Anorexia vs bulimia: What's the difference between the eating disorders?

Key Points

• Anorexia and bulimia are eating disorders with key differences but some overlap of symptoms.
• Eating disorders are mental health conditions, and diagnostic criteria often include physical, mental, and behavioral factors.
• Recovery can take time, but healing from an eating disorder is possible.
• Eating disorder treatment needs a team of eating disorder specialists, including doctors, registered dietitians (RD), psychiatrists, mental health counselors, and more.

Anorexia and bulimia are common eating disorders, and there are distinct differences between them. Anorexia is an eating disorder where a person becomes overly preoccupied with their weight, avoids or limits their food intake, and engages in harmful practices to try and lose weight.

Bulimia, on the other hand, is where a person eats excessive amounts of food in a short period and feels a lack of control over their eating. This is known as a binge eating episode. After a binge, they attempt to compensate for their eating habits through purging behaviors.

Both eating disorders reflect a complex relationship with food and self-image that can take a serious toll on physical and mental health. Eating disorders affect over 30 million Americans and are among the deadliest mental health conditions, second only to opioid addiction. 

Recognizing the differences and similarities between anorexia and bulimia can help you get the care that you or a loved one needs. Here's a closer look at anorexia vs bulimia.

What is anorexia?

Anorexia is an eating disorder characterized by low body weight and an intense fear of gaining weight. Also known as anorexia nervosa, the condition can lead to serious health consequences if left untreated. It has the highest mortality rate of all eating disorders, but it is treatable, and recovery is possible.

The first step to getting help is to learn more about its symptoms, diagnosis, and treatment methods.

What are the symptoms and types of anorexia?

According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), the criteria for anorexia include:

• Calorie restriction that leads to weight loss or a lack of weight gain to meet health standards based on age
• An intense fear of weight gain or becoming "fat"
• A distorted self-image.

However, there are many other signs and symptoms of anorexia.

Physical signs and symptoms:

• Severe weight loss or failure to meet the healthy weight range for their age
• Fatigue
• Frequent dizziness or fainting
• Chronic constipation, stomach pain, acid reflux
• Hair loss
• Weak muscles
• In females, irregular or missed periods
• Dry skin
• Brittle nails
• Feeling cold all the time (due to low body weight)
• Cold hands and feet
• Lanugo (fine hair all over the body)
• Sleep issues
• Slow heart rate
• Abnormal blood test results like anemia and thyroid-related issues.

Behavioral and emotional signs:

• Poor body image
• Intense fear and anxiety over weight gain
• Obsession with weight, food, meals, calorie counting, and dieting. Constant worry about being or becoming "fat"
• Often eliminate entire food groups, such as dairy, carbohydrates, or fats.
• Refuse to eat around people (or find ways to avoid eating or eat very little during meals)
• Develop excessive and strict rituals around food intake. They may eat foods in only a certain order, may push food around their plate to pretend to eat in a crowd, and may chew their food for an abnormally long time to restrict their calorie intake.
• Often offer to cook or bake to mislead others but, in reality, eat very little.
• Engage in excessive exercise.
• May lose interest in friendships, social activities, and hobbies that previously brought joy.

Registered Dietitian Rita Faycurry, RD, explains, "Anorexia has many signs and symptoms. Not everyone with anorexia has all of them. Additionally, symptoms of an eating disorder may overlap with those of other conditions. This is why consulting a healthcare provider or psychiatrist specializing in eating disorders is critical for proper evaluation, diagnosis, and treatment."

Types of anorexia nervosa

While the media often portrays anorexia as affecting those who are severely underweight, not everyone with anorexia fits this image. Some people may have anorexia but may be in a healthy body weight range or even overweight after losing a significant amount of weight. This is known as atypical anorexia.

There are also two types of anorexia based on behavior:

• Restricting type anorexia: People with restrictive type anorexia skip meals, eliminate food groups, and severely limit their food intake. They may also try to lower their body weight or prevent weight gain through extreme exercise.
• Binge-purge anorexia: Binge-purge anorexia involves binge eating followed by compensatory actions like taking laxatives or diuretics and inducing vomiting after eating. People with this type of anorexia maintain a low body weight.

What is bulimia?

Bulimia nervosa or bulimia is an eating disorder marked by cycles of binge eating and purging. Binge eating is when a person ingests excessive amounts of food in a short time. Following a binge, individuals with bulimia engage in compensatory behaviors such as vomiting, laxative use, fasting, or excessive exercise to prevent weight gain.

Faycurry RD notes, "On the outside, someone with bulimia may look healthy. Internally, they may experience an intense fear of gaining weight. Additionally, they may face other health consequences, including heart issues, digestive problems, type 2 diabetes, malnutrition, and more.”

What are the symptoms of bulimia nervosa?

The DSM-5 diagnostic criteria for bulimia nervosa include:

• Binge eating, which is eating an unusually large amount of food within a specific time period
• A feeling of loss of control over their eating during the binge
• Unhealthy behaviors to compensate for the food intake. These include laxative misuse, weight loss medications, and diet pills, exercising excessively, and others
• The binging and purging occur once a week, at minimum, for three months.

Physical signs and symptoms:

• Noticeable weight fluctuations (up or down).
• Stomach cramps or digestive issues like acid reflux or constipation
• Dizziness or fainting
• Cuts or calluses on fingers from self-induced vomiting
• Dental problems, including enamel erosion, cavities, or gum issues
• Swelling in the face from swollen salivary glands
• Muscle weakness and fatigue
• In females, menstrual irregularities or missed periods.

Behavioral and emotional signs:

• A preoccupation with body weight and appearance
• Evidence of binge eating such as missing food, empty containers or wrappers, and hiding or stealing food
• Frequent purging behaviors, including vomiting or misuse of laxatives
• Avoiding eating around other people (or eating very little in public and then binging and purging in private)
• Excessive exercise after eating to compensate for the calorie intake
• Feelings of shame, guilt, or despair after binge-purge cycles
• Low self-esteem and reliance on body image for self-worth.

There is an overlap between binge-purge anorexia and bulimia. However, the main difference is that, unlike anorexia, people with bulimia maintain a normal weight.

Eating disorder diagnosis

A healthcare provider may conduct a physical examination and a detailed review of a person's medical history. They often conduct lab tests, including a complete blood count (CBC), electrolytes, magnesium, calcium, blood glucose, and more, depending on specific symptoms.

Eating disorder treatment

There is no single approach to treating eating disorders. Treatment is tailored to the needs of each individual and the type of eating disorder.

Eating disorder treatment involves a team of specialists, including a doctor, psychotherapist, and registered dietitian. Other medical specialists may be called in depending on specific medical complications that need to be addressed.

Registered dietitians are an important part of an eating disorder treatment team. They help people with eating disorders work towards a healthy weight, develop personalized meal plans, offer nutrition counseling, and address nutritional deficiencies.

Dietitians also provide ongoing nutritional counseling and support throughout recovery.

Take the first step towards recovery. Find anorexia treatment near you.

The views expressed by authors and contributors of such content are not endorsed or approved by Fay and are intended for informational purposes only. The content is reviewed by Fay only to confirm educational value and audience interest. You are encouraged to discuss any questions that you may have about your health with a healthcare provider.