December 15, 2020

Anorexia vs. Bulimia: Understanding the Similarities and Differences

by | Dec 15, 2020 | Eating Disorders

Anorexia and bulimia are both eating disorders, and eating disorders affect at least 9% of the worldwide population. To date, they are among some of the deadliest mental illnesses, ranking only second to opioid overdoses. 

Unfortunately, eating disorders and body dysmorphia remain largely stigmatized and misunderstood. Many people don’t quite understand how they work, and they may not recognize if someone they love is struggling.

Anorexia and bulimia share many similarities, but it’s important to understand the main differences.

Understand the differences between anorexia, bulimia, and binge eating disorder in this video.

What Is Anorexia? 

Anorexia (short for anorexia nervosa) refers to the intense fear of gaining weight and the obsessive control over food intake. People with anorexia restrict their food severely. Many of them present as underweight, but the weight loss never seems to “be enough.” As a result, their physical and mental health can deteriorate quickly. 

Anorexia can start at any point in someone’s life, but symptoms frequently emerge during adolescence or young adulthood. It affects both men and women, although it may be harder to detect in men.

The common physical anorexia symptoms include:

  • Extreme weight loss (or failure to make appropriate developmental weight gain).
  • Thin, gaunt-like appearance.
  • Insomnia.
  • Dizziness or fainting.
  • Thinning hair (or hair falling out).
  • Menstruation problems or losing a period altogether.
  • Consistently feeling cold.
  • Heart problems.
  • Dehydration.
  • Low blood pressure.
  • Wearing many layers despite it being warm outside. 

The common emotional anorexia symptoms include:

  • Excessive preoccupation with food (frequent meal planning, counting calories, only eating safe foods, cooking for others without eating themselves).
  • Frequently skipping meals or eating very little during standard meals.
  • Engaging in rigid habits around food (only eating at certain times, chewing and spitting out food, allowing only specific foods to touch each other).
  • Feeling out-of-control around food.
  • Refusing to eat in public.
  • Excessive exercise.
  • Immense shame and guilt.
  • Bingeing and purging immediately after eating.
  • Consistently weighing or measuring oneself.
  • Intense anger or sadness about one’s body image.
  • Social withdrawal.
  • Apathetic or depressed mood.
  • Lack of interest in usual activities or relationships.
  • Severe depression and thoughts related to self-harm or suicide.

It’s important to remember that anorexia isn’t just about food or weight. Often, it’s about the need for control. People with anorexia tend to feel overwhelmed and out-of-control with their lives. Anorexia symptoms essentially serve as coping mechanisms to deal with this distress.

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What Is Bulimia? 

Bulimia (short for bulimia nervosa) represents the persistent pattern of bingeing on food and purging to compensate for the intake. People with bulimia may also restrict their food and have intense fears of gaining weight. They may present as underweight, average weight, or overweight.

The common physical symptoms of bulimia include:

  • Excess fatigue.
  • Digestive and gastrointestinal problems.
  • Dangerous tooth decay and gum disease (associated with vomiting).
  • Severe dehydration.
  • Absent or irregular periods.
  • Misuse of drugs or alcohol.
  • Extreme bloating and swelling.
  • Persistent sore throat or horse voice. 
  • Electrolyte imbalances.
  • Fluctuations in weight. 

The common emotional bulimia symptoms include:

  • Eating a large volume of food in a short period of time.
  • Feeling a loss of control when eating.
  • Engaging in purging behaviors after eating (vomiting, excess exercise, laxative abuse, severe restriction).
  • Consistently weighting or measuring oneself.
  • Immense shame and guilt. 
  • Refusing to eat in public.
  • Rigid patterns around food (having only a few safe foods, wanting to know the calories in foods before eating them, refusing to eat at certain times).
  • Co-occurring issues with alcohol or drugs.
  • Lack of interest in usual activities or relationships.
  • Severe depression and thoughts related to self-harm or suicide.

Bulimia behavior can also be very secretive. Some people present “normally” in public, but then binge and purge when alone. Therefore, it may be harder to detect.

To qualify for an official diagnosis, the symptoms must be pervasive. They need to last for at least a few months. Additionally, they usually impact other areas of functioning, like relationships, school, or physical health.

Can Someone Have Anorexia and Bulimia At the Same Time?

There are two different subtypes of anorexia: the restricting type and the binge-eating/purging type (which can sound just like bulimia).

But those who restrict in anorexia accomplish their weight loss via excess dieting, fasting, or exercise. They may binge or purge, but they always restrict. Restricting tends to be the dominant behavior. 

People with bulimia, on the other hand, don’t necessarily engage in restricting behavior (although some do). They also aren’t always underweight.

That said, it’s quite common for people to experience a crossover in eating disorders. Additionally, many more people struggle with disordered eating that doesn’t entirely fit the diagnosis criteria. These individuals may engage in various restricting and bingeing patterns, and they may also struggle with excessive exercise.

What Causes Eating Disorders?

Eating disorders don’t appear to have a single root cause. Instead, health experts postulate that several risk factors may increase one’s chances of developing anorexia. 

Genetics appear to play a prominent role. Eating disorders can run in families, particularly with mothers and daughters. That said, it’s unclear if it’s a distinct biological issue or if it’s the environmental transmission of anxiety, control, and restriction. Source: Mayo Clinic

Other common risk factors include:

  • The presence of other mental health issues like anxiety, depression, or substance use disorders.
  • An early history of dieting and starvation habits.
  • Compounded stress.
  • Perfectionistic tendencies in other areas of life, such as in school or athletics.
  • A history of trauma.
  • Athletic history of participating in weight-focused sports (dancing, wrestling, gymnastics).
  • Weight-related bullying or shaming.

Can Eating Disorders Be Prevented?

There is no evidence that any specific behavior can prevent eating disorders. However, there are some strategies that loved ones can take to promote a healthy lifestyle.

Avoid “diet talk”

Do not label foods as “good” or “bad.” Do not participate in fad diets or extreme weight loss challenges. If you want to eat healthier, do so in a way that practices more moderation and intuition, rather than deprivation. Remember that children watch their parents acutely. If you’re always on a new diet, they learn this kind of behavior is normal.

Aim to Cultivate and Embrace a Positive Body Image 

Body image problems can emerge as early as toddlerhood. It’s essential to practice unconditional positive regard, regardless of your child’s size or weight. Furthermore, try to avoid any criticism of your body in front of your child. Practice being more accepting and loving towards yourself.

Be Mindful of Negative Societal Messages

We live in a world innundated with rigid messages about how people should look, behave, and think. This pressure starts at a young age, and it tends to worsen with time.

As a loved one, be an ally for younger people. Sit with them and discuss what they see on social media or television. Have honest conversations about the different bodies you see. Make it clear that health and beauty come in all shapes and sizes.

Reach Out For Help

If you sense your loved one may be struggling, reach out to their doctor or a therapist. Eating disorders can be progressive, and you don’t want to dismiss concerning habits as “just a phase.” Let your child know you are there to support them unconditionally.

What Can You Expect From Eating Disorder Treatment? 

Eating disorder treatment can help you or your loved one develop a healthier relationship with food, body image, and self-esteem. There are many different treatment options available, and the best care will depend on the severity of the disorder.


In severe cases, individuals may need acute hospitalization for their eating disorder. Hospitalization tends to be short-term, and it’s designed to provide immediate stabilization.

An individual may require hospitalization if they:

  • Present as severely malnourished.
  • Have lost a significant amount of weight and present at risk for refeeding syndrome (which can be fatal).
  • Refuse to eat despite medical concerns.
  • Recently fainted or having an unstable heartbeat.
  • Are experiencing uncontrollable bleeding or vomiting.

After hospitalizations, many clients transition into a  long-term residential (inpatient) or partial hospitalization care program (outpatient).

Inpatient Care/Rehab 

Inpatient eating disorder treatment refers to 24/7 structure, support, and monitoring. Clients in this care receive all meals, housing, and clinical services throughout their stay. 

These programs tend to be most beneficial for high-risk clients who need assistance in addressing their eating disorder symptoms. This treatment typically includes a combination of:

  • Group therapy.
  • Individual therapy.
  • Family therapy.
  • Nutrition and meal planning.
  • Supervised exercise.
  • Medication management.
  • Aftercare planning. 
  • Relapse prevention.

The length of treatment varies, but care can last anywhere from 30 days to about a year.

Intensive Outpatient or Outpatient Care

Intensive outpatient or outpatient care also ranges in severity. Unlike inpatient care, residents do not live on-site. However, clients receive comprehensive clinical care throughout their stay. They may eventually step down to therapy once or twice a week.

It’s important to work with your treatment team to discuss your treatment needs. Relapse can be common in eating disorder recovery. You want to safeguard yourself against these risks as best you can.

Specific Types of Therapy

Therapists support clients struggling with eating disorders using a variety of modalities. Keep in mind that most people do not want to have an eating disorder. 

They may know their thoughts are irrational. They might recognize their behaviors are problematic. Unfortunately, they can’t stop that easily. 

In some ways, an eating disorder can closely resemble an addiction. Even if they realize how bad the situation has become, it doesn’t necessarily mean it’s easy to change it. 

Cognitive-Behavioral Therapy (CBT)

CBT examines the relationship between thoughts, feelings, and behaviors. For example, if you think you’re ugly or stupid, that’s the distorted thought. As a result, you may feel sad and ashamed. You may behave by restricting your food or bingeing on it.

CBT aims to unwind this automatic pattern. By replacing negative habits with more positive ones, you can learn to feel more empowered in your recovery.

Dialectical Behavior Therapy (DBT)

DBT is a form of CBT that helps people with mindfulness, distress tolerance, and emotional regulation. Today, many practitioners use this method for treating eating disorders. By learning to be more mindful of your emotions, they won’t feel so overwhelming. Subsequently, by practicing healthier coping skills, you learn to change disordered habits. 

Motivational Interviewing (MI)

Some therapists use MI to enhance a client’s willingness to enter recovery. This therapy explores a client’s ambivalence about getting better. It may examine the pros and cons of difficult situations like gaining weight, surrendering control over food, and talking about vulnerable emotions.

Nutritional Counseling

When entering recovery, it’s often recommended to work closely with a registered dietitian. They will help you with meal planning and weight goals. 

It’s important to work with someone who has experience treating eating disorders. Many times, dietitians work alongside with therapists and psychiatrists, particularly if you’re in a formal eating disorder treatment setting. 

Acceptance and Commitment Therapy (ACT)

Acceptance and commitment therapy helps increase awareness into your core values. You will learn how to live more congruently with those values. ACT also helps people detach themselves from difficult emotions and come to a greater acceptance that distress can be an integral part of existence. 

Medication for Eating Disorder Recovery

In some cases, medication may help with recovery. However, medication alone is rarely a sufficient treatment. It’s best to discuss your needs with your doctor or psychiatrist.

Antidepressants (SSRIs) 

Many people struggling with eating disorders also struggle with symptoms related to depression and anxiety. Antidepressants can help reduce some of the emotional tension and mood shifts, which may lessen issues related to cravings and control.


In some cases, stimulants may help with bulimia. For example, Vyvanse was the first medication approved by the FDA for treating binge eating disorder, which shares many simlarities to bulimia. 

Final Thoughts

Both anorexia and bulimia can be life-threatening mental illnesses. They require serious attention. If you are struggling, reach out for support. If you know someone who is struggling, be compassionate and encourage them to ask for help. 

Treatment is available. You don’t have to suffer in your body any longer. 

Start Your Mental Health Education:

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Disclaimer: This information is not specific medical advice and does not replace information you receive from your healthcare provider. This is only a brief summary of general information. It does NOT include all information about conditions, illnesses, injuries, tests, procedures, treatments, therapies, discharge instructions or lifestyle choices that may apply to you. You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care provider’s advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you.

You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care provider’s advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you.

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