What Is the Difference Between Anorexia and Bulimia?

Anorexia and bulimia are both serious and dangerous health conditions that cause people to lose weight. Although anorexia and bulimia are unique conditions with their own set of symptoms, they may have more in common than you might guess. One of the main things they have in common is they are both treatable conditions. But, if left untreated, they can both lead to serious health complications and even death.

Let’s go over what anorexia is, what bulimia is, and the differences and similarities between the two.

What is anorexia nervosa?

Anorexia nervosa, more commonly referred to as simply anorexia, is an eating disorder that causes people to severely restrict their diets to lose or prevent gaining weight. Around 0.6% of the population (and 0.9% of women) is estimated to have anorexia. ^[1]

Anorexia, like other eating disorders, is about more than just food. People who have anorexia struggle with a negative body image and have a severe fear of weight gain. When left untreated, the physical health complications of anorexia are like the complications of starvation or malnourishment. Untreated anorexia can lead to heart problems, bone loss, and even death.

In fact, anorexia is one of the most (if not the most) deadly mental health disorders; its mortality rate is around 5%. ^[2]

Symptoms of anorexia nervosa

According to the Diagnostic Statistical Manual Fifth Edition or DSM-V, a person must have all of these symptoms to meet the criteria for a diagnosis of anorexia:

• Restricting food (not eating or eating very little) to the point of significant weight loss or failure to gain the weight that’s appropriate for your age, sex, and height
• Fear of fatness or gaining weight
• Having a distorted body image and opinion of their condition; they might not see anything wrong with being underweight or think they’re fat when they’re at a normal body weight

There are also two subtypes of anorexia that are sometimes diagnosed:

1. Restricting type: This type of anorexia causes people to restrict their food intake or stop eating.
2. Binge-eating/purging type: People with this subtype of anorexia may eat large amounts of food, but then find a way to rid or “purge” themselves of the calories (for example, by vomiting or taking laxatives).

If you think the binge-eating/purging subtype of anorexia sounds similar to what you already know about bulimia, you’d be correct. These two disorders (bingeing/purging anorexia and bulimia) are very similar, but we’ll break down the differences between them below.

Physical symptoms of anorexia nervosa

Eating disorders are mental health disorders, but they have physical consequences because of the way they interact with the food you’re eating. Anorexia, in particular, leads to severe physical symptoms because of the significant weight loss it causes. The physical signs of anorexia are similar to those of starvation.

Some physical symptoms caused by anorexia include:

• Feeling cold all the time
• Weak bones and muscles
• Thin, brittle hair and nails or hair loss
• Fainting or dizziness
• Irregular periods for people with female reproductive organs (skipping periods is common)
• Dry or yellow skin
• Bloating or constipation

What is bulimia nervosa?

Bulimia nervosa, or bulimia, is another eating disorder. People with bulimia are also concerned about gaining weight. But unlike people with anorexia, people with bulimia don’t try to lose weight by restricting food. Instead, they have periods of binge-eating, followed by a “purge” to try to rid themselves of the consumed calories. They might purge through making themselves vomit, taking laxatives or diuretics, fasting, excessively exercising, and more.

The overall prevalence of bulimia in the past year is around 0.3% (less common than anorexia). ^[3] Like anorexia, bulimia is also more common than women. Around 0.5% of women live with bulimia, compared with 0.1% of men.

According to the DSM-V, the symptoms of bulimia nervosa are:

• Repeated episodes of binge-eating (a period of around two hours where you eat more food than people normally would in the same amount of time, and feeling out-of-control about what or how much you eat)
• Purging, or trying to compensate for the binge-eating episodes to prevent weight gain; this could include things like self-induced vomiting, taking laxatives, taking diuretics or other medications, fasting, or excessive exercise
• Going through the binge-purge pattern at least once a week for three months or more
• Not being better suited for an anorexia nervosa diagnosis (we’ll explain this in more detail later)

Bulimia is classically thought of as an eating disorder in which someone induces vomiting after meals. However, in non-purging bulimia, a person may try to compensate for a binge-eating period through other means like excessive exercise.

Unlike anorexia, bulimia does not require a person to have significant weight loss for a diagnosis. People with bulimia are less likely to be underweight than people with anorexia.

Physical symptoms of bulimia nervosa

Bulimia also can cause physical symptoms, especially if the person is vomiting frequently. Some of these symptoms include:

• Damaged enamel on teeth (may lead to clear or decaying teeth)
• Scraped or injured knuckles (if using fingers to induce vomiting)
• Bloodshot eyes
• Severe dehydration
• Gastrointestinal problems like acid reflux
• Sore throat or hoarse voice

Similarities between anorexia and bulimia

Although they’re different disorders, anorexia and bulimia have more in common than you may think. On top of that, many people have symptoms of both disorders. Someone diagnosed with anorexia may binge and purge (and be diagnosed with binge-eating/purging subcategory of anorexia). People with bulimia often restrict their food intake to compensate for binges.

Shared symptoms between anorexia and bulimia

Some of the symptoms and behavioral signs that anorexia and bulimia share are:

• Being overly preoccupied with weight, body shape, or dieting
• Having a distorted body image, like thinking you’re fat when you’re actually at a normal weight for your age and height
• Skipping meals or eating very small meals
• Being secretive about food and eating habits
• Withdrawing from friends, family, or activities
• Changes in mood; becoming depressed or irritable
• Frequent binge-eating periods followed by compensating behaviors like vomiting (binge-purge subtype of anorexia)

Shared risk factors of bulimia and anorexia

No eating disorder, including bulimia and anorexia, has one specific biological cause. However, researchers have narrowed down factors that put you at risk for both anorexia and bulimia. These risk factors ^[4] include:

• Gender. Girls and women are at higher risk than men for both anorexia and bulimia. However, this doesn’t mean that men can’t get these disorders (or another eating disorder). ^[5]
• Age. Both anorexia and bulimia typically come on during adolescence or early adulthood.
• Perfectionism. Having a perfectionistic personality can put you at higher risk for both of these disorders.
• Family history. If you have a family member with an eating disorder, you are also more likely to develop an eating disorder (including bulimia or anorexia). There is a genetic component to this; around half of the risk for both bulimia and anorexia comes from your genes. ^[6]
• Dissatisfaction with body shape or size. People with both bulimia and anorexia are unhappy with the shape or size of their bodies. They may be heavily influenced by societal beauty norms or “diet culture,” and may have even been bullied about their weight as children.
• Poor self-esteem. Those with anorexia and those with bulimia tend to tie their self-worth to their weight or body size. This may cause low self-esteem and put you at a higher risk for developing an eating disorder.

Shared comorbidities between bulimia and anorexia

Comorbidities are health conditions that frequently appear together. People with eating disorders, including anorexia and bulimia, are much more likely than the general population to have a comorbid psychiatric condition:

• Mood disorders like major depressive disorder
• Suicidality (death by suicide)
• Anxiety disorders
• Obsessive-compulsive disorder
• Social anxiety disorder
• Post-traumatic stress disorder
• Substance use disorder
• Personality disorders

There are some variations in how likely you are to have one of these conditions depending on whether they have anorexia or bulimia. For example, people with anorexia are more likely to die by suicide than people with bulimia. ^[7] However, both people with anorexia and people with bulimia are more likely than the general population to also have these conditions.

Differences between anorexia and bulimia

As you can see, anorexia and bulimia have a lot in common. These two disorders often overlap, and it can get confusing to differentiate between the two. It becomes even more complicated when taking the binge-purge subtype of anorexia into account.

There are some obvious differences between the symptoms of anorexia and the symptoms of bulimia. People with anorexia severely restrict their food intake; people with bulimia may not restrict their food intake, but find other ways to compensate for the food they consume during binge-eating periods.

However, some people with anorexia (within the binge-eating/purging sub-category) also have binge-eating periods. Just like people with bulimia, these people may eat a large quantity of food, and follow that binge with compensating behaviors like vomiting or fasting. So how do mental health providers differentiate between binge-eating/purging anorexia and bulimia?

One of the main differences between anorexia and bulimia has to do with weight. There is no weight criteria for bulimia; someone can have bulimia but not lose any weight. However, significant weight loss is a requirement for a diagnosis of anorexia. If someone binges and purges, and experiences significant weight loss because of this, they may actually have the binge-eating/purging subtype of anorexia.

Some people with anorexia may also engage in behaviors like taking laxatives or excessive exercise to lose even more weight, even when they haven’t had a binge-eating episode. People with bulimia, on the other hand, always experience binge-eating episodes that are followed by compensating behaviors like vomiting or taking laxatives.

Another, more subtle, difference between anorexia and bulimia has to do with control. Binge-eating episodes that are part of bulimia, by definition, are periods of time where a person feels completely out of control over how much they’re eating. Although this isn’t always the case, people with anorexia typically have a hard time ever losing control over their eating habits. In fact, they’re often so much in control that they’re restricting their diet to the point of physical harm.

It’s also important to remember that one of the requirements for a bulimia diagnosis is that the symptoms are not better explained by anorexia. If someone appears to fit the criteria for both anorexia and bulimia, then a diagnosis of anorexia will be given.

Because anorexia, by definition, leads to weight loss, the medical complications of anorexia are typically a lot more severe than those of bulimia. Although anorexia has been found to have slightly higher mortality rates than bulimia, both of these conditions can be deadly, especially when left untreated.

In summary:

Anorexia nervosa:

• Significant weight loss is a requirement of the diagnosis
• Restricts food intake to lose or avoid gaining weight
• Some people with anorexia may also have binge-eating periods, followed by compensating behaviors (purging) like vomiting or fasting; however, this is not a requirement of the diagnosis
• Can engage in unhealthy weight loss behaviors similar to purging (like self-induced vomiting or taking laxatives) even without a binge-eating episode
• Typically have an exaggerated need for control over eating habits
• Medical complications are similar to those of starvation, and include weak bones, heart problems, and brittle skin and hair
• Premature mortality (early death) rate is around 5 times higher than general population

Bulimia nervosa:

• Significant weight loss is not a requirement of the diagnosis; people with bulimia are more likely to be a normal weight
• To be diagnosed with bulimia, you must have frequent periods of binge-eating followed by compensating behaviors (or “purges”) like self-induced vomiting
• You must have these episodes at least once a week for three months
• Feel out-of-control during binge-eating episodes
• Medical complications are often tied to frequent vomiting (i.e. decaying teeth and sore throat)
• Premature mortality rate is around 50% (1.5 times) higher than the general population

Treatment for Anorexia and Bulimia

Anorexia and bulimia are unique eating disorders, but some might say they have more similarities than differences. Treatment usually varies depending on associated health complications; because anorexia causes such severe weight loss, people with anorexia may need to be hospitalized before starting behavioral treatments.

Hospitalization

Hospitalization is required more often for anorexia than for bulimia. This is because anorexia causes people to lose significant weight, which puts them at risk of medical complications like organ failure and malnutrition. However, people with bulimia may also need to be hospitalized if they are facing serious health problems.

Hospitalization isn’t meant as a long-term cure for anorexia or bulimia. But it’s an important step to take if anorexia or bulimia has started to have serious physical health consequences. Medical staff can make the determination whether you’re medically stable and your life is not in danger. Some people may need to be fed through a tube to return to a healthy weight.

Some medical treatment may be delivered on an outpatient basis. For example, if bulimia has caused acid reflux, a doctor can prescribe you the right medication.

Hospitalization might also be required if you are suicidal and at risk of harming yourself.

Residential treatment

After you are medically stabilized, you may choose to enter a residential treatment center. Residential, or inpatient, treatment is when you live on-campus at the same place where you receive your treatment. This is a helpful, and sometimes necessary, option if you don’t have strong support people at home. There are many different types of residential treatment facilities, from hospitals to luxury homes.

The residential treatment center at The Center • A Place for HOPE is designed with your comfort in mind. It’s located less than half an hour from downtown Seattle, in the waterside town of Edmonds, Washington. Each patient lives in a condominium-style private apartment and the facility has gorgeous views over the Puget Sound.

Outpatient therapy

Both anorexia and bulimia are mental health disorders, and for most people there are many underlying causes. People with these eating disorders may have gone through a traumatic experience, or they may be living with another psychiatric disorder like depression.

Psychotherapy methods like dialectical behavior therapy and cognitive-behavioral therapy are helpful for people with eating disorders, including anorexia and bulimia.

Eating Disorder Treatment at The Center • A Place of HOPE

Whether you have anorexia or bulimia, the truth is that any eating disorder is too serious to ignore. Without treatment, mortality rates for both of these conditions rise significantly. But having an eating disorder doesn’t have to mean the end of the road. There is effective treatment out there that can help you develop a healthy relationship with food and your body.

The Center • A Place of HOPE has over 3 decades of experience helping people like you recover from eating disorders, and our team truly cares about helping you heal your relationship with food. Our residential treatment program for eating disorders accepts many different insurance plans, and financing is also available.

There are specialized programs for women, men, and teens at our program. All of our programs are whole-person based, which means we see you as a complete human being, not just an eating disorder patient.

To learn more about our admissions process and how you can start your treatment journey with us, get in touch with us today.

[1] https://www.nimh.nih.gov/health/statistics/eating-disorders
[2] https://pubmed.ncbi.nlm.nih.gov/7793446/
[3] https://www.nimh.nih.gov/health/statistics/eating-disorders
[4] https://www.nationaleatingdisorders.org/risk-factors
[5] https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC2696560/
[6] https://jamanetwork.com/journals/jamapsychiatry/fullarticle/482517
[7] https://nedc.com.au/eating-disorders/eating-disorders-explained/types/comorbidity/