Anorexia Nervosa vs Bulimia: Differences, Symptoms, and Treatment

Anorexia nervosa is an eating disorder that affects 0.9 to 2.0 percent of women and 0.3 percent of males in the general population. On average, teenage girls aged 13-19 and are at the highest risk for developing the condition. Men who have anorexia nervosa are usually diagnosed at older ages. Bulimia nervosa, on the other hand, affects 1-15 percent of the general population. These disorders are often linked to other conditions, such as mood and anxiety disorders. In this article, we discuss the differences between anorexia nervosa vs bulimia and their available treatments.

What is anorexia nervosa?

To better understand the differences between anorexia nervosa vs bulimia, let’s define the conditions separately. Let’s start with anorexia nervosa.

Anorexia nervosa (AN) is an eating disorder wherein the patient intentionally restricts their food intake in an extreme drive to become thin. These patients have a distorted view of their body weight, size, or shape. They show relief of anxiety, stress, and negative emotions while developing a sense of accomplishment and control when they decrease their intake of food and increase their output of calories through excessive exercise or purging.

Signs and symptoms of  anorexia nervosa

Patients with this condition have an obsession with weight loss and anxiety when it comes to weight gain and they usually have monotonous eating rituals, which may include a reluctance of being seen eating. They may also present with excessive and intense exercise routines. Typically, the psychological profile of patients with anorexia nervosa are perfectionists, hard working, introverted, resistant to change, and highly self critical. Physical manifestations of anorexia may include:

• Lack of energy, feeling tired, cold and weak
• Dizziness or fainting
• Irregular or no menstrual cycles in females 
• Constipation due to excessive laxative use
• Hair loss
• Bradycardia (Slow heart rate)

Types of Anorexia

Anorexia nervosa can be divided into 2 subgroups of behavior, both with the primary intention of reducing caloric intake.

Binge-purge subtype. These patients binge eat large amounts of food in a short amount of time and then compensate either by vomiting, exercising, fasting, or using laxatives, similar to what is seen in patients with bulimia.

Restrictive type. These patients severely limit their food intake while compulsively and excessively exercising.

What is bulimia nervosa?

Bulimia nervosa (BN) is an eating disorder that presents as patients who have uncontrollable episodes of overeating, commonly known as bingeing. This is subsequently followed by intentional or induced vomiting (sometimes known as purging), laxative use, enemas, fasting, or excessive exercise to control their weight. These patients usually binge eat during the evening, followed by purging. Additionally, they often hide their eating habits out of shame and guilt. The purge offers them relief and a sense of control, different from that seen in anorexia.

Signs and symptoms of bulimia nervosa

Patients with bulimia will show signs similar to that of anorexia, however these patients overeat more when compared to patients with anorexia. They share the same profile as those with anorexia: impulsive, perfectionistic, introverted, hard working, resistant to change, and self-critical. Patients with bulimia show the following physical symptoms:

• Normal or high body weight
• Irregular or absent menstrual cycle
• Scarring on the back of the fingers from self-induced vomiting
• Swelling of the throat and/or neck
• Hyperacidity/ acid reflux disorder due to excessive self-induced vomiting
• Signs of severe dehydration, such as poor skin turgor and tachycardia
• Anemia

Anorexia nervosa vs. bulimia nervosa 

Patients with bulimia nervosa have many similarities to those with anorexia nervosa, such as an obsession with body image, self esteem issues, and purging; however, the key difference between these two conditions is that patients with bulimia have uncontrollable episodes of binging, whereas patients with anorexia present with an aversion to food. The motivations of patients with anorexia and bulimia are similar, but what provides relief for their anxiety is completely different. Patients with anorexia feel relief when avoiding food and purging, while patients with bulimia tend to overeat and then feel guilt, shames and anxiety. As a result, they decide to purge food to compensate. 

Physically, patients with bulimia tend to be of normal or high body weight, while patients with anorexia usually become dangerously thin and light. It is important to remember, however, that these disorders can affect people of different ages, genders, and body types. 

How to stop eating disorders

Along with medical management, psychiatric counseling is a major part of treating the disorder. The treatment of patient with eating disorders include:

• Nutritional counseling 
• Treatment of co-existing disorders and consequences of their condition, such as anemia or acid reflux
• Cognitive behavioral therapy 
• Psychoactive medications that may help conditions such as depression or anxiety
• Support groups
• Hospitalization with restraints or suicide watch if the patient has suicidal thoughts

Key takeaway

Bulimia nervosa and anorexia nervosa are eating disorders that affect can affect both anybody, particularly teenagers and young adults. When comparing anorexia nervosa vs bulimia, the two disorder can seem very similar. However, they can be differentiated based on their physical symptoms and motivations for purging. Patients with either disorder should receive counseling from a medical professional and emotional support from family and friends.

Learn more about mental health here.