The 5 differences between Anorexia and Bulimia

In today's society enormous relevance is given to physical appearance. From the media to the most private forms of interaction, few areas of life tell us. allow us to move away from the general conception that equates thinness and physical attractiveness with perfection and success.

Anorexia and bulimia are two eating disorders in whose development the social pressure to achieve an ideal physique plays a fundamental role. The closeness between these two diagnoses sometimes causes a certain confusion regarding their definition.

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Defining anorexia and bulimia

Anorexia nervosa is characterized by restriction voluntary consumption of food and by the progressive loss of weight until reaching underweight. Likewise, there is a distortion of the body image; this means that people with anorexia look thicker than they are.

Anorexia has two subtypes: restrictive, in which weight is lost mainly through fasting and physical exercise, and compulsive / purgative, in which bingeing and purging occur.

On the other hand, in bulimia the  emotional distress or stress triggers bingeing, generally from foods with a high caloric content, followed by purgative behaviors (vomiting, using laxatives) or compensatory (fasting, vigorous exercise) resulting from feelings of guilt or shame. During binge eating, a feeling of loss of control over eating is experienced.

Bulimia is also classified according to two types, one purgative and one non-purgative, which corresponds more to compensatory behaviors such as fasting.

Other psychological problems with a similar profile are the orthorexia nervosa, which is characterized by the obsession to eat only healthy food, the body dysmorphic disorder, which consists of an excessive concern for some physical defect, and vigorexia or muscular dysmorphia, a subtype of the previous one.

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5 differences between anorexia and bulimia

Even bearing in mind that the diagnoses are only guidance tools and that the symptoms of anorexia and bulimia can overlap, it is convenient to review the main differences between these two disorders as understood by the manuals of Psychology.

1. The main symptoms: restriction or binge eating

Behavioral symptoms are one of the fundamental differences between bulimia and anorexia. In general, in anorexia there is strict control over behavior while bulimia has a more compulsive and emotional component.

In the case of bulimia the presence of frequent binges is necessary for the diagnosis. Although these episodes can also occur in anorexia, they are basic only in the compulsive / purgative subtype, and they tend to be much less intense than in bulimia.

Purging and compensatory behaviors can occur in both disorders. However, in the case of bulimia there will always be one or both, since the person feels the need to lose the weight gained through binge eating, while in anorexia these behaviors may be unnecessary if caloric restriction is sufficient to meet the goals of loss of energy. weight.

The Binge eating disorder it is another diagnostic entity that is exclusively characterized by recurrent episodes of uncontrolled ingestion. Unlike those that occur in bulimia and anorexia, in this case binges are not followed by purgative or compensatory behaviors.

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2. Weight loss: underweight or fluctuating weight

Diagnosis of anorexia nervosa requires a persistent drive to lose weight and that it is significantly under the minimum weight that it should be based on its biology. This is usually measured by the Body Mass Index or BMI, which is calculated by dividing weight (in kilos) by height (in meters) squared.

In anorexia, the BMI tends to be below 17.5, which is considered underweight, while the normal range is between 18.5 and 25. They are considered to have obesity people with a BMI over 30. In any case, it must be taken into account that the BMI is an indicative measure that does not differentiate between muscle mass and fat tissue and is especially imprecise in very tall or very low.

In bulimia  weight is usually within the range that is considered healthy. However, there are important fluctuations, so that in periods when binge eating predominates, the person can become very fat, and when the restriction is maintained for a long time, the contrary.

3. The psychological profile: obsessive or impulsive

The anorexia  tends to relate to control and order, while bulimia is more associated with impulsivity and emotionality.

Although these are only general trends, if we wanted to make a psychological profile of a A “stereotypically anorexic” person could be classified as introverted, socially isolated, with low self-esteem, perfectionist and self-demanding. Conversely, bulimic people tend to be more emotionally unstable, depressive and impulsive, and more prone to addictions.

It is interesting to relate these diagnoses to the personality disorders that are most commonly associated with each of them. While obsessive-compulsive and avoidant personalities predominate in anorexia, in bulimia cases of disorder usually occur histrionic Y limit.

Additionally, in anorexia, a denial of the problem occurs more frequently, which is more easily assumed in people with bulimia.

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4. The physical consequences: severe or moderate

The physical alterations derived from anorexia are more severe than those caused by bulimia since the former can lead to death by starvation. In fact, in many cases of anorexia resort to hospitalization for the person to regain an acceptable weight, while in bulimia this is significantly less frequent.

In anorexia it is much more common to occur amenorrhea, that is, the disappearance of menstruation or its non-appearance in cases that start at a very young age. Dry skin, capillary weakness and the appearance of lanugo (a very fine, such as that of newborns), hypotension, feeling cold, dehydration and even osteoporosis. Most symptoms are attributable to starvation.

Some common physical consequences of bulimia are swelling of the parotid gland and the face, reduction of the potassium levels (hypokalemia) and tooth decay due to dissolving enamel caused by vomiting recurring. Vomiting can also cause a so-called "Russell's sign.", calluses on the hand due to rubbing with the teeth.

These physical alterations depend more on the specific behaviors of each person than on the disorder itself. Thus, although vomiting may be more frequent in bulimia, an anorexic person who vomits repeatedly will also damage their tooth enamel.

5. The age of onset: adolescence or youth

Although these eating disorders can occur at any age, the most common is that each of them begins in a certain period of life.

The bulimia  typically starts in youth, between 18 and 25 years old. Since bulimia is related to psychosocial stress, its frequency of occurrence increases at roughly the same age when responsibilities and the need for independence take on force.

On the other hand, anorexia  tends to start at a younger age, mainly in adolescence, between the ages of 14 and 18. In general, the development of anorexia has been associated with social pressures derived from sexual maturation and adoption of gender roles, specifically female, since for men the demand for thinness is usually lower.

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"Bulimia" and "anorexia" are just labels

Although in this article we have tried to clarify what are the fundamental differences between the diagnosis of bulimia and that of anorexia, the truth is that both behavior patterns are close in many ways. As we have seen, many of the characteristic behaviors of these two disorders, such as recurrent vomiting or intense exercise, are as typical of one as of the other and in some cases only their frequency or their centrality in the problem allow us to differentiate between anorexia and bulimia.

What's more, it is quite common for both diagnoses to overlap, either successively or alternately. For example, an occasional binge-eating case of anorexia could lead to bulimia. In addition, if the same person recovered their previous patterns, they would again fit the diagnosis of anorexia. In general, if the conditions for the diagnosis of anorexia are met, it is given priority over that of bulimia.

This makes us reflect on the rigidity with which we generally conceptualize disorders, whose names are still labels with function to help clinicians to have an overview of the most recommended intervention tools when facing each of their cases.

Bibliographic references:

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
• Fernández- Aranda, F. and Turón, V. (1998). Eating disorders: Basic guide to treatment in anorexia and bulimia. Barcelona: Masson.