What Is the Difference Between Anorexia and Bulimia?

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Anorexia and BulimiaAnorexia nervosa and bulimia nervosa are eating disorders that are among the most commonly seen in the American population. Anorexia is a condition where someone attempts to lose weight to the point of dangerous levels of starvation. Bulimia is characterized by periods of binge-eating followed by purges through induced vomiting and/or defecation.

The two conditions possess significant differences from each other, but also a number of overlapping traits. Complicating matters further is that it is possible for someone to experience both disorders simultaneously.

Symptoms and Manifestation: The Key Differences Between Anorexia and Bulimia

Anorexia and bulimia are both inherently psychological conditions based around certain repeated, ritualistic activities and a distorted relationship with their diets and self-perception. There are clear contrasts between the two conditions based both on their psychological and physical symptoms.

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Physical Signs of Anorexia Nervosa

  • Significant weight loss
  • Dry, yellowy skin
  • In women, the menstrual period will become erratic or stop entirely
  • The growth of “lanugo”, a type of fine downy hair on the face and arms
  • Distended abdomen
  • Tooth decay, bone loss, heart palpitations, and other presentations of nutritional deficiency
  • Loss of sex drive
  • Cold limbs at normal room temperature
  • More prone to kidney stones and failure
  • Skin bruises more easily

Physical Signs of Bulimia

  • Sudden weight gain/loss due to binging or purging
  • Swollen salivary glands
  • Dehydration
  • Electrolyte imbalance
  • Erosion of teeth
  • Gastric reflux
  • Inflammation of the esophagus
  • Bloating
  • Dry or loose skin
  • Thin or dull hair
  • Mouth sores or sore gums
  • Teeth marks or calluses on the knuckles (from inducing vomiting)
  • Swelling and soreness in cheeks

Shared Physical Signs

As both anorexia and bulimia can result in nutritional deficiencies and extreme weight loss, there is overlap in what physical symptoms can appear. Most notably, low blood pressure, mood swings, weakness, physical deterioration, hormone imbalances, constipation, and bad breath can all occur among both conditions. Many of anorexia’s signs can also appear in bulimic individuals.

People with anorexia or bulimia are capable of becoming pregnant and carrying a child to term. However, the risks of miscarriage, stillbirth, premature birth, birth defects, difficult births (like a breach position), and postpartum depression will all be higher.

Psychological Signs of Anorexia Nervosa

  • Intense or obsessive calorie-counting
  • Hesitancy to eat even small amounts
  • Hiding or discarding food or otherwise lying about how much has been eaten
  • Denial of being hungry
  • Social withdrawal or isolation
  • Very specific rituals regarding when, where, how, and what to eat (beyond those of a regular diet)
  • Cutting food into very small portions or move it around on a plate without eating

Psychological Signs of Bulimia Nervosa

  • Secretive behaviour around eating. Bulimics often won’t like to eat around others.
  • Sneaking or hiding food
  • Going through large amounts of food quickly
  • Overuse of laxatives or purgatives
  • Frequent trips to the bathroom, often immediately after eating
  • Displays periods of abnormally large appetite
  • In some cases, sneaky behavior as bulimics attempt to dispose of their vomit

Shared Psychological Signs

Both conditions feature obsessive relationships with food and diet along with intense fear relating to gaining weight. Low self-esteem, anxiety, and depression are common occurrences along with compulsive exercise and an obsession with diets and body shape, along with talking about such things. Anorexics may also abuse laxatives or purgatives but not to the same degree that bulimics do.

One of the more noteworthy signs is body dysmorphic disorder (BDD). For example, a person may believe that some aspect of their appearance is extremely flawed and they need to take excessive measures to fix it. Even with a normal or below-average body weight or dangerous levels of thinness, people with bulimia or anorexia can still see themselves as “fat” or otherwise ugly.

Some with anorexia or bulimia may also have a strong unwillingness to admit they have a problem. This can result in extreme attempts to rationalize their behaviour or see it as either normal or even ideal. Such feelings have resulted in Internet communities that support, encourage, and in some cases glorify anorexia and bulimia.

Making the Diagnoses

Treatment first begins with recognizing and diagnosing the disorder. This is often harder in practice than it sounds, especially in milder cases where the weight loss has not become as pronounced. There are several different illnesses that can result in nutritional deficiencies or sudden weight loss, so your doctor may need to rule those out first. Often it is a mix of physical and behavioral signs that help determine the final diagnoses. Since bulimia has more signature symptoms like dental decay and callused knuckles, less advanced cases are bulimia are comparatively easier to notice than anorexia.

As the conditions progress, anorexia will more likely be noticed. Even if one’s increasingly famished and distended appearance does not attract attention, anorexics will often end up in the hospital due to exhaustion and organ dysfunction or failure. Bulimics are actually capable of maintaining a normal weight and appearance, so extreme cases can go unnoticed for longer stretches.

Treating Anorexia and Bulimia

As mentioned, it’s not uncommon for anorexics and bulimics to be in denial about having a problem. This makes treatment difficult since any long-term success relies on the person giving up eating and lifestyle habits that characterizes their respective condition. Like with any psychological trouble, the first step is to want to change.

Assuming the person in question does want to get better, treatment consists of three main pillars:

  • Getting back to a healthy body weight
  • Resolving or managing any related psychological issues (like depression)
  • Managing the thoughts, actions, or influences that led to the disorder in the first place

These are accomplished through a mixture of doctor-approved food plans, psychotherapy, medicine, and community or personal support. Cognitive-behavior therapy has been known to help as well. It is a form of treatment that helps normalize how one thinks about food and body image and can aid in forming realistic understandings of the body.

Numerous support groups for both disorders also exist, both online and in-person, to provide shared support and comfort to people in recovery.

Read More:

Sources for Today’s Article:
“Anorexia Nervosa Fact Sheet,” Womenshealth.gov, July 16, 2012; http://www.womenshealth.gov/publications/our-publications/fact-sheet/anorexia-nervosa.html#f.
“Anorexia vs Bulimia,” Diffen web site, http://www.diffen.com/difference/Anorexia_Nervosa_vs_Bulimia_Nervosa, last accessed November 12, 2015.
“Bulimia Nervosa-Symptoms,” WebMD web site, November 14, 2014; http://www.webmd.com/mental-health/eating-disorders/bulimia-nervosa/bulimia-nervosa-symptoms.
“Bulimia Nervosa Fact Sheet,” Womenshealth.gov, July 16, 2012; http://www.womenshealth.gov/publications/our-publications/fact-sheet/bulimia-nervosa.html.
“Understanding Anorexia,” WebMD web site, February 28, 2015; http://www.webmd.com/mental-health/eating-disorders/anorexia-nervosa/understanding-anorexia-symptoms.


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Dr. Victor Marchione, MD

About the Author, Browse Victor's Articles

Victor Marchione, MD received his Bachelor of Science Degree in 1973 and his Medical Degree from the University of Messina in 1981. He has been licensed and practicing medicine in New York and New Jersey for over 20 years. Dr. Marchione is a respected leader in the field of smoking cessation and pulmonary medicine. He has been featured on ABC News and World Report, CBS Evening News and the NBC Today Show and is the editor of the popular The... Read Full Bio »