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Anorexia and bulimia are two terms that get thrown around like they’re one and the same.
The lack of knowledge about these two eating disorders has led to many people being misdiagnosed, undiagnosed, or unaware of how unrealistic their perceptions of body image really are.
We want to help clear up the confusion, bringing to light what really distinguishes bulimia nervosa from anorexia nervosa, so that more people can get the effective, accurate treatment they deserve. Keep scrolling to learn the 4 key differences between these eating disorders.
What is Anorexia?
Anorexia nervosa is an eating disorder that arises from fear and/or anxiety around weight gain. People who develop the disorder often have a distorted perception of body image, and will adopt extreme diets leading to unhealthy and extreme weight loss.
Symptoms
People who have anorexia can develop serious physical side effects. These physical symptoms eventually lead to emotional issues. Like a never-ending loop, these emotional symptoms may cause sufferers to amp up their coping methods, causing physical symptoms to arise.
Physical
These symptoms include, but are not limited to:
Severe weight loss
Low tolerance/inability to tolerate cold temperatures
Weakness and exhaustion
Insomnia
Fainting
Dizziness
Dehydration
Constipation
Thinning or weak hair follicles
Bluish tinge on extremities
Dry, cracked yellowish skin
Amenorrhea (absence of menstruation) in women
Downy, soft hair on the body, arms, and face
Arrhythmia (Irregular heartbeat)
Emotional
The most common emotional symptoms are:
Anxiety
Low self-esteem
Intentional social isolation
Mood swings
Depression
Warning Signs
Anorexia is often hard to detect. Taking up a fad diet—although probably ineffective—is not uncommon in our image-centric culture. Having concerns about weight and/or appearance is also not uncommon. But if you or a loved one is showing any combination of the below warning signs, it may lead to anorexia nervosa.
Perceiving self to be obese when weight is at or below a healthy level
Ongoing preoccupation with body shape, weight and/or image
Extreme fear of weight gain
Changes in eating habits
Rigid thinking around food (e.g. it’s either good or bad)
Repeatedly avoiding meals
Suicidal, self-harm ideation
Restrictive eating, extreme dieting
Making an effort to hide eating habits from others
Unhealthy obsession with exercise/staying in shape
Sensitive to any comments around their lifestyle (e.g. exercise, clothing choices, appearance, eating habits)
Any of the above emotional or physical symptoms
What is Bulimia?
Bulimia Nervosa is an eating disorder characterised by routine sessions of binge eating concluding with self-induced periods of vomiting, purging, or extreme exercise. People who have the disorder have an obsessive preoccupation with body image, to the point where they base their self-worth on what they look like. This obsession causes them to get caught up in unhealthy cycles of binge eating, followed by feelings of regret around their food consumption, leading to the purging phase. Each activity influences the other, making it difficult for sufferers to break their habits.
Symptoms
People who have bulimia are constantly putting their body and mind through intense periods of stress. A feedback loop of extreme eating influencing unhealthy dieting techniques. It’s no wonder why so many suffer physically as well as emotionally.
Physical
These symptoms include, but are not limited to:
Significant weight fluctuations from week to week (anywhere between 2 to 10 kilograms higher or lower)
Cracked, dry lips due to dehydration
Mouth sensitivity
Sores or scars on knuckles (due to self-induced vomiting)
Bloodshot eyes
Swollen lymph nodes
Bad breath
Emotional
The most common emotional symptoms are:
Anxiety
Low self-esteem
Intentional social isolation
Mood swings
Depression
Warning Signs
Similar to anorexia nervosa, bulimia nervosa also shares warning signs with many other disorders and diseases, it can often go undiagnosed, or misdiagnosed by doctors.
Making an effort to hide eating habits from others for fear of disapproval
Emotional outbursts
Sensitive to any comments about their lifestyle or appearance
Guilt or self-disgust
Repeat trips to the bathroom, especially after a meal
Repeatedly avoiding meals for fear of weight gain, or dreading the idea of purging a meal again
Loneliness
Suicidal, self-harm ideation
Any of the above emotional or physical symptoms
The 4 Key Differences Between Anorexia & Bulimia
While there may be some overlap between anorexia and bulimia, upon closer look the two eating disorders have different symptom profiles, treatment methods, and more.
1. Symptom Profile
Body Weight
People with anorexia are typically very underweight because of how little they eat daily. Comparing this to people with bulimia who are typically of average weight or overweight.
Why do both disorders show so differently? Those with bulimia are constantly engaging in cycles of restriction, binge eating, and purging. While their weight may drop significantly week on week, their binge eating habits counteract the effects of restriction/purging. This is why bulimia is often so hard to detect.
Body Image
This issue of body image also shows differently in both eating disorders. Those with anorexia have a more distorted perception of themselves coupled with an extreme fear of weight gain. They look in the mirror and see someone who is overweight and they can’t unsee this image. In reality, that person is underweight.
Those who have bulimia usually have a more “realistic” view of their body shape. But they base their entire self-worth on body image and appearance. This eventually leads to feelings of regret and shame as they try to diet their way to an impossible ideal of what they should look like.
Other Physical Symptoms
Other symptoms that occur more in those with anorexia include: loss of period, infertility, organ failure, low energy, constipation, and muscle weakness.
Likewise, those with bulimia experience more dental erosion, bad breath, acid reflux, puffy face, dehydration, electrolyte imbalance, and swollen neck due to self-induced vomiting.
2. Treatment Options
Treatment options for both eating disorders also vary. The fact that different treatments work better for anorexia over bulimia (and vice versa) strongly suggests that the two disorders are driven by different processes.
The best available treatments for anorexia are:
Family-based therapy
Specialist supportive clinical counselling
Cognitive remediation therapy
The best available treatments for bulimia are:
3. Treatment Intensity
People with anorexia are much more likely to undergo intense treatment (e.g. inpatient or day-patient hospital programs). Bulimia is usually treated face-to-face, at outpatient care centres. This is not to say that people with bulimia don’t undergo intense treatment options, however.
4. Success Rates
Out of the options currently available, treatments are more effective for bulimia than they are for anorexia. Approximately 40% of those with bulimia make a full recovery as opposed to 30% of people with anorexia.
Prevalence Rate
Bulimia is more common, affecting 1.2 – 1.5% of the total population, while anorexia affects 0.5% of the total population. This difference in prevalence rate suggests that bulimia treatments are more effective simply because we have much more extensive research on different types of psychological treatments for bulimia.
Natural Course
Once diagnosed, the path to recovery is also different.
In bulimia, people can often spontaneously recover from the condition. This is very rare in anorexia since the condition requires such a massive shift in body image perspective.
People with bulimia can switch to a binge-eating disorder diagnosis, whereas this is very rare in anorexia. Instead, patients are more likely to switch to a bulimia nervosa diagnosis, as they try to reconcile habits of restriction with eating more.
Similarities Between Anorexia & Bulimia
Underlying causes
Both eating disorders arise from numerous psychological and social causes, such as:
Dieting
Body image problems
Depression and anxiety
Perfectionism
Interpersonal problems
Obsessive-compulsive traits
Parental influences
Childhood overweight
Thin ideal internalization
Social media usage
Recent studies have shown that someone could have a genetic predisposition to develop an eating disorder. If a family member has an eating disorder, you could be at more risk of developing one yourself. It’s worth noting that research in this space is ongoing and more studies need to be done to confirm the validity of these claims.
Age of Onset
Both Anorexia nervosa and Bulimia Nervosa emerge at a similar age, roughly between ages 12-18. It can’t be ignored that this age range is a significant time of development in an adolescent’s life. The influence of peers, social media trends, and more could play part in how these disorders develop.
Psychological Consequences
Both Anorexia nervosa and Bulimia Nervosa appear to have similar psychological consequences that greatly affect the person’s life. They include:
Disrupted education and occupational commitments
Mood disturbances
Low self-esteem
Relationship breakdowns
Sexual dysfunction
Substance use and abuse
Irritability
Personality changes
Anorexia NervosaSimilaritiesBulimia Nervosa– Typically underweight
– Distorted perception of self
– Extreme fear of weight gain
– Less common
– Patients are more likely to develop another eating disorder on the path of recovery.– Underlying causes (such as dieting, depression, interpersonal problems)
– Ages of onset (around ages 12-18)
– Psychological consequences (such as low-esteem, mood disturbances, substance use)– Typically average or overweight
– More “realistic” view of self
– Extreme shame due to not having a certain body appearance
– More common
Patients can spontaneously recover
Diagnostic Criteria
For reference, the exact diagnostic criteria as put forth by the Diagnostic & Statistical Manual for Mental Disorders (5th edition) is below.
Bulimia Nervosa
Recurrent episodes of binge eating, which are characterised by both of the following:
Eating, in a discrete period of time (2-hour period), an amount of food that is larger than most people would eat during a similar period of time and under similar circumstances.
A sense of loss of control over eating during this episode, i.e., a feeling that one cannot stop eating or control how much or what one is eating.
Recurrent inappropriate compensatory behaviours in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, fasting, or compulsive exercise.
These behaviours both occur, on average, at least once a week for three months.
Regarding weight and shape as central to one’s self-worth
The disturbance does not occur exclusively during episodes of anorexia nervosa.
Anorexia Nervosa
Persistent restriction of energy intake leading to significantly low body weight (in the context of what is minimally expected for age, sex, developmental trajectory, and physical health).
Either an intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain (even though at a significantly low weight).
Disturbance in the way one’s body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Understand The Difference Between Bulimia and Anorexia
Both bulimia and anorexia are serious eating disorders that can take over someone’s life, leaving life-threatening physical and emotional damage in their wake.
While there are some similarities between both, knowing the 4 key differences above can help you or a loved one get the most effective treatment, increasing the likelihood of recovery.
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Looking for more help with an eating disorder? Check out the below:
Binge-eating Disorder VS Bulimia Nervosa: 7 Key Differences You Need To Know
Signs and Symptoms of Anorexia Nervosa
Types of Eating Disorders
