Anorexia Vs. Bulimia: What Are The Differences?
Content Warning: If you are experiencing a crisis related to an eating disorder or would like further resources, contact the ANAD Eating Disorders Helpline at 1-888-375-7767 from Monday to Friday, from 9 am to 9 pm CT. Please see our Get Help Now page for more immediate resources.
Anorexia and bulimia may be used in social conversation without understanding their meaning. Some people might be confused about the differences between these two disorders or have misconceptions based on myths they've seen in the media. Although anorexia and bulimia can overlap in symptoms, they are distinct conditions with unique manifestations. Consider learning more about both conditions to reduce the chances of unhelpful symptoms.
Understanding eating disorders
Anorexia and bulimia are both eating disorders listed in the DSM-5, the current diagnostic manual by the American Psychological Association (APA). Each can affect an individual's eating habits in unique ways, and both are serious conditions that can have potentially dangerous symptoms. Eating disorders often involve mental and physical health concerns. While a doctor may help with the physical effects or hospitalization, a therapist might be called to support an eating disorder's psychological aspects.
Though many associate eating disorders with people of a specific age or gender, anorexia, bulimia, and other eating disorders can affect anyone of any gender or age. Though these conditions may be more common in teens and young adults, someone can develop or be diagnosed with an eating disorder at any point. In addition, once an eating disorder occurs, it could return at any point in the individual's life.
It can also be common for an eating disorder to occur alongside another mental illness, like an anxiety disorder, substance use disorder, or depressive disorder. One resource found that 50% to 75% of people with an eating disorder also live with depression. However, outside of this connection, other factors may also impact the development of an eating disorder. Genetics, a dysfunctional family dynamic, pressure to maintain a certain body weight or shape, past trauma, peer pressure, and media exposure can also cause eating disorders.
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.
Signs of an eating disorder
Visible signs of an eating disorder may include visible weight changes for some people. Whether those weight changes are an increase or a decrease in weight, they may be associated with health risks. In addition, continuous dieting, counting calories and fat content, and weight tracking could be signs of an eating disorder.
Someone who eats ritualistically by cutting their food into tiny bites, eating by themselves, or hiding the food they eat, may be showing signs of an eating disorder. Some people cook elaborate or expansive meals for others but won't eat them themselves. Consider seeking support if you notice these behaviors in yourself or someone else.
Other potential signs of an eating disorder could include the following:
- Periods of fasting
- Periods of overeating or binge eating
- Fluctuations in weight
- Depression
- Lethargy
- Withdrawal from social situations
- Wearing loose and baggy clothing
- Hiding body parts
- Expressing shame about one's body
- Asking for reassurance about one's loss of weight
Note that someone may exhibit a mixture of these symptoms or experience other symptoms entirely. Consult a doctor or mental health professional if you or someone you love might be living with an eating disorder.
Anorexia vs. bulimia
Below are a few differences between anorexia and bulimia and their symptoms and impacts.
What is anorexia?
Anorexia nervosa is often one of the most well-known eating disorders in the public eye. However, the condition involves more than "being thin" or dieting. Those with anorexia nervosa severely limit their food consumption to lose weight. These individuals might believe they are overweight or unattractive, including when they are underweight. They might use dieting, exercise, and other means to reduce their need to eat.
People with anorexia may develop an obsession with their body or ritual to cope with a fear of gaining weight. As a result, they may partake in any possible activity they believe will stop them from gaining weight. Someone with anorexia can become dangerously underweight and may experience brain damage, organ failure, bone loss, infertility, heart problems, and death.
Note that anorexia can present in unique ways, and many people with this condition may partake in food-restrictive behaviors but not lose weight or initially show signs of a medical emergency. Looking at someone's weight may not be the first symptom used in diagnosis, as the mindset behind the condition can be more telling.
What is bulimia?
Bulimia nervosa is like anorexia because it can involve an obsession with weight and a desire to lose weight to achieve a specific body size. However, with bulimia, there are periods of binging and purging, which means that the person may go through a period where they eat excessive food and purge by using exercise, medications, or vomiting to expel the food from their body.
People with bulimia may keep these behaviors a secret, binging and purging when they believe it will not be noticed. This behavior can increase their guilt and shame about the disorder and their actions. Because of excessive binging and purging, these individuals can be any weight, like those with anorexia. For this reason, other symptoms might be considered first.
For those with bulimia, health problems can also occur, including gastrointestinal distress (due to forced vomiting or self-medication), heart problems, and dehydration.
How to receive support for an eating disorder
No matter the eating disorder you or a loved one may be living with, reaching out for support can be essential to reduce the risk of serious symptoms. Even someone who has only recently started purging or skipping meals could be damaging their body, and getting help quickly could offer prevention to these risks. Early on, damage may be reversible, but eating disorders may cause irreversible harm as they progress.
Several forms of treatment may benefit those with an eating disorder, including but not limited to the following:
- Inpatient eating disorder rehabilitation
- Inpatient hospitalization
- Outpatient eating disorder clinics
- An eating disorder support group, online or in person
- A therapist specializing in eating disorders
- Nutritionists with experience working with eating disorders
Alternative support options
A physician or your family doctor can start treatment for physical symptoms or impacts of an eating disorder. However, a therapist may offer the most effective support for the underlying psychological concerns. If you're nervous about seeking in-person guidance or want cost-effective eating disorder treatment, alternative forms of therapy like online counseling through a platform like BetterHelp may be beneficial.
Online therapy can have unique benefits compared to in-person options. You can connect with someone from wherever you are and whenever you need them, which might reduce embarrassment or shame for some individuals. Research indicates that people with anorexia and bulimia are more likely to have other mental health conditions like anxiety, depression, and mood disorders.
Studies show that online therapy can lead to a 50% improvement in symptoms of generalized anxiety disorder, depression, and other mental health conditions. Although more research is needed, some studies show that online therapy can effectively treat bulimia.
Takeaway
Why is it harder to diagnose bulimia than anorexia?
While bulimia and anorexia are both associated with an intense fear of gaining weight, only anorexia is known to cause extreme weight loss. Those with bulimia typically engage in periods of binge eating and then use compensatory behaviors like vomiting or abusing laxatives to purge the excess calories from their bodies. The similar psychological symptoms of bulimia and anorexia likely make it harder to distinguish them using standardized tools like a mental health questionnaire.
Those with anorexia tend to restrict their calorie intake severely, although they can also engage in binge/purging behaviors. In practice, those with bulimia can maintain at least a normal body weight, while anorexia always results in a lower-than-average body weight.
Those with anorexia do not receive enough calories to survive. The consequence of this is that a person with anorexia is often severely underweight, while those with bulimia tend to have a normal body weight. The malnourished state of someone with anorexia is highly noticeable, making the condition harder to hide. Bulimia is often easier to hide due to a normal body mass and eating behaviors that seem normal around others.
What is the key similarity between people with anorexia and people with bulimia nervosa?
Both people with anorexia and bulimia experience a preoccupation with food intake, body weight, weight loss, and body shape. Each condition causes a person to engage in behaviors that prevent weight gain. While the symptoms of each condition are unique and presentations are different, a diagnosis of either condition requires that the person being diagnosed is engaging in disordered eating to avoid gaining weight. Treatment options are also similar; the first-line pharmacological treatment for eating disorders is typically antidepressants, and psychotherapies like family therapy and cognitive behavioral therapy are used for both anorexia and bulimia.
How would you briefly differentiate between anorexia nervosa and bulimia nervosa?
The key difference between anorexia nervosa and bulimia nervosa is the ability to maintain body mass. Anorexia is a syndrome of self-starvation, meaning those with the condition commonly engage in extreme dieting and try to keep their calorie intake as low as they can. On the other hand, those with bulimia tend to engage in binge-purge cycles, wherein they consume a large amount of food and follow the consumption with purging behaviors, like vomiting or using laxatives to reduce calorie absorption.
It is also possible for someone with anorexia to engage in food binges, but they likely do not occur at the same frequency as the binges characteristic of bulimia. A person experiencing bulimia is usually unable to purge all the calories they consume. Because of this, they are typically at a normal or above-average body weight. In contrast, a person with anorexia is to be significantly underweight - at least 15% below average - and may appear noticeably deprived of nutrition.
How prevalent is anorexia vs bulimia?
The prevalence of anorexia and bulimia has been a topic of scientific research for decades. It is often difficult to get a clear picture of how common the diagnoses are, but recent evidence suggests that the lifetime prevalence of anorexia ranges from 0.1% to 3.6% in females and 0% to 0.3% in males. For bulimia, research suggests a lifetime prevalence of 0.3% to 4.6% in females and 0.1% to 1.3% in males.
Can anorexia and bulimia nervosa both involve body dysmorphia?
Body dysmorphia can occur alongside eating disorders like anorexia and bulimia. However, it is important to distinguish between the symptoms of eating disorders and body dysmorphic disorder (BDD). Both people with eating disorders and BDD experience an extensive preoccupation with their appearance, but those with eating disorders experience concerns related to body weight, while those with BDD can experience dysmorphia unrelated to gaining weight.
There is considerable overlap between the symptoms of BDD, anorexia, and bulimia. Each condition requires that the person have a distorted body image, meaning they do not perceive their body shape accurately. It is possible to have a diagnosis of BDD and an eating disorder simultaneously. In addition, both BDD and eating disorders are associated with other mental health concerns, like low self-esteem and depression.
Who is more likely to suffer from anorexia nervosa and bulimia nervosa?
Women and girls are most likely to be diagnosed with an eating disorder. There is a significant gender disparity in the diagnosis of eating disorders; girls are three times as likely to be diagnosed with an eating disorder. The LGBTQIA+ community is also at risk, especially transgender individuals. In addition, gay and bisexual boys represent nearly half of all eating disorders diagnosed in males.
Finally, victims of bullying are likely at a higher risk of developing eating disorders, likely due to persistent attacks on their appearance and self-esteem. Of all those diagnosed with an eating disorder, 60% cite bullying as one of the reasons that their condition developed.
Can a person who suffers from anorexia nervosa also be diagnosed with bulimia at the same time?
Anorexia and bulimia are rarely, if ever, diagnosed together. However, some marked similarities may lead to confusion. The Diagnostic and Statistical Manual of Mental Disorders splits anorexia into two subtypes: restricting and binge-eating/purging. The restricting subtype is more commonly known and is characterized by an individual restricting food intake or avoiding eating as much as possible. The binge/purge subtype has similar symptoms to bulimia; individuals may engage in binge eating and then use inappropriate compensatory behaviors, like self-induced vomiting, excessive exercise, or diet pills to account for the calories consumed while binging.
The main difference between anorexia’s binge/purge subtype and bulimia is whether the individual can maintain a normal body weight. A diagnosis of anorexia requires a person to be significantly underweight, while a person with bulimia might be a normal or above-average weight. While the symptoms of anorexia’s restrictive subtype are easy to distinguish from bulimia, the difference between the binge/purge subtype and bulimia comes down to body weight alone.
A person diagnosed with anorexia may move between the restrictive and binge/purge subtypes over the course of their illness. Despite the change in symptom presentation, the diagnosis does not switch to bulimia when binges occur. Generally speaking, a person who has a previous history of restrictive anorexia or who has been consistently underweight will receive a diagnosis of the binge/purge subtype rather than bulimia.
Is bulimia more culturally influenced than anorexia?
Cultural factors influence both bulimia and anorexia. Societal expectations communicated by the media regarding beauty, aesthetics, body shape, and attractiveness are likely the most prominent cultural forces influencing the development of eating disorders. The cultural factors influencing appearance are likely targeted more toward women than men, which is the most-cited reason why a significant gender disparity exists in the prevalence of eating disorders.
While cultural standards of beauty are likely the main driving force behind the development of eating disorders, there are minor factors that may be relevant. For example, bulimia requires substantial food supplies, and it may be that bulimia is more likely to occur in cultures that do not have strong values related to food scarcity.
What characteristics are shared by individuals with anorexia nervosa and individuals with bulimia nervosa?
Both anorexia nervosa and bulimia nervosa are characterized by an intense preoccupation with body shape, weight gain, and food. There is also some confusion on what differentiates the two conditions due to similar symptoms between bulimia and the binge-eating/purging subtype of anorexia. Many people are familiar with anorexia’s restrictive subtype, characterized by avoiding eating and limiting calorie intake to the lowest possible level. Fewer people may be familiar with the binge/purge subtype.
Both people with bulimia and the binge/purge subtype of anorexia engage in episodes of binge eating - consuming an excessive number of calories - followed by recurrent inappropriate compensatory behaviors, such as vomiting or abusing laxatives. The key difference between the two conditions is whether the person can maintain their body weight; those with bulimia may have an average or above-average body weight, while those with anorexia will always be underweight.
- Previous Article
- Next Article