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Key takeaways
Anorexia nervosa and bulimia nervosa are serious mental health conditions characterized by unhealthy eating habits and a negative body image, with anorexia involving extreme dieting or exercise for weight loss, and bulimia involving binging and purging cycles.
Risk factors for both anorexia and bulimia include genetic predispositions, mental health issues such as depression and anxiety, low self-esteem, and societal pressures emphasizing thinness, with some differences in specific triggers and conditions.
Diagnosis of anorexia requires meeting DSM-5 criteria including low body weight, fear of gaining weight, and a distorted self-view of body shape, whereas bulimia diagnosis involves criteria like recurrent binge eating and compensatory behaviors.
Treatment options for anorexia and bulimia both involve a combination of psychotherapy (such as cognitive behavioral therapy), medication, and nutritional counseling, with the severity of the condition sometimes necessitating hospitalization.
Anorexia vs. bulimia causes | Prevalence | Symptoms | Diagnosis | Treatments | Risk factors | Prevention | When to see a doctor | FAQs | Resources
Eating disorders are complex and serious mental health conditions that involve the development of unhealthy eating habits as well as negative body image that often leads to malnutrition. There are multiple types of eating disorders, two of which are anorexia nervosa and bulimia nervosa. These conditions are commonly abbreviated to “anorexia” and “bulimia.”
Anorexia nervosa is characterized by weight loss due to extreme dieting, starvation, or too much exercise. Those with anorexia have difficulty maintaining a healthy body weight in consideration of height and age. Bulimia nervosa is characterized by a cycle of binging and purging through self-induced vomiting, use of laxatives, exercise, or fasting.
Causes
Anorexia
Anorexia can occur simultaneously with another mental illness such as depression, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), or another anxiety disorder. Low self-esteem and striving for perfection are also common traits. History of trauma including physical, sexual, or emotional abuse can make people susceptible to developing an eating disorder—the condition serving as a control mechanism when facing trauma.
Media and culture emphasize thinness as a beauty standard which puts pressure on young people, especially girls, to have this body type. Professions or sports that emphasize thinness such as ballet, figure skating, running, and modeling can put pressure on individuals. Anorexia often runs in families which suggests that genetics are a factor in its development, although the link between genes and anorexia is still being researched.
Bulimia
Since eating disorders are illnesses that focus on food and body image, the risk factors of anorexia and bulimia are similar and can overlap. Risk factors of bulimia can include low self-esteem, history of trauma, media and social media influences, and more. View the table below for a more comprehensive list of anorexia and bulimia risk factors.
| Anorexia vs. bulimia causes | |
|---|---|
| Anorexia | Bulimia |
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Prevalence
Anorexia
A quarter of those with anorexia are male. Men have an increased risk of dying because they are diagnosed much later than women. This could be in part due to the misconception that men do not experience eating disorders. Additionally, eating disorders are the second most deadly mental illness (behind opiate addiction).
Bulimia
Researchers followed a group of 496 adolescent girls in a U.S. city over a span of eight years and found that by the age of 20 more than 5% of the girls met the criteria for anorexia, bulimia, or binge eating disorder. The median age of eating disorder onset was 18 years old for anorexia and bulimia nervosa.
| Anorexia vs. bulimia prevalence | |
|---|---|
| Anorexia | Bulimia |
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Signs and symptoms
Anorexia
Signs and symptoms of anorexia point to methods of losing weight and control of the individual’s weight. An individual will likely not have all signs/symptoms of anorexia and the following are a few common signs and symptoms, not a full list. Behavioral signs of anorexia include the development of food rituals, avoidance of mealtimes, denial of hunger, purging, excessive exercise regimen, excessive dieting, and withdrawal from social activities. Physical signs/symptoms of anorexia include dramatic weight loss, dizziness, abdominal pain, feeling cold often, dental problems, brittle hair and nails, thinning of hair, and muscle weakness.
Bulimia
Similar to anorexia, signs and symptoms of bulimia point to the prevention of weight gain and self-evaluation of one’s body shape and weight. An individual will likely not have all signs/symptoms of bulimia and the following are a few common signs and symptoms, not a full list. Behavioral signs and symptoms of bulimia include purging after meals, packages of laxatives or diuretics, trips to the bathroom after meals, signs of vomiting, large amounts of wrappers, development of food rituals, excessive water consumption, hoarding food, use of excessive mouthwash or mints/gum, excessive exercise regimen, withdrawal from social activities, and excessive dieting.
Physical symptoms of bulimia include discolored teeth, fluctuations in weight, abdominal pain, dizziness, feeling cold often, brittle nails, muscle weakness, menstrual irregularities, and cuts on the top of finger joints that signifies induced vomiting.
| Anorexia vs. bulimia symptoms | |
|---|---|
| Anorexia | Bulimia |
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Diagnosis
Anorexia
Three criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) must be met for a person to be diagnosed with anorexia nervosa. These criteria include low body weight in consideration of an individual’s age, sex, developmental trajectory, and physical health; fear of gaining weight despite a normal current weight, and disturbance in the way an individual views body weight or shape. A healthcare provider will perform a physical examination and ask about diet history, medical history, current medications, family history of eating disorders, and mental health disorders.
Blood tests or an electrocardiogram may be performed to check if physical illness may be a cause of weight loss.
Bulimia
Five criteria from the DSM-5 must be met to be diagnosed with bulimia nervosa. This includes recurrent episodes of binge eating, inappropriate compensatory prevention of weight gain such as purging, binge eating, and inappropriate compensatory behavior occur at least once a week for three months, self-evaluation is influenced by body shape and weight, and that these behaviors do not occur exclusively during episodes of anorexia nervosa. If an individual shows signs of bulimia, a healthcare provider will conduct tests to confirm a diagnosis and determine if weight loss is a result of a different condition. This may include a physical exam, lab tests, X-rays, electrocardiograms, and psychological evaluation.
| Anorexia vs. bulimia diagnosis | |
|---|---|
| Anorexia | Bulimia |
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Treatments
Anorexia
Eating disorders affect the body and mind, therefore treatment options for anorexia include a combination of psychotherapy, medication, and nutritional counseling. Cognitive behavioral therapy (CBT) is a common form of psychotherapy that helps a patient change their thoughts and behaviors surrounding their distorted views about weight and appearance. Family-based treatment advises family members on how to support the person with anorexia in the recovery process.
Medication to treat anxiety or depression, or to aid in weight gain, may be prescribed. An individual can be hospitalized due to severe weight loss, malnutrition, or other physical complications. A serious complication called refeeding syndrome needs to be treated in a hospital and occurs in severe cases when a malnourished person’s body can’t properly metabolize when given nutrition again.
Bulimia
Similar to anorexia, treatment for bulimia includes a combination of psychotherapy, medication, and nutritional counseling to break the binging and purging cycle, correct distorted thinking, change behaviors. CBT and family-based treatment are common forms of treatment in the recovery process.
Antidepressant and anxiety medication can be prescribed. In severe cases of physical illness as a result of eating behavior, an individual may be hospitalized until weight and health are stabilized.
| Anorexia vs. bulimia treatments | |
|---|---|
| Anorexia | Bulimia |
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Risk factors
Anorexia
Biological, psychological, and social factors can play a part in the development of an eating disorder. Eating disorders, including anorexia, affect a wide range of people, and risk factors interact differently for each individual. Risk factors for anorexia include having a family member with an eating disorder or mental health disorder, history of dieting, Type 1 diabetes, anxiety disorders, substance use disorders, negative body image, perfectionism, and other health problems. Social factors such as pressure to be thin, being a victim of bullying, professions or sports that emphasize thinness, and loneliness can lead to eating disorders as well.
Bulimia
Bulimia has the same risk factors as anorexia as eating disorders have similarities in their development. Overeating and bingeing large amounts of food can be compounded by these risk factors.
| Anorexia vs. bulimia risk factors | |
|---|---|
| Anorexia | Bulimia |
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Prevention
Prevention for eating disorders generally involves reducing risk factors such as depression, anxiety, low self-esteem, and negative self-image. One form of prevention is through treatment programs that focus on building self-esteem, a healthy diet, a healthy exercise regimen, and discussing cultural values. Prevention in children and adolescents can be nurtured at home as parents can foster self-esteem, positive body image, healthy dieting, and the danger of emotional eating.
| How to prevent anorexia vs. bulimia | |
|---|---|
| Anorexia | Bulimia |
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When to see a healthcare provider for anorexia or bulimia
Signs an individual may be developing anorexia or bulimia include unusual changes in a person’s weight, body mass index, exercise routine, or eating habits. A parent should schedule a check-up with a healthcare provider if they’re concerned that their child has an eating disorder.
An individual with anorexia or bulimia may be hospitalized due to weight loss and malnutrition until health is stabilized. Physical complications that should be screened for hospitalization include unstable heart rate, low blood pressure, hypothermia, fainting, and blood in vomit.
Frequently asked questions about anorexia and bulimia
Are anorexia and bulimia the same?
No, anorexia and bulimia are both eating disorders but they have different characteristics and diagnostic criteria. Anorexia is characterized by weight loss by extreme dieting, starvation, or too much exercise while bulimia is characterized by cycles of binging and purging.
What are the causes of anorexia and bulimia?
Eating disorders such as anorexia and bulimia result from a combination of biological, psychological, and social factors. Eating disorders run in families, suggesting a genetic component. Those with eating disorders often have comorbid mental disorders such as depression and anxiety as well as other psychological characteristics such as low self-esteem and strive for perfectionism. Social pressure to be thin through media, certain professions, and sports can also contribute to the development of an eating disorder.
What are forms of treatment for eating disorders?
Treatment for eating disorders often includes a combination of psychotherapy, medication, and nutritional counseling. Cognitive behavioral therapy (CBT) is a form of psychotherapy that focuses on changing a person’s thoughts and behaviors surrounding food and body image. Medication to treat anxiety or depression may be prescribed as well.
How do the recovery rates differ for anorexia and bulimia?
According to the University of California San Francisco, 21% of anorexia patients make a full recovery and 75% make a partial recovery. A 2017 study found that 68.2% of participants with bulimia nervosa recovered. Overall, 60% of those who have received eating disorder treatment make a full recovery.
Resources
- Dual diagnosis and co-occurring disorders, Eating Disorder Hope
- Warning signs and symptoms, National Eating Disorders Association (NEDA)
- Anorexia nervosa diagnosis and tests, Cleveland Clinic
- Anorexia management and treatment, Cleveland Clinic
- Bulimia nervosa management and treatment, Cleveland Clinic
- For referring physicians, Stanford Children’s Health
- Bulimia nervosa, Mayo Clinic
- Bulimia diagnosis, Walden Eating Disorders
- Risk factors, NEDA
- An 8-year longitudinal study of the natural history of eating disorders, Journal of Abnormal Psychology
- Prevention programs, National Eating Disorders Collaboration
- Many patients with anorexia nervosa get better, but complete recovery elusive to most, UCSF
- Recovery from anorexia nervosa and bulimia nervosa at 22-year follow-up, The Journal of Clinical Psychiatry