Anorexia nervosa and bulimia nervosa are different types of eating disorder. Eating disorders are psychological conditions that involve complicated relationships with body image and food. People with these conditions develop unhealthy eating habits and experience mental and physical symptoms.

According to a 2019 study, about 8 in 100 females and 2 in 100 males experience an eating disorder during their lifetime. Eating disorders are a group of mental health conditions that involve problematic eating and can lead to significant physical complications.

There are several types of eating disorders. This article will focus on two specific eating disorders: anorexia nervosa and bulimia nervosa, which people typically refer to as anorexia and bulimia, respectively.

The average onset of eating disorders is 18 years for anorexia and bulimia.

Eating disorders are not a lifestyle choice. They can severely disrupt a person’s emotions, thoughts, and eating behaviors.

In this article, learn more about the symptoms of anorexia and bulimia, the differences between these conditions, and when to seek help.

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The primary difference between the conditions is that a person with anorexia may use strategies to lose or avoid gaining weight. A person with bulimia typically uses strategies to “purge” the food from their system following episodes of binge eating.

According to the National Institute of Mental Health (NIMH), people with anorexia and bulimia fixate on their body weight, shape, and food. Some people with anorexia may be seriously underweight but unable to recognize this fact.

There are other key differences between anorexia and bulimia.

Anorexia nervosa

A person with anorexia may display the following behaviors:

  • eating very little, avoiding foods high in calories, or missing meals completely
  • being dishonest about what they eat and their body weight
  • wearing baggy clothes to avoid revealing how thin they are
  • taking medication to reduce hunger
  • having rituals around eating
  • weighing themselves often
  • exercising excessively, which may result in fainting
  • seeing themselves as overweight even when they are underweight

Some people may have a subtype of anorexia called binge-purge anorexia. These individuals will severely limit their food intake much of the time but also have periods of eating large amounts of food in a short time. After binge eating, they will purge by taking laxatives or diuretics or making themselves vomit.

Anexoria is a serious health condition that may lead to death through suicide or complications linked to starvation. According to the NIMH, people with anorexia often experience other mental health conditions, such as anxiety.

According to a 2019 article, there is an underreporting of males living with eating disorders, the numbers of whom may be rising.

Bulimia nervosa

The primary characteristic of bulimia is recurrent episodes of binge eating, after which a person will purge. An episode may involve overeating and then vomiting, using laxatives, or administering enemas to eliminate the consumed calories. People living with bulimia may have a normal weight or be slightly overweight or underweight.

Learn more about bulimia.

Classification of eating disorders

Classifications for eating disorders have recently changed. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) now includes binge eating disorder (BED) and avoidant/restrictive food intake disorder (ARFID). The DSM-5 has also reclassified eating disorders as feeding and eating disorders (FEDs).

Learn more about the different types of eating disorder.

According to the United Kingdom’s National Health Service (NHS), physical symptoms of anorexia include:

Some physical signs and symptoms of bulimia include:

  • feeling weak and tired
  • having a swollen or sore throat or neck due to vomiting
  • bad breath or a tear in the throat linked to stomach acid
  • a face that seems puffy
  • self-harming in other ways
  • acid reflux
  • abdominal pain or bloating
  • oral health problems, such as tooth loss or broken teeth
  • severe dehydration
  • electrolyte imbalances, which can cause health problems
  • irregular periods
  • fits and muscle spasms
  • bone issues, including osteoporosis or porous bones, which may be more prone to breaking

People of all body types and weights can have eating disorders.

Learn more about the signs of an eating disorder.

A healthcare professional will perform a physical examination and ask a person about their symptoms and medical history.

A person may find it difficult to talk about their relationship with food, but it is important to be honest. The person may undergo blood, urine, and EKG tests to check their health. A healthcare professional may also check their kidney and bone health.

Support and encouragement from loved ones can be important, helping a person receive an accurate diagnosis and intervention early. This is especially true for children and adolescents whose parents or caregivers may have to accompany them when they seek treatment.

Anyone who suspects that they may have an eating disorder should seek professional medical help. Healthcare professionals can provide nutritional and psychological help and monitor psychiatric well-being. The aims of treatment include:

  • addressing any health consequences of the disorder
  • tackling underlying psychological issues, such as depression, low self-esteem, or trauma, which may have initiated the disordered eating behaviors
  • aiming to restore a healthy body weight

Treatment will involve a multidisciplinary team, including a dietitian, primary care physician, therapist, and psychiatrist. A medical professional with experience in treating eating disorders should coordinate the approach.

Types of treatment include:

  • nutritional counseling to help correct nutritional imbalances and maintain a healthy body weight
  • medical treatment for the physiological complications of eating disorders, such as anemia or acid reflux
  • support groups to draw on the experiences of others
  • family-based treatment for families with adolescents
  • therapy, such as cognitive behavioral therapy (CBT)
  • medication for underlying mental health conditions, such as depression and anxiety
  • in-patient stay if the person is having thoughts of suicide or has severe health problems, such as organ failure
  • aftercare to help resolve underlying issues relating to the eating disorder

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 800-273-8255.

Click here for more links and local resources.

Therapy

There are various types of therapy for eating disorders. What works well for one person may not be effective for someone else. Choosing the right therapy also depends on a person’s stage of recovery.

Types of therapy for eating disorders include:

  • CBT and enhanced CBT (CBT-E): This short-term form of therapy targets the values, beliefs, and brain processes that underpin disordered eating behaviors.
  • Family-based treatment (FBT): FBT includes all family members in a home-based treatment. It enables adolescents with eating disorders to regain control of their eating, interrupt disordered behaviors, and achieve a healthy weight.
  • Dialectical behavior therapy (DBT): DBT aims to change a person’s behaviors and help them develop skills to replace disordered behaviors. The skills that a person will learn include practicing mindfulness, improving interpersonal relationships, tolerating distress, and regulating emotions.
  • Interpersonal psychotherapy (IPT): IPT focuses on improving interpersonal relationships and communication. Just as difficult interpersonal relationships can trigger the onset of eating disorder symptoms, developing healthy relationships can reduce the symptoms.
  • Cognitive remediation therapy (CRT): CRT targets the rigid thinking processes common among people with anorexia. A therapist can help a person build their ability to focus on more than one thing at a time.
  • Acceptance and commitment therapy (ACT): ACT requires a person to change their actions rather than their emotions. People identify their core values and goals that fulfill them. By living in line with their core values, they can start to feel better. This may work better for some people than simply focusing on trying to feel better.
  • Psychodynamic psychotherapy: This type of therapy aims to discover the root cause of the eating disorder. The theory is that symptoms reveal the underlying needs of a person with an eating disorder and that working through the issues can help resolve the eating disorder.

The recovery from an eating disorder generally takes some time. A person can go through several stages of change as they recover.

The stages involved in a person’s recovery include:

  • accepting that they have a problem
  • knowing that they should do something about it
  • preparing to change and taking action to confront their eating disorder while trusting their team of medical specialists
  • practicing and maintaining new behaviors

A person may sometimes relapse and return to old behaviors.

A person at risk of relapse should ask for help, communicate the issues they are facing, and try to resolve problems that arise.

A person may continue to experience certain health complications, such as infertility and anemia, after resolving their eating issues.

Many people who have experienced an eating disorder benefit from long-term support. It can help to return to therapy or support groups even after long absences, especially during times of stress.

People with eating disorders generally need support from those around them to recover. People can show support by:

  • avoiding mentioning the person’s appearance or weight
  • finding out more about eating disorders, as understanding the issues makes supporting someone easier
  • encouraging the person to seek professional help and supporting them to take the first steps
  • including the person in social gatherings and encouraging them to take part in their usual activities
  • building up their self-esteem through positive messages of appreciation
  • spending time with them
  • listening to the person and trying not to criticize them or give advice
  • avoiding talk about dieting, exercise, or food
  • avoiding embarrassing a person about their eating disorder or making judgmental comments

People living with anorexia and bulimia use strategies to avoid gaining weight or reduce their weight. People with anorexia may avoid eating altogether, whereas people with bulimia have episodes of binge eating and then purge their body of food.

Eating disorders often occur alongside other mental health conditions. Therapy can help people address any underlying issues and build a healthier perception of their body and eating.

Anyone with symptoms of an eating disorder should seek help from a healthcare professional. Prolonged eating disorders can harm a person’s mental and physical health.

If a person suspects that a loved one has an eating disorder, they should encourage them to seek help without blaming or judging them.