In today’s society, great importance is given to the physical aspect. From the media to the most private forms of interaction, few areas of life allow one to depart from the general conception which equates thinness and physical attractiveness with perfection and success.
Anorexia and bulimia are two eating disorders in development, social pressure to achieve an ideal physique plays a key role. The proximity between these two diagnoses sometimes leads to some confusion as to their definition.
Define anorexia and bulimia
Anorexia nervosa is characterized by a restriction voluntary consumption of food and by gradual weight loss until underweight. There is also a distortion of body image; this means that people with anorexia look bigger than they are.
Anorexia has two subtypes: restrictive, in which weight is lost primarily through fasting and exercise, and compulsive / purgative, in which binge eating and purges occur.
For his part, in bulimia the emotional distress or stress triggers temper tantrums, Usually high-calorie foods, followed by purgative (vomiting, use of laxatives) or compensatory (fasting, strenuous exercise) behaviors that result from feelings of guilt or shame. During binge eating, a feeling of loss of control over consumption is felt.
Bulimia is also classified into two types, a purgative and a non-purgative, which rather corresponds to compensatory behaviors such as fasting.
Other psychological problems with a similar profile are nervous orthorexia, which is characterized by the obsession with eating only healthy foods, a bodily dysmorphic disorder, which consists of excessive preoccupation with a physical defect, and vigor or vigor, a subtype of this who is before.
5 differences between anorexia and bulimia
While keeping in mind that the diagnoses are only indicative tools and that the symptoms of anorexia and bulimia may overlap, it is worth reviewing the main differences between these two disorders as they are. included in psychology textbooks.
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 seizures is necessary for the diagnosis. While these episodes can also occur in anorexia, they are only basic in the compulsive / purgative subtype and tend to be much less intense than in bulimia.
Purgatory and compensatory behaviors can occur in both troubles. However, in the case of bulimia one or both will always occur, as the person feels the need to lose the weight gained from binge eating, while in anorexia these behaviors may be unnecessary if the calorie restriction is sufficient to achieve your weight loss goals.
Binge eating disorder is another diagnostic entity characterized exclusively by recurrent episodes of uncontrolled drinking. Unlike those of bulimia and anorexia, in this case the binges are not followed by purgative or compensatory behaviors.
2. Weight loss: underweight or fluctuating weight
Diagnosis of anorexia nervosa requires a persistent push to lose weight and that it is significantly lower than the minimum weight it should have based on its biology. This is typically measured using body mass index or BMI, which is calculated by dividing weight (in pounds) by height (in meters) squared.
In anorexia, the BMI tends to be below 17.5, which is considered to be underweight, while the normal range is between 18.5 and 25. People with a BMI over 30. It should be borne in mind, in all cases, that BMI is an indicative measurement that does not differentiate between muscle mass and adipose tissue and is particularly imprecise in very tall or very short people.
In bulimia weight is generally within the range considered healthy. However, large fluctuations occur, so that in times when binge eating is predominant, the person can gain a lot of fat, and when the restriction is maintained for a long time, the reverse can occur.
3. The psychological profile: obsessive or impulsive
anorexia it tends to be related to control and order, While bulimia is rather associated with impulsivity and emotionality.
Although these are only general tendencies, if we wanted to make a psychological profile of a “stereotypically anorexic” person, we could describe them as introverted, socially isolated, with low self-esteem, perfectionist and demanding. On the other hand, bulimics they tend to be more emotionally unstable, Depressive and impulsive, and more prone to addictions.
It is interesting to link these diagnoses to the personality disorders that are most often associated with each of them. While in anorexia obsessive-compulsive and avoidant personalities predominate, in bulimia there are usually cases of histrionic and borderline disorder.
Also, in anorexia denial of the problem occurs more frequently, which is more easily assumed in people with bulimia.
4. The physical consequences: severe or moderate
The physical changes resulting from anorexia are more serious than those caused by bulimia because the former can lead to death from starvation. In fact, in many cases, anorexia hospitalization is resorted to so that the person regains an acceptable weight, while in bulimia, this is much less common.
In anorexia it is much more common to occur amenorrhea, i.e. the disappearance of menstruation or non-onset in cases beginning at a very young age. Dry skin, weak hair and the appearance of lanugen (1 very thin hair, like that of newborns), hypotension, feeling cold, dehydration and even osteoporosis are also commonly detected. Most of the symptoms are attributable to starvation.
Some common physical consequences of bulimia are swelling of the parotid gland and face, reduced potassium levels (hypokalaemia), and the development of dental caries due to enamel breakdown caused by recurrent vomiting. Vomiting can also cause the so-called “Russell sign”, Calluses on the hand due to friction with the teeth.
These physical alterations depend more on the specific behaviors of each person than on the disorder itself. So while vomiting may be more common in bulimia, a person with anorexia who vomits repeatedly will also damage their tooth enamel.
5. Age of onset: adolescence or youth
Although these eating disorders can occur at any age, it is more common for all of them to begin at some point in life.
bulimia it usually starts in youth, Between 18 and 25 years old. Since bulimia is associated with psychosocial stress, its frequency of occurrence increases at around the same age when responsibilities and the need for independence gain strength.
Instead of anorexia tends to start at an earlier age, Mainly in adolescence, between 14 and 18 years old. The development of anorexia has generally been associated with social pressures resulting from sexual maturation and the adoption of gender roles, especially female, as for men the requirement to be thin is usually more low.
“Bulimia” and “anorexia” are just labels
Although in this article we have tried to clarify what are the basic differences between the diagnosis of bulimia and anorexia, the truth is that the two behavior models are close In many ways. As we have seen, many of the characteristic behaviors of these two disorders, such as recurrent vomiting or the practice of intense exercise, are so typical of both and in some cases only its frequency or its centrality in the problematic makes it possible to differentiate between anorexia and bulimia.
Outraged, it is quite common for the two diagnoses to overlap, Either successively or alternately. For example, a case of anorexia in which you are bored every now and then can lead to bulimia. In addition, if the same person returned to their previous patterns, they would again fall under the diagnosis of anorexia. In general, if the conditions for diagnosing anorexia are met, priority is given to it over bulimia.
This makes us reflect on the rigidity with which we typically conceptualize disorders, names are still labels with the function of helping clinicians gain an overview of the most recommended intervention tools when dealing with each of these. their cases.
- 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: A Basic Treatment Guide for Anorexia and Bulimia. Barcelona: Masson.