Anorexia nervosa and bulimia nervosa are two of the most common eating disorders. While similar behaviors characterize both, some differences are important to highlight. Let’s break down some key definitions, differences and similarities between anorexia nervosa and bulimia nervosa.
What is Anorexia Nervosa?
Anorexia nervosa, commonly known as anorexia, is an eating disorder characterized by an intense fear of gaining weight and a distorted body image that leads to restricted food intake. Individuals with anorexia often see themselves as overweight, even underweight.
The psychological core of anorexia is the extreme overvaluation of shape and weight.
The person with anorexia practices constant “body checking,” which consists of obsessive and repeatedly weighing, measuring and mirror gazing at their bodies to reassure themselves that they are still thin.
What is Bulimia Nervosa?
Bulimia nervosa, or bulimia, is an eating disorder involving cycles of binge eating followed by purging behaviors such as self-induced vomiting, excessive exercise, or laxatives.
Unlike anorexia, individuals with bulimia often maintain a relatively average weight or have fluctuations in weight.
Anorexia vs. Bulimia: What’s the Difference?
While these disorders share commonalities, such as their impact on one’s relationship with food and body image, there’s a difference between anorexia nervosa and bulimia.
- Anorexia: Individuals severely restrict their food intake, often consuming fewer than 1,000 calories daily. It’s common for anorexia sufferers to eliminate entire food groups from their diets, like carbohydrates and fats.
- Bulimia: Individuals go through cycles of binge eating, consuming large amounts of food in a short period, followed by purging. In this case, they don’t limit calories or food options but always follow eating behaviors with purging rituals.
- Anorexia: Purging is less common but can occur. The primary focus is on food restriction or fasting.
- Bulimia: Purging is a defining characteristic, often involving self-induced vomiting, excessive exercise, or the use of laxatives.
Physical and Mental Signs
- Anorexia: Physical signs include extreme thinness, brittle nails, and hair loss. All of these are a direct consequence of food restriction and nutritional deficiencies.
- Bulimia: Physical signs may be less noticeable, including dental issues, irregular menstrual cycles in females, and ongoing gastrointestinal problems. It’s believed that bulimia nervosa often co-occurs with other mental health issues such as anxiety or depression.
Similarities Between Anorexia and Bulimia
Both disorders share common psychological traits such as low self-esteem, a distorted body image, and a preoccupation with food and weight. They also both have high comorbidity rates with other mental health conditions like depression and anxiety.
Young Female Tendency
One study reveals that anorexia nervosa is more than twice as common in teenage girls, with the average onset around 15 years. And almost 90% of patients with anorexia are female. Similarly, it’s believed that bulimia nervosa affects up to two percent of adolescents and young adult women, with 80% of patients with bulimia being female.
Co-occurrence with Mental Illnesses
The co-occurrence of other mental illnesses with bulimia nervosa and anorexia nervosa is quite common. According to the National Institute of Mental Health (NIH):
- For Anorexia, 48% also experienced an anxiety disorder, 42% mood disorders, 31% impulse control disorder, 27% substance use disorder, and 56% any mental health disorder.
- For Bulimia, 81% also experienced an anxiety disorder, 71% mood disorders, 64% impulse control disorders, 37% substance use disorders, and 95% any mental health disorder.
These statistics highlight the complex nature of eating disorders and the need for comprehensive treatment that addresses both the eating disorder and any co-occurring mental health conditions.
Both anorexia nervosa and bulimia nervosa share several long-term physical and psychological consequences if left untreated.
- Nutritional Deficiencies: Both disorders can lead to severe nutritional deficiencies, affecting vital organs and bodily functions.
- Cardiovascular Issues: Heart problems, including irregular heartbeats and heart failure, are potential long-term consequences for both disorders.
- Gastrointestinal Problems: Both disorders can lead to long-term digestive issues. Anorexia may result in chronic constipation and gastroparesis, while bulimia can cause acid reflux and esophageal issues.
- Bone Density: Both disorders can lead to osteoporosis due to a lack of essential nutrients like calcium and vitamin D.
- Hormonal Imbalance: Both can lead to hormonal imbalances affecting the menstrual cycle in females and testosterone levels in males.
- Depression and Anxiety: Both disorders have high comorbidity rates with mood disorders like depression and anxiety.
- Cognitive Impairment: Chronic malnutrition can lead to cognitive impairments, affecting concentration and decision-making abilities.
- Social Isolation: The secretive nature of both disorders can lead to social withdrawal and isolation.
- Quality of Life: Both disorders can severely impact the overall quality of life, affecting relationships, work, and general well-being.
According to NIH, about 34% of individuals with anorexia nervosa and 43% with bulimia nervosa have sought treatment specifically for their eating disorder. Interestingly, males with anorexia nervosa seek treatment more often than females, while females with bulimia nervosa and binge eating disorder are more likely to seek treatment than males.
While treatment varies by patient, it’s often a combination of the following:
- Cognitive Behavioral Therapy (CBT). CBT is considered the standard treatment for bulimia nervosa and also works for anorexia. Here, the patient learns to self-monitor their binge eating episodes, slowly normalize their eating behaviors and learn about the thoughts and feelings that could trigger them to relapse.
- Medication. Combined with CBT, serotonin reuptake inhibitors such as fluoxetine, citalopram, and sertraline can reduce symptoms of bulimia nervosa. There’s also Trazodone, which can significantly reduce the frequency of binge-eating episodes.
- Dual Diagnosis. As said before, eating disorders can co-occur with mental illnesses like anxiety and depression. Getting dual diagnosis treatment for your or your loved one ensures that all aspects of an individual’s well-being are addressed, leading to a comprehensive recovery.
- Family Work. Family therapy is highly recommended since these disorders tend to emerge in the young population. Studies on teenagers with relatively recent onset anorexia showed that therapy involving the whole family was superior to treating just the patient.
The Bottom Line
Understanding the complexities of eating disorders like anorexia nervosa and bulimia nervosa is crucial for both awareness and intervention.
While these disorders may manifest differently, they share several long-term consequences and often co-occur with other mental health conditions. If you or someone you know is struggling with an eating disorder, seeking professional help is a critical step toward recovery and long-term well-being.