Anorexia vs. bulimia
We are taking a deeper look into two common eating disorders: anorexia and bulimia. People may think of these as two completely different eating disorders with little overlap. However, when we remove weight* as a diagnostic criteria, we are able to see many common signs and symptoms between the two.
*Eating Recovery Center (ERC) acknowledges that diagnostic criteria for anorexia are limiting and not reflective of weight-inclusive care. We would like to note that individuals in larger bodies can have restrictive anorexia or binge/purge anorexia. Lastly, here we refer to anorexia nervosa restricting subtype as “restrictive anorexia.” We recognize that anorexia nervosa binge/purge subtype also includes restrictive behaviors.
What is anorexia?
Anorexia is a serious medical and mental health condition that can be life-threatening. It is characterized by an often obsessive fear of weight gain, a distorted body image and refusal to maintain one’s natural body weight.
Individuals with restrictive anorexia nervosa may restrict overall caloric intake whereas those with binge/purge anorexia may purge calories consumed through vomiting, laxative/diuretic abuse and/or compulsive exercise.
Learn more about the symptoms of anorexia here.
What is bulimia?
Bulimia is an eating disorder characterized by patterns of bingeing (consuming a large amount of food in a short period of time) and purging (eliminating calories consumed). Purging can occur via self-induced vomiting, laxative/diuretic use and/or exercise. Individuals struggling with bulimia also often experience negative body image, obsessive/intrusive thoughts about food and their bodies, and fear of weight changes.
Learn more about bulimia symptoms here.
Anorexia vs. bulimia: How are they different?
What are the similarities and differences between anorexia and bulimia? It is important to note that an individual does not need to experience all symptoms listed below to be diagnosed with an eating disorder. This is not a comprehensive list of signs and symptoms but references the most commonly experienced signs/symptoms.
| Common Signs/Symptoms | Restrictive Anorexia | Binge/Purge Anorexia | Bulimia |
| Obsessive/intrusive thoughts about food | X | X | X |
| Obsessive/intrusive thoughts about body shape/size | X | X | X |
| Binge/purge cycles | X | X | X |
| Compulsive exercise | X | X | X |
| Laxative/diuretic misuse | X | X | |
| Changes in eating habits | X | X | X |
| Personality changes | X | X | X |
| Withdrawal from friends/family | X | X | X |
| Changes in weight | X | X | X |
| Sudden preoccupation with foods | X | X | X |
| Restricted overall caloric intake | X |
Binge/purge anorexia vs. bulimia
Individuals with binge/purge anorexia and bulimia experience very similar symptoms, which can make it difficult to determine the difference. A key difference between the two is that those with binge/purge anorexia are unable to maintain what is considered a natural weight for their body* whereas individuals with bulimia may be able to do so. It is important to note that weight changes can be observed with either one of these serious mental health illnesses.
*Here at ERC we believe in a weight-inclusive care model. We do not rely on the BMI scale to determine health and severity of illness.
Learn more about the subtypes of anorexia here.
Health risks of anorexia and bulimia
Health risks of bulimia and anorexia can be very serious. Often, we see more information regarding the health risks and medical complications of anorexia, in particular, restrictive anorexia. However, both disorders, irrespective of BMI/weight, have serious and life-threatening medical complications.
It is important to note that an individual may not experience all of the health risks listed below. This is not a comprehensive list of health risks but references the most commonly experienced health risks.
| Health Risks | Restrictive Anorexia | Binge/Purge Anorexia | Bulimia |
| Cardiac complications | X | X | X |
| Dehydration | X | X | X |
| Edema | X | X | X |
| Electrolyte imbalances | X | X | X |
| Esophageal inflammation | X | X | |
| Dental erosion | X | X | |
| Fatigue/muscle wasting | X | X | X |
| Ulcers, pancreatitis | X | X | |
| Digestive irregularity | X | X | X |
| Hypoglycemia | X | ||
| Disruption to fertility/hormones (including low testosterone) | X | X | X |
| Osteoporosis/bone loss | X | X | |
| Bradycardia | X | X |
Causes of anorexia and bulimia
Both anorexia and bulimia are caused by a multitude of factors. There is no single cause for either condition. Current research also does not show a single factor that predisposes an individual to restrictive anorexia, binge/purge anorexia or bulimia. In fact, all eating disorders are caused by a combination of biological, psychological and sociocultural factors.
The following can play an important role in the risk of developing an eating disorder:
- Genetics
- Temperament
- Traumatic experiences or trauma-related symptoms
- Support system conflict
- Emotion regulation challenges (cognitive rigidity, high impulsivity)
- Low self-esteem/self-efficacy
- Depression
- Anxiety
- Cultural norms, social media/societal pressures
Treatment for anorexia vs. bulimia
Lasting recovery from anorexia and bulimia is possible. Treatment for anorexia and bulimia both typically begin with nutritional rehabilitation. When indicated, weight restoration is also part of the initial phase of treatment.
Nutritional rehabilitation is crucial despite eating disorders not being "about the food.” When an individual is malnourished, their cognitive abilities are impacted. The brain isn’t able to process thoughts, feelings and behaviors when it is not provided with consistent and appropriate nutrition. Once adequate nutrition is consumed, brain functioning is restored and individuals are able to engage in the behavior changes and therapies necessary for recovery.
“In order to return to wellness, we must address that conditioned response, starting with a person’s focus on food, weight and body size, then move into other areas of distress,” explains Elizabeth Easton, PsyD, CEDS.
While treatment for anorexia and bulimia is similar, at ERC we provide additional support surrounding mealtimes for individuals struggling with binge/purge anorexia and bulimia. Dr. Easton explains that “this may include prior planning for use of individual coping skills and direct support from trained staff to help them move through their urges without using unhelpful behaviors.”.
Learn more about eating disorder treatment at ERC.
Can I have both anorexia and bulimia?
Although an individual cannot be diagnosed with both anorexia nervosa and bulimia nervosa at the same time, it is possible to be diagnosed with both eating disorders at different times. It is not uncommon for individuals suffering from an eating disorder to find their clinical diagnosis can change depending on what symptoms/behaviors are being expressed at any given time.
Do you find yourself or someone you love experiencing any of the symptoms discussed above? You are not alone and we are here to help. Take one of the following quizzes, or call for a free, zero commitment assessment to learn more.
