Binge and Purge

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December 28, 2021 / By thadmin2

What is Eating disorder?

Eating disorders (ED) are characterised by unhealthy eating patterns caused by dysfunctional thoughts and emotions. The usual onset of ED generally starts at the age of 11 to 13 (NCCS, 2020). A Singapore-based study revealed that females are more commonly affected by ED with males only making up 10% of all reported cases (NCCS, 2020). However, contrary to popular belief, males are as likely to develop ED as females but many cases go undiscovered due shame and fear that comes with the diagnosis.

There is no specific cause for ED as it can vary for different individuals. ED can potentially develop when an individual is unable to cope with difficult feelings and turns to food for comfort. Both psychological and environmental factors play a part that determines whether a person is more at risk of developing ED (Eating Disorder Hope, 2021). An example of psychological factors can include impaired emotional regulation and self-esteem. An environmental factor can include negative body image due to media portrayal.



Amongst all ED, Binge eating disorder (BED) and Bulimia Nervosa (BN) are the hardest to identify. Individuals with BED and BN consume large amounts of food in one sitting, often in secret, with little to no control. Occasional overeating during special occasions, such as a celebration or party does not necessarily equate to having BED. To be diagnosed with BED, a person must have at least one bingeing episode every week for 3 months. Symptoms of BED are associated with three or more of the following (American Psychiatric Association, 2013): 

  1. Eating large amount of food over a short period of time
  2. Feeling that it is uncontrollable 
  3. Eating even when uncomfortably full
  4. Eating when alone because of being embarrassed by how much one is eating
  5. Feeling guilty or ashamed after eating.


BN  includes recurrent episodes of binge eating and inappropriate compensatory behaviours. BN is potentially life-threatening as individuals would use unhealthy methods such as over-exercising, fasting, or even self-induced vomiting to get rid of the calories they took in during their binge episode (MayoClinic, 2018). The purging behaviour emerges from desire to avoid weight gain despite engaging in binge eating (EatingDisorderHope, 2021). People who have bulimia also evaluate their self-worth based on their weight as well as their body shape. Symptoms of Bulimia Nervosa are associated with three or more of the following (American Psychiatric Association, 2013):

  1. Purging methods such as self-induced vomiting after eating
  2. Excessive exercise after eating
  3. Misuse of laxatives
  4. Diuretics 
  5. Unhealthy fasting

The severity of these disorders is classified by how frequent these behaviours occur (MayoClinic, 2018).


Developing Eating Disorders: Risk Factors

There are no exact causes for ED, it can stem from many different reasons. Recent studies have shown that several biological, psychological and social risk factors have resulted in individuals becoming more susceptible to developing ED (NEDA, 2018).

  • Biological factors
      • Close relatives with ED: Similar to other mental health conditions like anxiety and depression, food addiction is a behaviour that can also be picked up from family members. Hence, having a close relative with an eating disorder increases a person’s risk for developing an eating disorder. 
      • History of dieting and negative energy balance: Having lesser calorie intake than how much the body uses can lead to negative energy balance. Many people report that their disorder began with deliberate efforts to diet. Having a history of dieting and other weight controlling methods is also associated with the development of binge eating.
  • Psychological factors
      • Perfectionism: One of the strongest risk factors for an eating disorder is perfectionism, especially self-oriented perfectionism, which involves setting unrealistically high expectations of themselves. A perfectionist may not be happy with their body and take extreme measures in their diet to get their desired results. One common habit that develops is the yo-yo diet when the body goes through extreme weight changes. This dieting habit leads 35% of the dieters to disordered eating.
      • Body image dissatisfaction: Individuals who have body image dissatisfaction are more likely to be involved with extreme methods to reach their body goals. Similarly to perfectionism, a common habit that develops is the yo-yo diet where they go through an extreme dieting habit that brings their weight up and down.
  • Social factors
    • Stigma: Weight stigma could lead to discrimintion or even prejudice based on a person’s weight. Unhealthy body images perpetuates the idea that thinner people are better looking can drive one to engage in unhealthy eating habits that could potentially escalate to eating disorders due to frequent exposure to this stigma.
    • Social pressures: Bullying or even teasing about someone’s weight is one of the risk factors that can lead to eating disorders. Victims may feel ashamed because of the teasing which results in unhealthy eating patterns such as purging behaviours after eating.
    • Social Media: With the increase in social media usage, exposure to socially-defined “Ideal body type” can lead to negative upwards comparison that can hurt one’s own self-esteem. Frequent exposure to that information solidifies the impression towards the benchmark of beauty standards. Wanting to look just as good, or even better than others can drive people to engage in unhealthy eating habits. 


Health Risks

BED and BN  are behaviours that are considered to be unconventional and extremely unhealthy. If left untreated, it can take a toll on the body in the long run. Binge eating will lead to weight gain and other health risks such as obesity, high blood pressure, high cholesterol, cardiovascular diseases, and also Type II diabetes. The main source of energy for the body is carbohydrates and fats. Without sufficient carbohydrates and fats, protein will be broken down to generate energy for the body. In cases of BN , consuming fewer calories than what the body needs will mean that the body will be breaking itself down to fuel its own tissues. Some of the common health related issues that may arise are as follows: 

  1. Obesity: Overeating can lead to severe weight gain towards obesity.  Individuals with obesity have significantly higher chances of getting heart diseases, high blood pressure, diabetes, and high cholesterol (Watson. n.d.). These potentially fatal diseases can be prevented when the right help is determined and given early.
  2. Cardiac complications: The first protein group that will be broken down to fuel the body is the muscle group. In the muscle group, our heart plays an extremely important role to maintain strong heartbeat and blood pressure. If our heart muscles are weakened, the risk of cardiac problems would exponentially increase (NEDA, 2021). 
  3. Gastrointestinal system: Binge eating can cause the stomach to rupture from over expanding and malnutrition from purging can cause pancreatitis. Inadequate nutrition intake can also cause constipation when there is not enough nutrients in the intestines for the body to create waste products. On top of that, bowel movement will also become abnormal.
  4. Purging: Vomiting or use of laxatives depletes the body of electrolytes. Electrolytes also play an important role in general muscle contractions which includes maintaining regular heartbeat. An imbalance of electrolytes will lead to irregular heartbeat and even death (NEDA, 2021).
  5. Damage to esophagus: Our esophagus, the tube that carries food from mouth to stomach will also be damaged by the stomach acid from frequent purging. The damage to the esophagus will weaken in the long run, creating more risk of acid reflux which might lead to esophagus inflammation or even rupture, creating life-threatening problems (NEDA, 2021).



In psychotherapy/counselling, psychologists seek to help clients understand the root of the problem in a supportive, respectful and non-judgemental manner. It is a collaborative process in identifying the thoughts and factors that contribute to, and maintain the cycle of ED. Together they will formulate plans and interventions to help them break the cycle and achieve abstinence from these behaviours. Behavioural therapy aims to replace negative behaviours with positive ones, by working to promote healthy, positive choices and behaviours..

Hypnotherapy is a remarkably flexible intervention tool that facilitates various psychological treatments and therapies. It is used to induce an individual into a relaxed, yet focused state, where they become more receptive to different ways of looking at their experiences. This can be especially helpful for treatment-resistant disorders such as ED.

Group therapy aims to nurture intimate conversation and allows people to receive the support and encouragement of the other members of the group. These therapeutic sessions can unstring emotional isolation through interactions with people facing similar circumstances, relieve emotional pain by sharing their problems and provide emotional healing through peer support which is especially crucial for individuals overcoming ED.


How can you help?

It is not easy to watch someone you care about hurting themselves. If you notice your family or friends displaying  signs and symptoms of eating disorders, try to persuade them to seek professional help as soon as possible and show compassion by understanding the root cause of those behaviours. Here at Thrive Psychology Clinic, we are committed to providing effective and efficient support for every adolescent, child or adult in their mental health. If you believe that your child may be struggling, feel free to contact us via email: or call: 6962 9753 and we will be happy to assist you.



  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  • EatingDisorderHope (2021, October 15). What is bulimia: Symptoms, complications and causes. Eating Disorder Hope. Retrieved November 29, 2021, from
  • MayoClinic. (2018, May 10). Bulimia nervosa. Mayo Clinic. Retrieved November 29, 2021, from 
  • NCCS. (2020, January 14). Eating Disorders in Children and Adolescents. What are eating disorders? Retrieved November 29, 2021, from 
  • NEDA. (2018, August 3). Risk factors. National Eating Disorders Association. Retrieved December 1, 2021, from 
  • NEDA. (2018, February 21). New in the DSM-5: Binge eating disorder. National Eating Disorders Association. Retrieved December 1, 2021, from 
  • NEDA. (2018, February 22). Health consequences. National Eating Disorders Association. Retrieved December 4, 2021, from 
  • Watson, S. (n.d.). Serious health problems caused by binge eating disorder. WebMD. Retrieved December 10, 2021, from