Bulimia nervosa and anorexia nervosa may seem like polar opposites. After all, bulimia nervosa involves binge eating, while anorexia nervosa involves food restriction. When it comes to bulimia vs anorexia, the two disorders have more in common than you might think. The warning signs and symptoms for both are similar. The myths and misconceptions of both are similar too. Show
Let’s take a closer look at the differences between the two eating disorders as well as what they have in common. Defining Bulimia and AnorexiaThe definitions of bulimia nervosa and anorexia nervosa show the differences between the two disorders. Both are serious conditions. Bulimia nervosa is a cycle of binge eating followed by compensatory behaviors, such as self-induced vomiting, excessive exercise, or severely restricting food intake. Anorexia nervosa is characterized by severe food restriction. This could be limiting the amount of food or types of food. The diagnostic criteria for anorexia nervosa, according to the DSM-5, the manual used by mental health professionals, include “low body weight” but does not define “low”. The DSM-5 also makes allowances for Individuals who are not at “low body weight.”. This is referred to as “atypical anorexia.” According to the National Eating Disorder Association, “Research studies have not found a difference in the medical and psychological impacts of anorexia and atypical anorexia.” In other words, atypical anorexia and typical anorexia have the same impact. For the purposes of our discussion, both fall under the umbrella of anorexia nervosa. Bulimia vs Anorexia: Common SymptomsAlthough the way the two eating disorders manifest are a bit different, many of the symptoms and signs are the same. Symptoms for both disorders may show behaviorally, physically, or both. Behavioral symptoms include:
Physical symptoms include:
Those with bulimia nervosa may show signs of binge eating, such as hiding food or leaving empty wrappers or containers. Bulimia vs Anorexia: Common Causes and Risk FactorsNobody knows exactly what causes eating disorders. Researchers think it may be a combination of genetics, psychological factors, and societal influence. For example, according to NEDA, those with a close relative with an eating disorder are more likely to develop one themselves. Similarly, those with a close relative with a mental health condition, such as depression, anxiety, or addiction, are more likely to develop an eating disorder. When it comes to psychological traits, perfectionism is common. No one can be perfect all the time, but many of us expect ourselves to perform perfectly all the time. This extends to having the “perfect” body or following the “perfect” diet. These unrealistically high expectations of ourselves can lead to disordered eating. Dissatisfaction with our bodies is another common factor. The media sets the standards for what is seen as the ideal body, but for most of us, that body is unattainable. Although more body types are slowly being included in movies, television shows, and advertising, we still have a long way to go. These unrealistic standards also lead to weight stigma and weight bias. Those of us who are in higher-weight bodies may have experienced bullying or teasing growing up. According to NEDA, more than 60% of people with an eating disorder said the bullying contributed to their disorder. Bulimia vs Anorexia: Common MythsWhen it comes to eating disorders, myths abound. Here are a few of the most common myths and misconceptions around bulimia nervosa and anorexia nervosa: Myth #1: It’s the parent’s fault.Parents, and mothers in particular, have been blamed for their children developing an eating disorder. Although family dynamics might play a role, parents are not to blame. Myth #2: It’s a choice.Nobody chooses to develop anorexia or bulimia. Both conditions are complex and multi-faceted, and no one can just “get over” them. Recovery takes time, and often requires professional intervention. Myth #3: Only teen girls have eating disorders.Although adolescent girls are particularly vulnerable to eating disorders, anyone can develop one. This includes people of all genders, orientations, sizes, and backgrounds. Myth #4: People in higher-weight bodies can’t have anorexia or bulimia.People of all sizes can develop anorexia and bulimia. In fact, people in higher-weight bodies often have a more difficult time getting diagnosed because of this stereotype. Eating disorders are serious, and they can have a negative impact on the health of someone in a larger body. A person in a larger body who has anorexia or bulimia needs assistance and deserves recovery. They shouldn’t be encouraged to continue disordered eating simply because they are losing weight. Losing weight is not inherently positive for people in higher-weight bodies. Recovering from Anorexia or BulimiaThe good news is that people can recover from anorexia and bulimia. It takes time, and often requires professional treatment. Many treatment options are available. Most involve a combination of medical care, counseling, education, and working with a nutritionist. Treatment may also involve supportive family members in counseling and education. Although anorexia and bulimia are different, they are essentially branches of the same tree. Both conditions are serious, but recovery is possible. Melinda Sineriz is a freelance writer and fat acceptance advocate. Read more of her thoughts on Twitter or visit her website to learn more. Eating disorders include anorexia nervosa, a form of self-starvation; bulimia nervosa, in which individuals engage in repetitive cycles of binge-eating alternating with self-induced vomiting or starvation; binge-eating disorder (BED), which resembles bulimia but without compensatory behaviors to avoid weight gain (e.g. vomiting, excessive exercise, laxative abuse); avoidant restrictive food intake disorder (ARFID) in which people may have lack of interest in food, avoid certain textures or types of foods, or have fears and anxieties about consequences of eating unrelated to shape or weight concerns (e.g. fear of choking, vomiting or abdominal discomfort) and other specified feeding and eating disorders (OSFED). Eating disorders can occur in any age group, gender, ethnic or racial group. Anorexia nervosa and bulimia are psychiatric illnesses that center on food and its consumption and are usually characterized by:
These unhealthy behaviors and preoccupations can develop into a consuming passion and come to interfere with physical, psychological and social well-being. Eating disorders have many causes. They may be triggered by stressful life events, including a loss or trauma; relationship difficulties; physical illness; or a life change such as entering one’s teens, starting college, marriage or pregnancy. An eating disorder may develop in association with another psychiatric illness such as a depressive disorder, obsessive-compulsive disorder, or substance abuse. Current research indicates some people are more genetically predisposed to developing an eating disorder than others. How common are eating disorders?The eating disorders anorexia nervosa and bulimia nervosa, respectively, affect 0.5 percent and 2-3 percent of women over their lifetime. The most common age of onset is between 12-25. Although much more common in females, 10 percent of cases detected are in males. Binge eating disorder and OSFED are more common and rates of ARFID are not yet known as this diagnosis was defined relatively recently. What is the difference between anorexia nervosa and bulimia?Both anorexia nervosa and bulimia are characterized by an overvalued drive for thinness and a disturbance in eating behavior. The main difference between diagnoses is that anorexia nervosa is a syndrome of self-starvation involving significant weight loss of 15 percent or more of ideal body weight, whereas patients with bulimia nervosa are, by definition, at normal weight or above. Bulimia is characterized by a cycle of dieting, binge-eating and compensatory purging behavior to prevent weight gain. Purging behavior includes vomiting, diuretic or laxative abuse. When underweight individuals with anorexia nervosa also engage in bingeing and purging behavior the diagnosis of anorexia nervosa supercedes that of binge/purging type. Excessive exercise aimed at weight loss or at preventing weight gain is common in both anorexia nervosa and in bulimia. What causes an eating disorder?Eating disorders are believed to result from a combination of biological vulnerability, environmental, and social factors. A useful way of thinking about what causes an eating disorder is to distinguish predisposing, precipitating and perpetuating factors that contribute to its onset and maintenance.
Are certain personality traits more common in individuals with eating disorders?Individuals who develop eating disorders, especially those with the restricting subtype of anorexia nervosa are often perfectionistic, eager to please others, sensitive to criticism, and self-doubting. They may have difficulty adapting to change and be routine bound. A smaller group of patients with eating disorders have a more extroverted temperament and are novelty-seeking and impulsive with difficulty maintaining stable relationships. There is no one personality associated with eating disorders, however. What forms of treatment are effective for anorexia nervosa?Treatment of anorexia nervosa involves nutritional rehabilitation to normalize weight and eating behavior. Psychotherapy is aimed at correcting irrational preoccupations with weight and shape, managing challenging emotions and anxieties and preventing relapse. Interventions include monitoring weight gain, prescribing an adequate diet, and admitting patients who fail to gain weight to a specialty inpatient or partial hospitalization program. Specialty programs combining close behavioral monitoring and meal support with psychological therapies are generally very effective in achieving weight gain in patients unable to gain weight in outpatient settings. The fear of fatness and body dissatisfaction characteristic of the disorder tend to extinguish gradually over several months once target weight and normal eating patterns are maintained, and 50-75% of patients eventually recover. No medications have been shown to significantly facilitate weight gain in patients with this disorder. In the case of patients under 18 years of age, family therapy aimed at helping parents support normal eating in their child has been found to be more effective than individual therapy alone. What forms of treatment are effective for bulimia nervosa?Most uncomplicated cases of bulimia nervosa can be treated on an outpatient basis although inpatient treatment is occasionally indicated. The best psychological treatment is cognitive-behavioral therapy, which involves self-monitoring of thoughts, feelings, and behaviors related to the eating disorder. Therapy is focused on normalizing eating behavior and identifying environmental triggers and irrational thoughts or feeling states that precipitate bingeing or purging. Patients are taught to challenge irrational beliefs about weight and self-esteem. Several medications have also been shown to be effective in decreasing bingeing and purging behaviors in bulimia. What about the treatment of other eating disorders including BED, ARFID and OSFED?Eating disorders are behavioral problems and the most successful modalities of treatment all focus on normalizing eating and weight control behaviors whilst managing uncomfortable thoughts and feelings. Increasingly, we understand eating disorders as not just psychological problems but as disorders of learning and habit. Changing established habits can feel challenging, however practice of healthy eating behavior under expert therapeutic guidance helps develop skills needed to manage anxieties regarding food, weight and shape -- all of which fade over time with the gradual achievement of mastery over recovery. How do I know if I need inpatient treatment?If you think you have an eating disorder, if your symptoms have persisted or worsened despite attempts at outpatient treatment, or if you feel constantly preoccupied by thoughts of food and weight, then a good place to start is with a comprehensive evaluation in our Consultation Clinic. To safely provide the best possible care during the COVID pandemic, we have expanded our outpatient telemedicine services to include remote clinical consultation and outpatient visits with our eating disorders doctors by videolink across multiple states. Video visits allow patients to connect face-to-face in real time without leaving their home by using their smartphone, tablet or computer. Virtual connections are secure and HIPAA compliant. You will be seen by a psychiatrist who will perform a thorough review of your history and symptoms, medical tests and past treatment. We recommend you forward any past treatment records ahead of your appointment for the doctor to review. Whenever possible we ask that you attend the consultation with a close family member or significant other, since we believe family support and involvement is very important when you are struggling with an eating disorder. The doctor will also be interested in any medical or psychiatric problems you may have besides the eating disorder. Common co-occuring psychiatric conditions include depression, anxiety, substance abuse and obsessive-compulsive disorder. Co-occurring medical conditions that may bring patients to treatment include gastrointestinal symptoms, infertility problems or menstrual irregularities, osteoporosis, or chronic pain conditions. At the end of your evaluation, the consulting physician will review his or her impression and diagnosis of your condition and will make suggestions regarding the best next steps for you in terms of treatment. These suggestions may include recommendations for medication, psychotherapy, further testing, or consultation with another medical specialist in The Johns Hopkins Health System. Does our program have published treatment outcomes?You can read about patient satisfaction with our treatment program for anorexia nervosa. Reference: Guarda AS, Cooper M, Pletch A, Laddaran L, Redgrave GW, Schreyer CC. Acceptability and tolerability of a meal-based, rapid refeeding, behavioral weight restoration protocol for anorexia nervosa. Int J Eat Diord. 2020;online ahead of print. You can read about our treatment outcomes for anorexia nervosa in Hopkins BrainWise: A Weighty Approach to Anorexia Nervosa. Learn more about published treatment outcomes from our program for patients with ARFID. What insurance does the hospital take?If you are being admitted to one of our hospital-based programs, both Inpatient and Partial Hospitalization, our business office will verify your benefits beforehand, and the admissions coordinator will contact you with information about your coverage. Admission to our program in the Johns Hopkins Hospital Department of Psychiatry qualifies as a mental health hospitalization and will be authorized under the mental health portion of your insurance, not the medical portion. Please see the Admissions page for more information. Helpful web links:Note: You are being redirected to a web site outside of Johns Hopkins for informational purposes only. Johns Hopkins is not responsible for any aspect of the external web site. |