What Is the Difference Between Anorexia and Bulimia?

Generally, eating disorders are behavioral conditions characterized by a severe and persistent disturbance in eating behaviors, often which are associated with negative thoughts or mental illness. There are several different kinds of eating disorders, two of which are bulimia and anorexia. When comparing bulimia vs anorexia, many people tend to group them into one category because their symptoms are similar. However, understanding their differences is crucial to recognizing their symptoms and getting treatment. Today, we’re answering the common question: “what is the difference between anorexia and bulimia?” so you can better understand the signs and symptoms of each.

What’s the Difference Between Anorexia and Bulimia?

Let’s jump right into it. Anorexia nervosa is an eating disorder that causes people to obsess about their weight and what they eat. Anorexia is identified by a distorted body image and an extreme, unwarranted fear of being overweight or gaining weight. People with anorexia may try to maintain a below-normal weight by starving themselves or over-exercising.

Bulimia nervosa is also an eating disorder, but it’s characterized by bingeing, followed by drastic methods to lose weight or avoid weight gain. People with this condition tend to binge eat, hence the name. They may purge (vomit), over-exercise, or fast to lose weight or maintain an unhealthily low weight.

If you compare anorexia and bulimia from the surface, they may seem pretty similar. However, there are some key differences between the two that play huge roles in diagnosing and treating them.

The difference between anorexia nervosa and bulimia nervosa is that people with anorexia may adopt extreme diets or restrict their food intake to lose weight, while people with bulimia binge eat and then purge to lose weight and avoid weight gain. Bulimia episodes may involve eating excessive amounts of food in a short period and then purging or vomiting, using laxatives, or administering enemas to get rid of those calories.

It’s also important to note that while eating disorders are more common in women, they can occur in anyone. In the United States alone, 9% of the population, or 28.8 million people, will develop an eating disorder in their lifetime.

Without treatment, these disorders can become fatal. If you or someone you know has anorexia or bulimia, Banyan Treatment Centers offers eating disorder treatment in Philadelphia that provides the support you need to recover.

Differences in Symptoms

When comparing bulimia nervosa vs anorexia nervosa, you’ll also find that their symptoms are slightly different. The most common symptoms of anorexia are restricting food intake and extreme dieting. The main symptom of bulimia is purging the food or vomiting after binge episodes or excessive eating.

While some other symptoms and behaviors of these conditions may be done privately, the symptoms of both anorexia and bulimia are more likely to be apparent to others. Below are the differences between signs and symptoms of anorexia and bulimia and what you should look out for.

Anorexia Symptoms

The symptoms of anorexia range include behavioral, emotional, and physical changes that may become more apparent the longer the individual goes without anorexia treatment. These signs may become more obvious to loved ones over time.

Some signs of anorexia include:

Talking about weight or food often
Not eating or eating very little
Refusing to eat in front of other people
Wearing baggy clothes to hide their body
Isolating from loved ones
Depression
Suicidal thoughts
Thin, brittle, or dry hair
Feeling faint, dizzy, or weak
Swollen joints
Growth of fine hair all over the body
Constipation
Bloating
Stopped or irregular menstrual cycles

Anorexia has the highest mortality rate of any other mental illness. In fact, anorexia’s mortality rate is 12 times higher than the death rate of all causes of death in females aged 15 to 24 years old.2 While many people with anorexia nervosa die from health complications caused by starvation, others die by suicide.

Bulimia Symptoms:

Symptoms of bulimia vary from person to person, depending on the frequency and severity of purging. Repetitive vomiting causes stomach acids to constantly come up into the throat and mouth. This can wear down tooth enamel, increase the likelihood of tooth decay, as well as it can create throat problems.

People with bulimia nervosa may also utilize laxatives to lose weight. Over time, repeated use can lead to chronic gastrointestinal problems.

However, it’s also important to note that not all people with bulimia purge after binge eating, a disorder known as non-purging bulimia. People with this condition may use other means, such as diet pills, stimulants, fasting, skipping meals, and excessive exercise to lose weight.

Some common signs of bulimia include:

- Swelling in the cheeks or jaw
- Broken blood vessels in the eyes (this gives a bloodshot-eye appearance)
- Acid reflux
- Constipation
- Severe dehydration
- Extreme concern or obsession about body weight
- Often going to the bathroom right after eating
- Excessively exercising
- Mood swings
- Poor body image
- Decreased interest in activities they once enjoyed

Differences in Diagnosis

Another main difference between anorexia and bulimia is their criteria for diagnosis. If your doctor suspects that you have an eating disorder, they’ll run several tests and look out for particular symptoms.

In addition to running lab tests to rule out any other possible causes for weight loss, they may also ask you to fill out a mental health questionnaire. In diagnosing an eating disorder, your doctor will also utilize the criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association.

Below are the individual criteria for diagnosing anorexia nervosa and bulimia nervosa.

Anorexia

- - Restriction of food or energy intake, causing significantly low body weight relative to age, sex, development, and physical health
  - Intense fear of gaining weight or becoming overweight, even if they’re underweight
  - Disturbance in the way the person perceives their own body shape or weight, undue influence of body weight or shape on self-evaluation, or denial about the seriousness of their current low body weight
  - Even if all of these criteria are not met, you may still be diagnosed with an eating disorder. Atypical anorexia is a similar condition in which the person meets the criteria for anorexia but isn’t underweight despite extreme weight loss.

Bulimia

- - Recurrent episodes of binge eating (characterized by eating an abnormally large amount of food within any two-hour period) and feeling that you can’t stop eating or control what or how much you’re eating
  - Recurrent inappropriate compensatory behaviors to prevent weight gain or to lose weight, such as self-induced vomiting (purging); misusing laxatives, diuretics, diet pills, or any other medications; fasting; or excessive exercising
  - The occurrence of binge eating followed by inappropriate compensatory behaviors at least once a week for three months
  - Influence of body weight and shape on self-evaluation

What Are The Side Effects Of Bulimia?

Bulimia can lead to numerous health complications depending on the purging behaviors employed. Some of the most frequently reported side effects include:

- Persistent sore throat

- Swelling of the salivary glands around the neck and jaw

- Erosion of dental enamel leading to cavities

- Various stomach issues such as acid reflux

- Severe dehydration

- Electrolyte imbalances, which can be dangerous and potentially lead to serious cardiovascular complications like heart attacks or strokes.

These side effects can develop gradually and become more severe as the eating disorder progresses.

What Are The Side Effects Of Anorexia?

The side effects associated with anorexia are extensive, affecting various bodily systems:

- Extreme weight loss

- Decreased bone density, leading to fragile bones

- Dull, fragile hair and nails

- Dry, sometimes yellowish skin

- A soft down of fine hair covering the body

- Digestive issues such as constipation

- An abnormally low body temperature

- Fatigue and a lack of energy

- Irregularities in menstrual cycles

- A reduction in breathing rate

- Cardiovascular problems, including lowered blood pressure and heart rate

- Potential brain damage

- Risk of failure in multiple organs

The longer anorexia persists, the more severe and numerous these health complications can become.

How Do Anorexia And Bulimia Affect A Person's Relationship With Food?

Anorexia and bulimia significantly alter an individual's interaction with food, each in distinct ways. In the case of anorexia, an individual exerts a high degree of control over their eating habits. This often involves extremely precise decisions about the type, quantity, and timing of food intake. Such control can evolve into rigid routines and rituals surrounding meals, reflecting a dominating need for order and control over their dietary environment.

Conversely, bulimia is characterized by a tumultuous loss of control. Individuals suffering from bulimia often experience uncontrollable binge eating episodes, where excessive amounts of food are consumed in a short period. These episodes are typically followed by intense feelings of shame and guilt, prompting behaviors to compensate for overeating, such as self-induced vomiting. This pattern creates a cycle of bingeing and purging, driven by an inability to control intake and a subsequent compulsion to mitigate the overindulgence.

What Is The Average Age Of Onset For Anorexia And Bulimia?

The average age at which both anorexia and bulimia typically begin is 18 years old. Generally, the onset of anorexia occurs around late adolescence or early adulthood, as indicated by the National Institute on Mental Health. Bulimia also shares this average onset age, with symptoms commonly emerging in the late teens to early twenties.

What Are The Prevalence Rates Of Anorexia And Bulimia In Young Females?

The prevalence rates of eating disorders among young females, as indicated in the DSM-5, show that approximately 0.4% of this group is diagnosed with anorexia annually. For bulimia, the rate is slightly higher, with between 1% and 1.5% of young females meeting the criteria for this condition each year.

What Are The Potential Causes And Risk Factors For Bulimia?

The origins of bulimia are not entirely understood, but it is believed to be influenced by a variety of risk factors. These factors encompass both psychological and social aspects, such as experiencing anxiety from a young age, including social pressures, and depression. Individuals with low self-esteem may also be more susceptible to developing bulimia, particularly those who focus intensively on their body image from an early period in their lives. Experiences of childhood abuse or a family history of bulimia can further elevate the risk. Additionally, societal pressures and personal beliefs that idealize thinness play a significant role. Physical factors like childhood obesity or early onset of puberty are also considered relevant risk factors in the development of bulimia.

What Is The Prognosis For Individuals With Anorexia And Bulimia?

The prognosis for individuals diagnosed with anorexia can vary. Some individuals may experience the disorder only once and recover completely with appropriate treatment. However, others might encounter recurrent episodes and find it more difficult to respond to treatment, experiencing numerous relapses. Generally, the DSM-5 notes that a majority of those afflicted with anorexia tend to reach full remission approximately five years after the initial onset of symptoms. Prognosis tends to be less favorable in older adults, who often display more severe symptoms and suffer from the disorder for a longer duration compared to younger individuals.

In the case of bulimia, the disorder typically emerges during times of significant stress and can persist for many years. Symptoms may gradually lessen over time, even without intervention. However, individuals who undergo professional treatment often see a faster improvement and are likely to experience longer periods free from binge-eating and purging behaviors. Undergoing treatment is therefore recommended to enhance the likelihood of recovery and maintain long-term health.

What Are The Differences In Treatment Approaches For Anorexia And Bulimia?

The treatment approaches for anorexia and bulimia have different focal points and methodologies. For anorexia, the Maudsley approach, which encompasses family-based therapy, is particularly effective for adolescents. This method actively involves the family, especially the parents, in managing and supervising the dietary habits of their child to facilitate weight gain and healthier eating patterns. This is often supported by pharmacological treatments such as antidepressants, mood stabilizers, or antipsychotics which can help in reducing the symptoms more rapidly.

In contrast, the primary treatment for bulimia is cognitive behavioral therapy (CBT). This technique addresses the psychological aspects of the eating disorder by concentrating on the identification and modification of distorted thinking patterns that negatively impact emotions and behaviors. CBT aims to change these maladaptive thoughts to more realistic and beneficial ones, thereby helping to decrease and eventually cease the cycles of binge eating and purging. Similar to anorexia, medication such as antidepressants may also be used to support the treatment process by stabilizing mood or alleviating associated psychological issues.

Overall, while both disorders may utilize similar medications, the psychotherapeutic strategies differ significantly, with anorexia using a family-centric approach and bulimia employing cognitive behavioral interventions.

What Are Some Effective Treatment Methods For Anorexia And Bulimia?

Effective treatment strategies for anorexia often include the Maudsley approach, especially suitable for adolescents. This method actively involves the patient's family in their treatment process, where family members play a critical role in overseeing the improvement of the patient's dietary habits and ensuring weight gain. This therapy is sometimes augmented with various medications, such as antidepressants, mood stabilizers, or antipsychotics, which can help in reducing the symptoms more swiftly.

For bulimia, a distinct treatment modality called Cognitive Behavioral Therapy (CBT) is commonly used. CBT focuses on understanding and changing the harmful thought patterns that influence emotions and behaviors negatively. By identifying and correcting these distorted thoughts, patients can develop healthier beliefs and behaviors that aid in diminishing, and ultimately stopping, binge and purge cycles. Similar medications used for anorexia may also be prescribed for bulimia, supporting the treatment process.

Eating Disorder Support

While there are similarities between anorexia nervosa and bulimia nervosa, they usually present themselves in different ways. Regardless, both conditions are serious and should be treated as soon as possible.

Finding anorexia and bulimia nervosa treatment can save your life. If you or someone you know has anorexia, bulimia, or other similar conditions, Banyan Treatment Centers Philadelphia offers eating disorder programs that can help.

In addition to eating disorder support, we also offer Philadelphia drug treatment to help those who have become addicted to drugs or alcohol. Addiction often co-occurs with eating disorders as a result of stimulant abuse to lose weight.

To learn more about our services, contact our drug rehab in Philly today at 888-280-4763.

Related Reading:
Treating Stimulant Addiction
Eating for Sobriety – What to Eat in Recovery

Sources:

Alyssa, Director of Digital Marketing

Alyssa is the National Director of Digital Marketing and is responsible for a multitude of integrated campaigns and events in the behavioral health and addictions field. All articles have been written by Alyssa and medically reviewed by our Chief Medical Officer, Dr. Darrin Mangiacarne.