What’s the Difference Between Anorexia and Bulimia?

Anorexia nervosa (anorexia) and bulimia nervosa (bulimia) are both eating disorders. They are conditions that involve a person trying to lose weight using unhealthy strategies. They have some symptoms in common, however the conditions manifest in different food-related behaviors.

Although eating disorders can occur at any age and to any gender, research shows they’re most often reported in women. The National Institute of Mental Health reports that the lifetime prevalence of anorexia is three times higher among females (0.9%) than males (0.3%). For bulimia, the condition is five times higher among females (0.5%) than males (0.1%).

The National Association of Anorexia Nervosa and Associated Disorders estimates that 9% of the U.S. population, or 28.8 million Americans, will have an eating disorder in their lifetimes.

Read on to learn how anorexia and bulimia differ, how they’re diagnosed, available treatment options, and more.

Scale in front of depressed, frustrated, sad woman sitting on floor holding head and arms on knees

Tero Vesalainen / Getty Images

Differences

Anorexia is characterized by severe food restriction. This could be limiting the amount or types of food. People with anorexia may restrict their food intake to a degree that can lead to malnourishment and even death.

Some people with anorexia exercise to excess. Also, a person with anorexia may vomit or take laxatives to lose weight.

People with bulimia have recurrent episodes of eating unusually large amounts of food and feeling a lack of control over these binges.

This binge eating is followed by behaviors that compensate for overeating, such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors.

Unlike those with anorexia nervosa, people with bulimia nervosa may maintain a normal weight or be overweight.

Causes

Eating disorders can affect people of all ages, racial/ethnic backgrounds, body weights, and genders. It isn’t clear what causes anorexia or bulimia to develop, but many medical experts believe it’s due to a combination of complex environmental, biological, and psychological factors.

Some risk factors for developing an eating disorder include:

  • Genetics: Research suggests you may be more likely to develop an eating disorder if you have a first-degree relative (like a parent or sibling) with an eating disorder.
  • Perfectionism: One of the strongest risk factors for an eating disorder is perfectionism, especially a type of perfectionism called self-oriented perfectionism, which involves setting unrealistically high expectations for yourself.
  • Bullying or teasing: People in higher-weight bodies may have experienced bullying or teasing growing up. According to the National Eating Disorders Association, more than 60% of people with an eating disorder said the bullying contributed to their disorder.

Symptoms

Many people who have an eating disorder have an intense preoccupation with food and often express dissatisfaction with their body image.

Other symptoms are often specific to the individual condition.

Anorexia

Many different emotional, behavioral, and physical symptoms can signal a person has anorexia.

Behavioral symptoms are often the first warning signs that can be noticed by loved ones, and they include:

  • Talking about weight or food all the time
  • Not eating or eating very little
  • Refusing to eat in front of others
  • Social withdrawal
  • Talking badly about their body
  • Trying to hide their body with baggy clothes
  • Extreme exercise, such as exercising for too long or too intensely

Emotional symptoms of anorexia may increase as the disorder progresses. They include:

  • Anxiety
  • Depression and suicidal thinking
  • Moodiness

Physical symptoms usually emerge over time as a result of ongoing starvation as the body attempts to conserve reserves in order to survive.

The physical symptoms of anorexia include:

  • Thin, brittle hair and nails
  • Feeling cold all the time
  • Feeling faint, dizzy, or weak
  • Feeling tired or sluggish
  • Irregular periods or periods stopping completely
  • Dry, blotchy, or yellow skin
  • Growth of fine hair all over the body
  • Severe constipation or bloating
  • Weak muscles or swollen joints

Anorexia Nervosa and Mortality Rate

Anorexia nervosa has the highest mortality rate of any mental disorder. While many people with this disorder die from complications associated with starvation, others die by suicide.

Bulimia

Symptoms of bulimia will differ depending on the mode and frequency of purging. Repeat vomiting can cause stomach acids to dissolve tooth enamel, making teeth much more vulnerable to decay, while overuse of laxatives can cause chronic gastrointestinal problems.

Non-Purging Bulimia

Bulimia does not always include vomiting after eating; you can also have non-purging bulimia. This is a disorder in which you binge but use compensatory behavior like diet pills or stimulant drugs, fasting and skipping meals, or obsessively exercising.

Physical symptoms of bulimia may include:

  • Swollen cheeks or jaw area
  • Calluses or scrapes on the knuckles (if using fingers to induce vomiting)
  • Teeth that look clear instead of white and are increasingly sensitive and decaying
  • Broken blood vessels in the eyes
  • Acid reflux, constipation, and other gastrointestinal problems
  • Severe dehydration

People with bulimia may also exhibit the following behavioral changes:

  • Extreme concern about body weight
  • Often going to the bathroom right after eating
  • Exercising a lot
  • Acting moody or sad, hating the way they look, or feeling hopeless
  • Having problems expressing anger
  • Not wanting to go out with friends or do activities they once enjoyed

Purging Disorder vs. Bulimia Nervosa

Many people strictly associate the word “purging” with bulimia nervosa because it can be a feature of this eating disorder. But purging also exists on its own in purging disorder, where purging takes place in the absence of binging.

Diagnosis

If your doctor suspects that you have an eating disorder, they’ll run several tests to aid diagnosis. The first step will be a physical exam. Your doctor will likely ask about your eating and exercise habits. They may also ask you to complete a mental health questionnaire.

At this stage, your doctor may order lab tests to help rule out other causes of weight loss and look for complications that have occurred as a result of an eating disorder.

In diagnosing an eating disorder, your doctor will use the criteria set out in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5), published by the American Psychiatric Association.

Anorexia

To be diagnosed with anorexia according to the DSM-5, the following criteria must be met:

  1. Restriction of energy intake relative to requirements leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health
  2. Intense fear of gaining weight or becoming fat, even though underweight
  3. 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

Even if all the DSM-5 criteria for anorexia are not met, a serious eating disorder can still be present. Atypical anorexia includes those individuals who meet the criteria for anorexia, but who are not underweight despite significant weight loss.

Bulimia

The DSM–5 uses the following criteria to determine a diagnosis of bulimia:

  1. Recurrent episodes of binge eating, as characterized by eating, within any two-hour period, an amount of food that is definitively larger than what most individuals would eat in a similar period of time under similar circumstances, and a feeling that one cannot stop eating or control what or how much one is eating
  2. Recurrent inappropriate compensatory behaviors to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise
  3. Binge eating and inappropriate compensatory behaviors, on average, at least once a week for three months
  4. Self-evaluation influenced by body shape and weight
  5. Disturbance not exclusively during episodes of anorexia nervosa

How Eating Disorders Are Treated

People with eating disorders need a treatment plan that addresses the physical and psychological symptoms. The overall goal of treatment is to:

  • Restore weight and nutrition
  • Address underlying factors that contribute to the condition
  • Improve the relationship with food
  • Modify any unhealthy behaviors

Effective treatment can include:

  • Nutritional counseling to help correct nutritional imbalances and maintain a healthy body weight
  • Therapy, such as cognitive-behavioral therapy (CBT), which focuses on identifying and changing the negative underlying thoughts and attitudes about weight and shape
  • Medication for underlying mental health conditions such as depression and anxiety
  • Joining support groups
  • Hospitalization, if the person is having thoughts of suicide or has severe health problems

Seek Help

If you or a loved one is coping with an eating disorder, contact the National Eating Disorders Association Helpline for support at 1-800-931-2237

For more mental health resources, see our National Helpline Database.

Frequently Asked Questions

How do you treat anorexia?

The best chance of recovery from anorexia comes from a multidisciplinary approach to treatment, which may include:

  • Nutritional counseling
  • Psychotherapy
  • Medications to control anxiety and depression symptoms
  • Hospitalization (in severe cases)

How many eating disorders are there?

The following eight eating disorders are recognized by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5), published by the American Psychiatric Association:

How many people have eating disorders?

The National Association of Anorexia Nervosa and Associated Disorders estimates that 9% of the U.S. population, or 28.8 million Americans, will have an eating disorder in their lifetimes.

A Word From Verywell

While there are similarities between anorexia and bulimia, they can often present in different ways. Extreme weight loss is not always an indicator of bulimia, and in anorexia, behavioral symptoms may be the first sign of the condition. Both eating disorders are incredibly serious and need treatment as soon as possible to achieve remission.

Prompt treatment of eating disorders saves lives. If you think you have an eating disorder, you should seek help from a doctor or therapist. If you suspect a loved one has an eating disorder, it is vital to encourage them to seek help.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Institute of Mental Health. Eating disorders. Updated November 2017.

  2. National Association of Anorexia Nervosa and Associated Disorders. Eating disorder statistics.

  3. National Eating Disorders Association. Health consequences.

  4. National Eating Disorders Association. Bulimia nervosa.

  5. Helder SG, Collier DA. The genetics of eating disorders. Curr Top Behav Neurosci. 2011;6:157-75. doi:10.1007/7854_2010_79

  6. Boone L, Soenens B, Vansteenkiste M, Braet C. Is there a perfectionist in each of us? An experimental study on perfectionism and eating disorder symptoms. Appetite. 2012;59(2):531-540. doi:10.1016/j.appet.2012.06.015

  7. Office on Women’s Health. Anorexia nervosa. Updated August 28, 2018.

  8. Swinbourne J, Hunt C, Abbott M, Russell J, St Clare T, Touyz S. The comorbidity between eating disorders and anxiety disorders: prevalence in an eating disorder sample and anxiety disorder sampleAust N Z J Psychiatry. 2012;46(2):118-131. doi:10.1177/0004867411432071.x

  9. Thornton LM, Welch E, Munn-Chernoff MA, Lichtenstein P, Bulik CM. Anorexia nervosa, major depression, and suicide attempts: shared genetic factorsSuicide Life Threat Behav. 2016;46(5):525-534. doi:10.1111/sltb.12235.x

  10. Office on Women’s Health. Bulimia nervosa. Updated August 28, 2018.

  11. Harrington BC, Jimerson M, Haxton C, Jimerson DC. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosaAm Fam Physician. 2015;91(1):46-52.

  12. American Psychiatric Association. What are eating disorders?