In today’s society, enormous importance is given to physical appearance. From the media to the most private forms of interaction, few areas of life 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 social pressure to achieve an ideal physique plays a fundamental role. The closeness between these two diagnoses sometimes causes some confusion regarding their definition.
Defining anorexia and bulimia: characteristics of both disorders
Anorexia nervosa is characterized by restriction voluntary food consumption and progressive weight loss 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 binge eating and purging occur.
For its part, in bulimia the Emotional upset or stress triggers binge eating generally of foods with a high caloric content, followed by purgative behaviors (vomiting, using laxatives) or compensatory behaviors (fasting, intense exercise) that are a consequence of 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 They are orthorexia nervosa, which is characterized by the obsession with eating only healthy food, body dysmorphic disorder, which consists of excessive concern about some physical defect, and vigorexia or muscle dysmorphia, a subtype of the previous one.
The main differences between anorexia and bulimia
Even keeping in mind that diagnoses are only indicative tools and that the symptoms of anorexia and bulimia can overlap, it is worth reviewing the main differences between these two disorders as they are understood by Psychology manuals.
1. The main symptoms: restriction or binge eating
The 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 binge eating is necessary for the diagnosis. Although these episodes can also occur in anorexia, they are basic only in the compulsive/purging subtype, and they tend to be much less intense than in bulimia.
Purgative 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 calorie restriction is sufficient. to meet weight loss goals.
Binge eating disorder is another diagnostic entity that is characterized exclusively by recurrent episodes of uncontrolled eating. Unlike those that occur in bulimia and anorexia, in this case the binge eating is not followed by purgative or compensatory behaviors.
2. Weight loss: underweight or fluctuating weight
The diagnosis of anorexia nervosa requires a persistent drive to lose weight and that it is significantly below the minimum weight it should have based on its biology. This is usually measured by the Body Mass Index or BMI, which is calculated by dividing weight (in kilograms) by height (in meters) squared.
In anorexia, the BMI tends to be below 17.5, which is considered underweight, while the normal range ranges between 18.5 and 25. People with a BMI of more than 30 are considered obese. There are It must be taken into account, in any case, that BMI is an indicative measure that does not differentiate between muscle mass and fat tissue and is especially imprecise in very tall or very short people.
in bulimia weight is usually within the range that is considered healthy. However, there are important fluctuations, so that in periods in which binge eating predominates the person can gain a lot of weight, and when the restriction is maintained for a long time the opposite can occur.
3. The psychological profile: obsessive or impulsive
anorexia tends to relate to control and order while bulimia is rather associated with impulsivity and emotionality.
Although these are nothing more than general trends, if we wanted to make a psychological profile of a “stereotypically anorexic” person we could classify them as introverted, socially isolated, with low self-esteem, perfectionist and self-demanding. On the contrary, bulimic people They tend to be more emotionally unstable depressed and impulsive, and more prone to addictions.
It is interesting to relate these diagnoses with the personality disorders that are most commonly associated with each of them. While obsessive-compulsive and avoidant personalities predominate in anorexia, cases of histrionic and borderline disorder often occur in bulimia.
Additionally, in anorexia, a denial of the problem occurs more frequently, which is more easily assumed in people with bulimia.
4. Physical consequences: serious or moderate
The physical alterations derived from anorexia are more severe than those caused by bulimia since the former can lead to death from starvation. In fact, in many cases of anorexia hospitalization is resorted to 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 begin at a very early age. Dry skin, capillary weakness and the appearance of lanugo (very fine hair, like that of newborns), hypotension, a feeling of cold, dehydration and even osteoporosis are also usually detected. Most symptoms are attributable to starvation.
Some common physical consequences of bulimia are swelling of the parotid gland and face, reduced potassium levels (hypokalemia), and the appearance of dental caries due to the dissolution of enamel caused by recurrent vomiting. Vomiting can also cause the so-called “Russell sign.” calluses on the hand (on the knuckles) 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 recurrently will also damage their tooth enamel.
5. Age of onset: adolescence or youth
Although these eating disorders can occur at any age, the most common thing is that each of them begins at a certain period of life.
bulimia typically begins in youth between 18 and 25 years old. Since bulimia is related to psychosocial stress, its frequency of occurrence increases at approximately the same age when responsibilities and the need for independence gain strength.
On the other hand, anorexia tends to start at younger ages mainly in adolescence, between 14 and 18 years old. In general, the development of anorexia has been associated with social pressures derived from sexual maturation and the adoption of gender roles, specifically feminine ones, since for men the demand for thinness is usually lower.
The cognitive component is also different between anorexia and bulimia. In anorexia, there is a constant discomfort with one’s own appearance. which leads the person to avoid gaining weight at all costs, and to try to get closer to a very thin beauty ideal (perceived as less thin than it really is).
Instead, In bulimia, the thoughts behind the disorder have to do with the feeling of guilt caused by binge eating. which leads the person to want to restore balance. There is no distorted view of one’s own body.
“Bulimia” and “anorexia” are just labels
Although in this article we have tried to clarify 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 the other and in some cases only their frequency or their centrality in the problem allow us to differentiate between anorexia. and bulimia.
Besides, It is quite common for both diagnoses to overlap either successively or alternately. For example, a case of anorexia in which binge eating occasionally could end up leading to bulimia. Furthermore, if the same person recovered their previous patterns, they would once again fit the diagnosis of anorexia. In general, if the conditions for the diagnosis of anorexia are met, priority is given to it over that of bulimia.
This makes us reflect on the rigidity with which we generally conceptualize disorders, whose names are still labels with the function of helping clinicians to have an overview of the most recommended intervention tools when facing each of their problems. cases.
Treatment of this type of eating disorders
Both anorexia and bulimia are severe pathologies that must be treated urgently by mental health professionals, given that their mortality rate is high (and very high in the case of the former). In this sense, psychotherapeutic and medical intervention is necessary.
During the consultation, professionals will be guided by the differences between bulimia and anorexia to know what type of disorder the patient suffers from and will apply an intervention plan adapted to each case.
