Understanding the difference between bulimia and anorexia

Eating disorders are mental health conditions that affect a person’s eating habits and attitude toward food. Each eating disorder has its own unique symptoms, but they can all lead to serious health issues, including anxiety, depression, malnutrition, and organ failure. Two common eating disorders are anorexia nervosa and bulimia nervosa.

Anorexia and bulimia both cause people to fixate on body image and food, but they involve different approaches for preventing weight gain or losing weight. Both conditions are more common in people who were assigned female at birth, and the average onset happens at age 18. With both anorexia and bulimia, early intervention and access to appropriate care are essential for recovery and healing.

What is bulimia nervosa?

Bulimia nervosa, commonly referred to as bulimia, is an eating disorder that causes binging and purging. Binging is when a person consumes large amounts of food at one time, and purging involves compensatory behaviors to get rid of the food and prevent weight gain. Some examples of compensatory behaviors include vomiting, taking laxatives, fasting, and excessive exercising.

To be diagnosed with bulimia, a person must engage in repeated episodes of binge eating and purging at least once a week for three months. People with bulimia feel that they cannot stop or control their eating and that their sense of self is influenced by their body weight and shape.

Bulimia symptoms

The leading sign of bulimia is a pattern of overeating followed by compensatory behaviors to prevent weight gain. Bulimia occurs on a spectrum, with mild cases involving 1 to 3 compensatory behaviors per week and extreme cases including as many as 14 per week or more. 

Other common behavioral and emotional signs of bulimia include:

• Feeling guilty about eating
• Obsession with body image
• Food disappearing or appearing in unusual places
• Withdrawing socially from friends and family
• Mood swings, depression, and irritability 

Bulimia can also cause physical signs and symptoms, like:

• Swollen cheeks or jawline
• Bloodshot eyes
• Dehydration
• Gastrointestinal problems, like constipation, stomach cramps, and acid reflux
• Fainting
• Irregular menstrual periods
• Calluses on the back of the hands from self-induced vomiting 

What is anorexia nervosa?

Anorexia nervosa is a serious eating disorder characterized by extremely restricted food intake. People with anorexia try to keep their weight as low as possible by severely limiting their food, eating small quantities of only certain foods, or avoiding food altogether. 

An anorexia diagnosis is based on three main criteria:

• Severe restriction of calories, which causes low body weight relative to a person’s age, sex, height, and stage of growth
• Intense fear of gaining weight
• Having a distorted view of body shape or weight, leading to low self-worth

There are two main subtypes of anorexia: restrictive and binge-purge. People with restrictive anorexia severely limit their food consumption, while those with binge-purge anorexia may also engage in episodes of binge eating and purging.

Anorexia symptoms

Anorexia can cause a range of emotional, behavioral, and physical symptoms.

Emotional symptoms include:

• Intense fear of gaining weight
• Distorted body image or denial that thinness is a concern
• Being self-critical
• Feelings of irritability or depression

Behavioral symptoms include:

• Extremely restricted eating
• Avoiding eating around other people
• Obsession with calorie counting and dieting
• Hiding weight loss with baggy clothing
• Compulsive exercising

Physical symptoms include:

• Noticeable weight loss 
• Extreme thinness 
• Brittle nails
• Thinning hair
• Dry skin
• Low blood pressure
• Severe constipation
• Anemia 

Three key differences between bulimia and anorexia 

Although there are several similarities between bulimia and anorexia, it’s important to remember that they’re distinct conditions. Here are three key differences. 

1. Eating behaviors: People with anorexia typically severely limit their food intake, while a key feature of bulimia is consuming an excessive amount of food in a short period of time. 
2. Compensatory behaviors: People with bulimia routinely engage in compensatory behaviors after they eat, like purging, fasting, or excessive exercise. 
3. Body weight: To be diagnosed with anorexia, a person must be significantly underweight for their age, sex, height, and stage of growth. To be diagnosed with bulimia, a person must engage in compensatory behaviors to prevent weight gain, but their actual weight is not a criteria for diagnosis. 

Can you have both anorexia and bulimia?

There are some overlapping symptoms between anorexia and bulimia. However, the main difference is that a person diagnosed with anorexia has a low body weight, intense fear of weight gain, and reduction in food intake. Someone diagnosed with bulimia will feel out of control and eat a large amount of food in a short time. What follows is a type of behavior that compensates for the binge, such as purging (like vomiting or excessive use of laxatives or diuretics), fasting, or excessive exercise. 

If a person has symptoms that align with both conditions, they will most likely be diagnosed with the binge-eating/purging subtype of anorexia, rather than both conditions as separate diagnoses. 

Treatment options for bulimia and anorexia

When treating anorexia or bulimia, most people benefit from a collaborative approach that integrates medical, mental, and nutritional care. Anorexia can lead to malnutrition, so it’s important to work with a nutritionist or dietician to restore healthy weight. 

From there, a combination of talk therapy and medication management can help people develop healthier coping methods, manage symptoms, and address co-occurring conditions. Cognitive behavioral therapy (CBT) is an effective form of therapy for helping people identify and challenge unhealthy beliefs and behaviors around eating and body image.

Find care with Rula

With access to the right resources and support, it’s possible to treat anorexia nervosa, bulimia nervosa, binge eating disorder, and other serious eating disorders. For many people, the first step toward recovery is finding a qualified mental health professional. Rula can connect you with a therapist who is taking new clients, accepts your insurance, and can help you develop a healthier relationship with food and your body. 

With Rula’s easy-to-use therapist-matching program, you can find the right provider for your needs in less than 30 seconds and begin treatment as soon as tomorrow. And if medication management is part of your treatment plan, we can connect you with a psychiatric provider to find the right solution for you. 

Find a therapist with Rula