The Difference Between Anorexia and Bulimia
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The Difference Between Anorexia and Bulimia

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Eating Disorders

Written by: Kim Langdon, M.D.
Reviewed by: Dr. RY Langham PhD
Last Updated: May 24, 2018

Eating disorders are actually considered psychiatric or psychological conditions. In addition, they are more prevalent in teenager, than in adults. The Diagnostic and Statistical Manual of Mental Disorders, Fifth-Edition (DSM-5) lists the diagnostic criteria for the subtypes of these eating disorders. For instance, anorexia nervosa, also simply referred as “anorexia,” is divided into two subtypes – restricting and the binging/purging type.

The restricting type is the result of not eating even the bare minimum to maintain a healthy weight, while the binge/purging type occurs when a person vomits immediately following a meal, takes an excessive amount of laxatives, continuously uses enemas, and/or regularly uses diuretics to control and maintain a certain weight.

In fact, a recent study on American adolescents found the following prevalence rates:

• Anorexia nervosa (0.2%)
• Bulimia nervosa (0.6%)
• Binge-eating disorder (1.6%)
• Subthreshold anorexia nervosa (0.9%)
• Subthreshold binge-eating disorder (1.1%)

The Table below compares two of the most widely known eating disorders – anorexia and bulimia.

 Anorexia NervosaBulimia Nervosa
What is it?Anorexia Nervosa (AN) is an eating disorder that stems from an inability to maintain a “healthy” or “minimally healthy” weight. It involves an unusual fear of weight gain, along with relentless attempts to control food intake to prevent weight gain. Bulimia Nervosa (BN) is a set of repetitive behaviours that are used to rid your body of the extra calories consumed during eating binges. A person with this condition may rid himself/herself from the extra calories by vomiting immediately following meals, excessively using laxatives, and/or frequently engaging in diuretic abuse.
Age of onsetLate Adolescence/TeensTeens/Late Teens
Psychological
Symptoms
Perfectionism, social isolation, complaints of feeling “fat,” irritability, anxiety, and/or conflict issuesDepression, bipolar II, anxiety, drug abuse, and/or poor impulse control
Physical Symptoms • Dry skin
• Yellow skin
• Fine body hair
• Blue hands and feet
• Decreased breast volume
• Under the jaw swollen glands
• Swollen feet and legs
• Underweight
• Excessive exercising
• Dizziness
• Dehydration
• Skin changes and/or acne
• Abdominal pain
• Lack of menstruation
• Dental decay
• Under the jaw swollen glands
Shared SymptomsLack of menstruation, skin changes, dizziness, dehydration, electrolyte imbalances, and/or under the jaw swollen glands Lack of menstruation, skin changes, dizziness, dehydration, electrolyte imbalances, and/or under the jaw swollen glands.
BehavioursDislike (or avoidance) of public eating, restricting food intake, pushing food around on the plate, hiding food, and/or feeding food to your dogPreferring to eat in secret and/or eating to excess
Commonality0.3 to 0.5%1-3%
Causes and
Risk Factors
The cause varies; however, a combination of biologic, psychological, and social factors appear to play a significant role in its development. In addition, negative remarks from a mother to a child, family crises (i.e. divorces and break-ups), low self-esteem, and/or difficult dealing with conflict also appear to contribute to the condition. The cause varies; however, a combination of hormones, genetics, and sociocultural and developmental factors appear to play a significant role in its development. In addition, an abnormally high serotonin level, strained family dynamics, teasing/bullying, and/or depression appear to contribute to the condition. Note: Athletes, bodybuilders, dancers are more prone to bulimia.
Treatment• Treatment usually involves psychotherapy.
• Psychotherapy for eating disorders typically involves multiple approaches.
• Medications are beneficial, if depression or anxiety is present.
• Hospitalization is required, if the condition becomes dangerous and/or severe.
• Treatment involves a variety of mental health professionals – i.e. doctors, nurses, dieticians, psychologists, and family members.
• Family therapy
• Individual therapy (insight-oriented)
• Cognitive analytic therapy
• Cognitive behavioral therapy (CBT) (This therapy is better for adult-onset AN)
• Enhanced cognitive-behavioral therapy (CBT-E)
• Cognitive remediation therapy (CRT). This therapy is better for motivated people
• Treatment usually involves doctors, nurses, dieticians, and psychologists.
• Family therapy is recommended for children and teens, suffering from an eating disorder.
• The goals of treatment are to reduce and, when possible, eliminate restrictive eating and/or binge and purging.
• Physical complications are treated to restore your nutritional health.
• Patients are encouraged to adopt healthier eating patterns.
• One of the goals of treatment is to provide you and your family with education on healthy nutrition and eating patterns
• Treatment helps you change dysfunctional thoughts, attitudes, motives, conflicts, and feelings, so you can heal from the eating disorder.
OutlookEarly diagnosis and intervention is crucial, and has the most favorable prognosis. Be on the lookout for weight loss, abnormal eating behaviors, and/or loose clothing. Overall, this condition has a good prognosis, but relapses are common. Because it is a chronic disease, it requires constant surveillance.Factors like the length of symptoms, age at the beginning of treatment, severe weight loss, and/or clinical depression, have been associated with a poorer prognosis. The rate of relapse for all eating disorders is fairly high, and usually triggered by social stress.

Conclusion

Although, some people believe that eating disorders stem from cultural beliefs that value “thinness” and place unreasonable expectations on physical appearance, this is not always the case. In fact, researchers are beginning to theorize that “a lack of control” and “family dysfunction” play important roles in the development of eating disorders.

But, as mentioned previously, the cause varies from person-to-person. The best way to treat eating disorders is to create an “awareness” of the cultural and social factors that could be contributing to these conditions, and by providing education for both children and their parents on common attitudes and behaviours that could trigger eating disorders. The hope is that these tools will reduce the frequency of these disorders.

Treatment interventions can occur in a variety of settings, such as: at the doctor’s office, at sports facilities, and in educational settings. Moreover, school-based programs that emphasize health, fitness, and a range of physical and psychological competences have shown promise in preventing or delaying the development of eating disorders – especially when they arise during the school years.

It is important to understand that anorexia has one of the highest mortalities of all mental disorders. The good news is that “awareness” and educational programs can alert you to a developing eating disorder, so you or your loved one can receive an early diagnosis, treatment, and thus, a prolonged remission.

About the Author Kim Langdon, M.D.

Dr Langdon is a retired obstetrician-gynecologist with 19 years clinical experience. She has invented six novel medical devices for common maladies, and founded Coologics to commercialize her patent-pending technologies. She researches and writes about many medical topics such as pregnancy, birth, and eating disorders.

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