Are Anorexia and Bulimia the Same?

Overview

Anorexia

Anorexia is the refusal to eat enough food to maintain minimum body weight, with intense anxiety related to eating food in quantity. (See more in-depth information about anorexia in the anorexia section of our website.)

Bulimia

Bulimia is the practice of eating a large quantity of food and then purging it through vomiting, laxatives, or extreme exercise. (See more in-depth information about bulimia in the bulimia section of our website.)

Commonalities

Anorexia and bulimia do share a number of similarities, including the following:

• They are both eating disorders.
• In both, a person adopts an abnormal pattern of food consumption.
• Sufferers from both anorexia and bulimia experience a very negative body image, often feeling “fat” even when they are clinically underweight.
• Both place an excessive emphasis on physical appearance and weight.
• Both tend to make the assumption that the thinner you are, the more worth you have as a person.
• Both develop early in life, though anorexia tends to develop earlier.
• Both tend to exist with common traits:
  • Low self-esteem
  • Need for control
  • Anxiety
  • Shame, guilt, and secrecy

Differences

Anorexia and bulimia also have a few key differences, including these:

• Death rate. Anorexia has the highest death rate of all psychiatric illnesses. The primary cause of death for anorexia sufferers is suicide, followed by malnutrition.
• Development of the other condition. Anorexics may adopt bulimic methods after time, but bulimics do not usually end up anorexic.
• Noticeability. Anorexia typically makes a person visibly look thinner, but with bulimia, the person may have a normal-looking weight or even weight fluctuations. Therefore, it’s often harder to detect bulimia.

No conclusive link

There are also areas where anorexia and bulimia show no conclusive similarities or differences, or where different studies draw opposite or inconclusive results.

• Race. Anorexia and bulimia can affect all populations of people from varying different ethnic backgrounds. Some studies seem to indicate a higher prevalence of anorexia among white females, but this is not conclusive.
• Family background. The likelihood of getting anorexia or bulimia cannot be linked to having a certain type of upbringing. Children of all parenting styles, from rigid and authoritarian to loose and chaotic, can all be susceptible to getting an eating disorder.
• Depression. While depression is very common among people with an eating disorder, there is not a distinct common thread for whether the depression caused the eating disorder or the eating disorder caused the depression, or if both appeared at the same time.

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Clinical definition

Definition of Anorexia and Bulimia from the American Psychiatric Association:

Anorexia Nervosa

• Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85 percent of that expected; or failure to make expected weight gain during period of growth leading to body weight less than 85 percent of that expected).
• Intense fear of gaining weight or becoming fat, even though underweight.
• Disturbance in the way in which one’s body weight or shape is experienced; undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
• In post-menarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration).

Restricting Type:

• During the current episode of Anorexia Nervosa, the person has not regularly engaged in binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas.)

Binge eating/Purging Type:

• During the current episode of Anorexia Nervosa, the person has regularly engaged in binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). Anorexics who purge risk more serious harm than restricting only.

Bulimia Nervosa

Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

1. Eating, in a discrete period of time (e.g., within any two-hour period), an amount of food definitely larger than most people would eat during a similar period of time and under similar circumstances.
2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

• Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.
• The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for three months.
• Self-evaluation is unduly influenced by body shape and weight.
• The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Purging Type:

• During the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas. Bulimics who purge are at greater risk of harm than the Nonpurging Type (Garfinkel, Paul E. and Barbara J. Dorian. 2001. “Improving Understanding and Care for Eating Disorders.” Pp. 9-26 in R. H. Striegel-Moore and L. Smolak (eds.)
  Eating Disorders: Innovative Directions in Research and Practice. Washington, DC: American Psychological Association)

Nonpurging Type:

• During the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.