Anorexia vs Bulimia: Similarities, Differences & Treatment

Approximately 9% of the US population, or 28 million Americans, will have an eating disorder in their lifetime. These disorders are directly responsible for over 10,000 deaths each year. But eating disorders are treatable in most people. Please continue reading to learn more about the similarities and differences between two types of eating disorders - anorexia and bulimia, how they are diagnosed, and treatment options for these serious medical conditions.

What is an eating disorder?

An eating disorder is a mental health condition in which there is a preoccupation with food, eating, and body weight and shape. This preoccupation results in severe and persistent changes in eating behaviors, leading to mental and physical symptoms.

There are different types of eating disorders, but they all involve changes in how a person thinks about their weight and body shape and their relationship with food and eating, leading to dangerous eating behaviors.

Anyone can develop an eating disorder, but they are more common in adolescents and young adults and twice as common in females compared to males.

Without treatment, eating disorders can lead to serious health complications and even death. With medical care, it is possible to relearn healthy eating behaviors and reverse some of the damage caused to overall health by eating disorders.

The key characteristics of common types of eating disorders are described below.

Anorexia

Also called anorexia nervosa, this is an eating disorder in which there is an unrealistic view of body weight and shape. This is typically accompanied by an unhealthy low body weight with a body mass index (BMI) below 18.5. Another distinguishing characteristic of anorexia nervosa is an intense fear of weight gain.

People who develop anorexia tend to severely limit food intake and avoid certain high-calorie food groups altogether, instead sticking to “safe” low-calorie foods. They may attempt to lose weight through excessive exercise, self-induced vomiting, use of diet aids and laxatives, and other methods. The intense efforts to lose weight can result in serious health problems, even if the person’s weight is not dangerously low.

Signs and symptoms in people with anorexia may include:

Irregular or absent menstrual periods
Dizziness due to dehydration
Muscle weakness and muscle wasting
Acid reflux (from vomiting)
Severe constipation
Bloating or fullness after meals
Hair loss and brittle nails
Stress fractures
Depression, anxiety, irritability, low self-esteem

Bulimia

Also called bulimia nervosa, this eating disorder is characterized by uncontrolled episodes of binge eating followed by forced purging. Binge eating involves consuming large amounts of food, often calorie-dense foods, in a short period of time. This is followed by feelings of intense shame and guilt, leading to purging through self-induced vomiting, excessive exercising, use of laxatives, or changes in the doses of medicines (for example, insulin prescribed for diabetes) in an effort to get rid of calories. Some people with bulimia nervosa will go through periods of self-starvation, followed by more intense urges to binge and purge.

Signs and symptoms in people with bulimia nervosa may include:

Large amounts of food inexplicably missing or unexplained empty food containers in the trash
Using the bathroom immediately after meals
Misusing laxatives, diet pills, or water pills (diuretics)
Swollen lymph nodes and/or salivary glands
Recurrent diarrhea
Heartburn and gastroesophageal reflux disease
Chronic sore throat due to acid reflux
Tooth decay due to enamel erosion from refluxed stomach acid
Dizziness due to dehydration

Binge Eating

This is an eating disorder with binge eating. Unlike bulimia, it is not followed by purging. People with binge eating disorder will eat large amounts of food, often more than planned, even if they are not hungry and past the point of being uncomfortably full.

What are the similarities between anorexia and bulimia?

Both anorexia and bulimia are eating disorders in which there is a preoccupation with weight and body shape, an unrealistic view of what constitutes an appropriate body weight and shape, low self-esteem, and harsh self-judgment about personal appearance.

Bulimia and anorexia may have some similar symptoms. For example, a person with anorexia may have intermittent periods of binge eating and purging, and a person with bulimia may have periods of compensatory fasting and excessive exercise.

Additionally, some of the physical symptoms can be similar, such as gastrointestinal problems, weight fluctuations, dizziness, sleep difficulties, mood changes, and missing menstrual periods.

Anorexia and bulimia also have similar causes and risk factors, including a genetic predisposition (for example, a first-degree family member with an eating disorder), other mental health issues, a history of weight shaming or bullying, and stress.

What is a major difference between anorexia and bulimia?

The major difference between anorexia and bulimia is that people with anorexia severely restrict their food intake to prevent weight gain, whereas those who have bulimia eat excessively and then purge to prevent weight gain.

How do doctors diagnose anorexia and bulimia?

The exact diagnostic criteria for eating disorders is described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). If a doctor suspects an eating disorder, they will perform a physical exam to rule out other causes of the symptoms, order lab tests to diagnose complications related to the eating disorder, and refer to a mental health professional for an evaluation to assess eating behaviors, relationship with food, and self-worth.

What are the complications of eating disorders?

In severe cases, eating disorders such as anorexia and bulimia can lead to health problems such as anemia, electrolyte imbalances, tooth decay, gastroesophageal reflux disease, esophageal inflammation, and tears, ulcers, gastric rupture, bone loss, kidney problems, heart rhythm abnormalities, and seizures.

What are the treatments for eating disorders?

Treatment for eating disorders consists of the following:

Normalizing eating and weight control behaviors.
Encouraging a healthy, balanced diet that includes a range of foods with varying caloric values and meals at regular intervals.
Restoring body weight to a healthy level.
Treating co-occurring mental illnesses that can be the underlying cause of anorexia or bulimia, such as anxiety or other symptoms.
Joining support groups to aid in recovery.
Involving parents or another family member in children and adolescents with eating disorders to monitor meals.
Getting counseling and therapy to address body image issues.
Prescribing medications such as antidepressants, appetite stimulants, or others to treat health problems related to an eating disorder.