Bulimia Nervosa vs. Anorexia Nervosa: The Difference Between the Two

Anorexia nervosa and bulimia nervosa are serious eating disorders with distinct characteristics. Anorexia is marked by extreme food restriction, an intense fear of weight gain, and significant underweight, while bulimia involves binge eating followed by purging, often with individuals maintaining a normal weight.

Both disorders have severe emotional and physical health consequences, with anorexia having a higher mortality rate. Key differences include eating behaviors, body weight, and specific symptoms. Although primarily affecting women, particularly adolescents, bulimia also impacts men and various age groups. 

Understanding these differences is crucial for effective diagnosis and treatment, as eating disorders arise from a complex interplay of genetic, social, and environmental factors.

Research data provided by The National Association of Anorexia Nervosa and Associated Disorders (ANAD) suggest how widespread the prevalence of eating disorders is in America.

• At least one person loses their life every 62 minutes from complications directly linked to an eating disorder.
• More than 30 million Americans from all demographics struggle with an eating disorder.
• Eating disorders are one of the most deadly mental illnesses (second only to opioid addiction and overdose).

Eating disorders are complex mental health challenges that have significant physical and psychological consequences.

What Are Eating Disorders?

Eating disorders are complex mental illnesses characterized by abnormal and harmful eating behaviors. The effects of disordered eating do not stop at weight loss or gain. 

Eating disorders can have a significant and detrimental impact on mental, physical, and psychological health. Each year, more than ten thousand Americans lose their lives to complications directly related to these disorders. It is important to note that there is no single “cause” or specific risk factor that increases the likelihood of developing an eating disorder; rather, they arise from a complex interplay of various influences.

It is believed that a combination of genetic, social, cultural, and environmental factors contributes to the development of an eating disorder. Like alcohol for someone with an alcohol use disorder, someone who struggles with an eating disorder manipulates food intake to manage stress and feel a sense of control over their environment.

What is Anorexia Nervosa?

Anorexia nervosa is a condition where staying “thin” becomes a critical motivation in one’s relationship with food. Some of the more visible symptoms of anorexia nervosa include low body weight, low blood pressure, anxiety, altered eating habits, dehydration, and mismatched body weight perception. Without help from a treatment program like The Los Angeles Outpatient Center, the mental and physical health impacts of anorexia nervosa can cause dangerous physical and psychological health impacts.

Annual studies show anorexia nervosa has the highest mortality rate of any eating disorder. Some research suggests it may have the highest fatality rate of all mental illnesses. The same reports show that as many as 4% of all women (regardless of age) are diagnosed with anorexia nervosa. Although the average age of onset for anorexia nervosa is one’s early teens, it can occur at any age.

A study conducted in 2003 of female teens with anorexia nervosa indicated they were 56 times more likely than those without an eating disorder to engage in self-harm, including attempted and successful suicide attempts. Also, women diagnosed with anorexia nervosa were more than twelve times more likely to die from complications linked to anorexia than women without the illness.

There are two types of anorexia nervosa; the restricting type and the binge-eating and purging type. Symptoms of the restricting type include calorie counting, meal skipping, and limiting specific foods or monitoring food intake. Someone with this type of anorexia nervosa may also omit particular food categories and follow strict rules regarding food.

Someone with the binge-eating and purging type of anorexia nervosa will eat and then purge what they have eaten. This form of anorexia is not to be confused with bulimia nervosa, although it shares similar symptoms.

What are the Symptoms of Anorexia Nervosa?

The symptoms of anorexia nervosa include struggles with perceptions about body weight and food. People with this condition often have an intense fear of gaining weight, low body weight, and a distorted perception of “ideal” body weight. Someone who struggles with anorexia nervosa places an abnormally high value on controlling body shape and size and will do “whatever is needed” to maintain weight.

The signs and symptoms of anorexia nervosa include the following:

Behavioral Symptoms:

• Restricted food intake (through fasting or dieting)
• Skipping meals
• Not eating in public
• Frequent weight checking
• Lying about food consumption
• Excessive exercise
• Rigid eating rituals

Emotional Symptoms:

• Intense fear of gaining weight
• Distorted perception of “ideal” body weight
• High value placed on controlling body shape and size

Physical Symptoms:

• Abnormal blood counts
• Dizziness
• Extreme weight loss
• Insomnia
• Fainting spells
• Stomach problems
• Irregular heartbeat
• Exhaustion
• Thinning hair or hair loss
• Irregular menstruation (in females)

What is Bulimia Nervosa?

Bulimia nervosa is characterized by instances of binging and purging, unlike anorexia which involves severely restricted food intake. Someone with bulimia nervosa will binge on food and then forcibly purge the food from their body. Purging is often accomplished by laxative use or (more commonly) self-induced vomiting. Other symptoms someone with bulimia nervosa may exhibit include anxiety, bad breath, weight changes, food aversions, hunger, and problems with dental hygiene. Bulimia is believed to affect as many as three percent of women and less than one percent of men. It is almost nine times more likely to occur in women than men and has a mortality rate of around four percent.

While bulimia nervosa is not as common or well-known as other eating disorders, it is a severe and potentially life-threatening condition. Different than anorexia, bulimia nervosa involves eating rather than intentionally restricting calories. The Diagnostic and Statistical Manual of Mental Disorders (DSM) lists several specific diagnostic criteria for bulimia nervosa that set the illness apart from anorexia nervosa.

For medical or mental health providers to diagnose bulimia nervosa, you must experience recurrent episodes of binge eating followed by behavior to “compensate” for binge eating. Compensatory behaviors may include self-induced vomiting, laxative abuse, diuretic abuse, or misuse of other medications designed to enhance weight loss. The DSM explains binge eating as consuming an abnormally large amount of food in a specific period (usually 2 hours).

This amount of food is more considerable than most people would consume in the same period under similar circumstances. Moreover, there is a distinct lack of control over eating behaviors during this period. In addition to binging and compensating, you must engage in both binging and compensating at least once per week for three months.

What Are The Symptoms of Bulimia Nervosa?

The symptoms of bulimia nervosa include a range of emotional, behavioral, and physical signs as below:

Behavioral Symptoms:

• Uncomfortable eating around others
• Frequent trips to the restroom after eating
• Skipping meals
• Trying “fad diets”
• Drinking excessive amounts of water
• Creating rituals around binging and purging
• Withdrawing from others
• Consistently checking the mirror
• Fixating on weight
• Eating in secret
• Experiencing extreme mood swings

Emotional Symptoms:

• Primary concern with food and weight loss
• Attitudes indicating a preoccupation with dieting and body image

Physical Symptoms:

• Reduced immunity
• Notable weight changes
• Stomach problems
• Chills
• Problems sleeping
• Cuts or bruises on the tops of the fingers (from inducing vomiting)
• Dental problems
• Dry skin and nails
• Thinning and brittle hair
• Poor wound healing

What’s the Difference Between Anorexia Nervosa and Bulimia Nervosa?

Anorexia nervosa and bulimia nervosa are both serious eating disorders, but they differ significantly in their behaviors and symptoms. Anorexia is characterized by extreme food restriction and an intense fear of weight gain, often leading to severe underweight conditions. 

In contrast, bulimia involves cycles of binge eating followed by purging, with individuals often maintaining a normal weight. Both disorders have serious emotional and physical consequences, but anorexia has a higher mortality rate. Understanding these differences is crucial for effective diagnosis and treatment.

Feature	Anorexia Nervosa	Bulimia Nervosa
Definition	An eating disorder characterized by extreme weight loss and a distorted body image.	An eating disorder marked by episodes of binge eating followed by purging.
Eating Behavior	Severe restriction of food intake; may include skipping meals and calorie counting.	Binge eating is followed by compensatory behaviors like vomiting or laxative use.
Body Weight	Typically underweight; significant weight loss.	Weight can be normal, underweight, or overweight; fluctuations are common.
Compensatory Behaviors	May include purging (in the binge-eating/purging type) but primarily involves restriction.	Frequent purging through vomiting, laxative use, or excessive exercise.
Emotional Symptoms	Intense fear of gaining weight; distorted body image.	Preoccupation with food, weight, and body image; extreme mood swings.
Physical Symptoms	Low blood pressure, dizziness, extreme weight loss, irregular heartbeat.	Notable weight changes, dental problems, cuts on fingers from vomiting.
Demographics	Affects primarily women, with a higher prevalence in teens.	More common in women, but also affects men; occurs in various age groups.

Seeking Eating Disorder Help at The Los Angeles Outpatient Center

Recovery from an eating disorder like anorexia nervosa or bulimia nervosa is possible with treatment. Unfortunately, those who do not get help at an eating disorder treatment program like ours at The Los Angeles Outpatient Center are at an increased risk for ongoing physical and emotional complications. There is also an increased risk of acute medical emergency and death for some. Treatment to address eating disorders is most successful when started as soon as possible. Research indicates that early medical intervention, therapy, and mental health support can help you begin your recovery journey before the dangerous medical and emotional effects of eating disorders have a lasting impact on your overall health and well-being.

An inpatient or residential treatment is typically the most beneficial treatment environment for someone ready to heal from an eating disorder. It is crucial to participate in a therapeutic program that addresses all aspects of your health, including physical, psychological, and spiritual wellness. Our eating disorder treatment programs at The Los Angeles Outpatient Center include mental health care, medical interventions, therapy, and nutritional counseling to ensure you can safely learn more about your eating disorder and how to put a troubled relationship with food in the past.

If you or a loved one struggles with symptoms of an eating disorder such as anorexia nervosa or bulimia nervosa, it is crucial to seek help. Eating disorders do not (typically) resolve on their own. In fact, symptoms often worsen, leading to significant and potentially dangerous physical and emotional health complications. At The Los Angeles Outpatient Center, our team will work with you to develop a treatment program to help you overcome and heal from an eating disorder. Let us help you begin your journey to recovery. Contact us today to learn more about our Los Angeles-based treatment programs.

---