Anorexia vs. Bulimia: What’s the Difference?

Anorexia and bulimia may seem similar, but they are unique eating disorders. Learn more about the difference between anorexia and bulimia and find out how to help someone you care about who you suspect has an eating disorder.

Eating disorders are psychological conditions that distort a person’s relationship with food and their body. This distortion can influence every aspect of a person’s life and impacts their mental health, physical health and social health.

The are several types of eating disorders, but anorexia and bulimia are two of the most common disorders. Despite their differences, anorexia and bulimia share many similarities. These similarities can make it challenging for a person to quickly and accurately identify the disorder.

What’s the Difference Between Anorexia and Bulimia?

By knowing the differences anorexia vs bulimia, you put yourself and your loved ones in a better position to understand and manage the condition that affects your life.

Signs & Symptoms

Every mental health disorder has a series of signs and symptoms that experts use to identify and treat the disorder. Anorexia and bulimia are no different. Being able to recognize their signs and symptoms allow people to better recognize the disorder in themselves, friends or family members. The sooner someone receives treatment for their eating disorder, the faster they can resume a healthy lifestyle.

Anorexia

Also known as anorexia nervosa, anorexia has several symptoms that medical professionals look for in a diagnosis. The symptoms of anorexia include:

• The restriction of energy intake (i.e., a reduced amount of food and drinks consumed) leading to a very low weight
• An intense fear of gaining weight or “being fat”
• Consistent behaviors that make weight gain impossible
• Flawed ability to accurately view their body

Professionals rate the intensity and severity of anorexia by a person’s body mass index (BMI), which is a calculation of their height and weight. As a person’s BMI decreases, the severity of anorexia increases.

People with anorexia may display other signs and symptoms including:

• Low self-esteem
• Poor body image
• Inconsistent or undesirable relationships
• Focusing on weight, dieting and calories
• Skipping meals
• Viewing self as much larger than reality
• Withdrawing from friends and social opportunities
• Struggling in school or work

The warning signs of anorexia can be challenging to observe, but weight loss and low BMI will are clues about the possibility of the condition.

Bulimia

The signs and symptoms of bulimia overlap with anorexia and involve an individual focusing on their weight and being thin. Bulimia nervosa is characterized by bingeing and purging behaviors.

Bingeing, or binge eating, is marked by:

• Eating an exceptionally large amount of food over a specific period
• A total lack of control during this period of binge eating

Purging is finding an extreme way to prevent weight gain from the food consumed including:

• Vomiting
• Abusing laxatives or diuretics
• Fasting
• Excessive exercising

Additionally, to be diagnosed with bulimia users must binge and purge at least once per week for three months and disproportionately base their self-worth on physical appearance, weight and body shape.

Whereas anorexia grades severity based on BMI, bulimia bases severity on the number of purging episodes completed during a week. The severity is:

• Mild with 1 – 3 episodes per week
• Moderate with 4 – 7 episodes per week
• Severe with 8 – 13 episodes per week
• Extreme with 14 or more episodes per week

Like anorexia, people with bulimia may show additional signs and symptoms like:

• Low self-esteem
• Poor body image
• Inconsistent or undesirable relationships
• Focusing on weight, dieting and calories
• Withdrawing from friends and social opportunities
• Struggling in school or work
• Being secretive or very focused on food
• Disappearing after meals

People with bulimia are more likely than those with anorexia to be at an average weight for their age group.

Relationship to Food

Eating disorders always influence a person’s relationships with eating and food. However, people with anorexia and people with bulimia have slightly different relationships with eating and the food they do or do not consume.

Anorexia

With anorexia, the person’s relationship with food is based on strong and complete control. The person is methodical and meticulous when it comes to what they eat, when they eat and how much they eat. Their behavior is planned and carried out with precision.

People with anorexia sometimes build rituals and routines around eating by only eating a certain food at certain times.

Bulimia

People with bulimia will have an intense focus on food as well, but their relationship is based on a lack of control rather than maintaining full control. During a binge, the person may feel powerless to stop eating after a reasonable amount. After binging, the individual usually feels shameful and guilty about what they did, which fuels the desire to purge again.

Side Effects

Eating disorders can change a person’s mental and physical health by triggering many side effects. Some are so significant that they are irreversible.

Anorexia

The most common side effects of anorexia are:

• Being very thin
• Thin bones and lower bone density
• Thin hair and brittle nails
• Skin that appears dry or yellow
• New growth of fine body hairs
• Constipation
• Low body temperature
• Low energy
• Menstrual changes
• Slowed breathing
• Heart damage with low blood pressure and heart rate
• Brain damage
• Other organ failures

These side effects become more numerous and problematic the longer anorexia continues.

Bulimia

The most common bulimia side effects vary based on the methods of purging and include:

• Sore throat
• Enlarged glands in the neck and jaw
• Tooth decay
• Numerous gastrointestinal problems like acid reflux
• Dehydration
• Imbalance of electrolytes that could result in a stroke or heart attack

Side effects of bulimia may appear slowly and increase in severity as the cycle of binging and purging continues.

Causes

The precise cause of mental health conditions are often impossible to know. Medical professionals have not found a definitive connection between eating disorders and one particular cause. However, some risk factors may increase the likelihood that someone experiences anorexia or bulimia.

Anorexia

Although the exact cause of anorexia is unknown, some factors may influence the development of the eating disorder. The current understanding of anorexia is that several risk factors contribute to the development of the disorder. Anorexia risk factors include:

• A tendency to become obsessive
• Coming from an environment where thinness is valued
• Having a close family member with anorexia

Bulimia

Similar to anorexia, the exact cause of bulimia is unknown, but several risk factors are potential contributors. The risk factors of bulimia include:

• Social anxiety and childhood anxiety
• Depression
• Low self-esteem
• Being concerned about weight early in life
• Childhood abuse
• A belief that being thin is ideal
• Childhood obesity
• Going through puberty at a very young age
• Having family members with bulimia

Is Bulimia or Anorexia More Common?

About 30 million people in the United States will have an eating disorder, like anorexia and bulimia, at some point in their life. However, of the people who have one of the two disorders, bulimia occurs more often than anorexia.

One possible explanation is the stringent criteria for anorexia. Someone could have all the symptoms of the condition, but until their weight is low enough they will not receive the diagnosis.

Anorexia

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), every year about 0.4 percent of young females will meet the criteria for anorexia.  It’s rarer for males to have the condition, though. Research points to 10 females with anorexia for every one male. Other studies find males make up about 25 percent of those with the condition.

Bulimia

More people have bulimia than anorexia. The DSM-5 states that between 1 and 1.5 percent of young females have bulimia. Like with anorexia, little information exists about the condition’s prevalence in men, but women with the condition outnumber men with the condition by 10 to 1.

Age of Onset

Age of onset may refer to the time where symptoms first emerge or when a professional first diagnoses the condition. The age of onset for anorexia is very similar to the age of onset of bulimia.

Anorexia

Anorexia symptoms usually begin during late adolescence or early adulthood. The average age for the onset of anorexia is 18 according to the National Institute on Mental Health.

Bulimia

Interestingly, the average age of onset for bulimia is also 18. Just like anorexia, symptoms of bulimia tend to appear during the late teens or early twenties.

Mortality Rate

Mortality rate is a way to identify how a disorder affects a person’s health and lifespan. A disease with a higher mortality rate signifies more danger and shorter life expectancies. Both anorexia and bulimia have a high mortality rate due to poor physical health and the increased risk of suicide.

Anorexia

Anorexia’s mortality rate is higher than bulimia’s, which suggests that anorexia has a more negative influence on the person’s life than bulimia does. According to the DSM-5, the mortality rate is 5 percent for anorexia and about 12 people per 100,000 with the disorder commit suicide each year.

Bulimia

The DSM-5 states that bulimia’s mortality rate is 2 percent, which is high enough to create concern. People with bulimia also experience a higher risk of suicide than people without the condition experience.

Treatment

Effective treatment methods are available to help people with eating disorders. By utilizing a combination of individual, group and family, and online psychotherapy with medications, symptoms diminish and a desirable level of functioning returns.

Eating disorders may be treated in inpatient or outpatient settings, including online through teletherapy services, depending on the disorder’s intensity and the patient’s medical status. Treatment for eating disorders may also involve medical care and nutritional counseling to confirm the individual is doing well physically and understands the role of healthy eating in their life.

Anorexia

One effective psychotherapy for anorexia is called the Maudsley approach. This style, aimed at teens with anorexia, involves the entire family. The approach places the parents in a position to ensure their child improves their eating habits and gains weight.

The Maudsley approach, combined with medications like antidepressants, mood stabilizers or antipsychotics, can shorten the duration of symptoms.

Bulimia

Bulimia treatment includes use of the same medication groups as anorexia while employing a different therapeutic approach. Cognitive behavioral therapy (CBT) helps a person identify how flawed thinking patterns affect their feelings and behaviors. When distorted thoughts are replaced with healthier ones, beliefs and actions can improve. The goal of CBT is the reduction and eventual elimination of binging and purging behaviors.

Prognosis

Although experts try, it is impossible to accurately predict who will respond well to treatment and who won’t. By investigating risks factors, support networks and stress levels, people can gain a better understanding of the potential prognosis.  

Anorexia

Some people with anorexia will have just one experience with the disorder and then make a full recovery with treatment. Others may have a challenging time with treatment and experience setbacks. According to the DSM-5, most people with anorexia achieve a full remission about five years after symptoms emerge.

Older people may have a poorer anorexia prognosis. They will have more symptoms than younger people and they exhibit their symptoms for longer periods.

Bulimia

Bulimia often begins during a period of high stress and continue for several years for most people. Over time, symptoms seem to diminish regardless if a person seeks treatment. Though it should be noted that professional treatment is linked to quicker recovery and longer periods without binging or purging behaviors.

Anorexia vs. Bulimia: Key Differences and Points

Because there so much information about eating disorders like anorexia and bulimia, it can be easy to confuse the two. Here are some key points to remember about the difference between anorexia and bulimia:

• Anorexia and bulimia are both eating disorders that disrupt a person’s diet and body image
• Anorexia typically involves restricting food intake while bulimia involves eating large amounts of food during binges and compensating with behaviors like vomiting to reduce weight gain
• Anorexia and bulimia adversely impact a person’s mental and physical health, which may contribute to an early death
• Although males can have the disorders, bulimia and anorexia mostly affect females during adolescence and early adulthood
• Anorexia is more dangerous in terms of mortality rate, but bulimia is more common
• Treatment that combines therapy and medication works to reduce and shorten symptoms of the two disorders

Eating disorders are too serious to ignore. The long-term risks of eating disorders are too high, so seeking treatment is encouraged for anyone affected by anorexia or bulimia.

Call The Recovery Village for information about treatment options for substance use disorders and co-occurring disorders like anorexia or bulimia. Our admissions representatives can help you start the treatment process to achieve the healthy future you deserve.

Editor – Thomas Christiansen

With over a decade of content experience, Tom produces and edits research articles, news and blog posts produced for Advanced Recovery Systems. Read more

Medically Reviewed By – Eric Patterson, LPC

Eric Patterson is a licensed professional counselor in the Pittsburgh area who is dedicated to helping children, adults, and families meet their treatment goals. Read more