, Iowa City, IA, USA

a2 Psychiatric/Mental Health Department, Connell School of Nursing, Boston College, Boston, MA, USA

a3 Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA


Background Recent studies suggest that purging disorder (PD) may be a common eating disorder that is associated with clinically significant levels of distress and high levels of psychiatric co-morbidity. However, no study has established evidence of disorder-related impairment or whether distress is specifically related to PD rather than to co-morbid disorders.

Method Three groups of normal-weight women [non-eating disorder controls (n=38), with PD (n=24), and with bulimia nervosa (BN)-purging subtype (n=57)] completed structured clinical interviews and self-report assessments.

Results Both PD and BN were associated with significant co-morbidity and elevations on indicators of distress and impairment compared to controls. Compared to BN, PD was associated with lower rates of current and lifetime mood disorders but higher rates of current anxiety disorders. Elevated distress and impairment were maintained in PD and BN after controlling for Axis I and Axis II disorders.

Conclusions PD is associated with elevated distress and impairment and should be considered for inclusion as a provisional disorder in nosological schemes such as the Diagnostic and Statistical Manual to facilitate much-needed research on this clinically significant syndrome.

(Received March 19 2007)

(Revised June 04 2007)

(Accepted June 21 2007)

(Online publication September 10 2007)


c1 Address for correspondence: P. K. Keel, Ph.D., E11 Seashore Hall, Iowa City, IA 52246, USA. (Email: