A Comparison of Anorexia and Bulimia
Eating disorders are very real, and they are very common. According to the eating disorders advocacy group Beating Eating Disorders, people of any age can develop an eating disorder, and despite what the media might suggest, men can get eating disorders, too. Beating Eating Disorders suggests that about 25 percent of people with eating disorders are male.
If left untreated, any eating disorder can be considered dangerous. In fact, according to research provided by the National Eating Disorders Alliance (NEDA), death rates due to eating disorders are nearly indistinguishable. In this NEDA data, mortality rates for anorexia were 4 percent, they were 3.9 percent for bulimia, and they were 5.2 percent for eating disorders not otherwise specified.
This research suggests that any eating disorder brings about the risk of an early death. That makes many eating disorders very similar to one another, but there are dissimilarities between eating disorders too. Knowing what those differences are is vital, as it can help families to choose a treatment program that has the ability to deliver the right help at the right time.
This article contains a comparison between two major types of eating disorder: anorexia and bulimia. With complete information, families can make informed decisions about the health and happiness of the people they love.
Life with Anorexia
The eating disorder anorexia nervosa is characterized by an unwillingness to allow the body to achieve a weight that doctors might call healthy. Some people with anorexia achieve this goal by refusing to eat anything but the tiniest of meals, while other people with anorexia achieve a low body weight through the use of exercise or laxatives.
The National Institute of Mental Health (NIMH) suggests that less than 1 percent of women in the United States have anorexia at one point in life; the rate in men is lower still. Researchers are not quite sure what causes anorexia, but it is possible that societal pressures play a role. Women in the media are almost always thin, trim, and toned. Thin people are portrayed as sexually desirable, powerful, and healthy. People who are not thin, on the other hand, are often portrayed as lazy, slothful, and undesirable. People may internalize these messages and come to believe that they can only be adequate and functioning members of society if they fall on the thin side of the spectrum. Anything else can look like a failure.
Anorexia has also been called a disorder of misplaced control. People with anorexia may feel a deep-set need to be in charge of almost everything — including things that really cannot be controlled, such as other people’s thoughts and behaviors — and they may turn to relentless appetite control in a mistaken attempt to achieve what they want. To a person with anorexia, refusing to eat or gain weight is an assertion of power and a sign of strength. To them, the thinner they are, the better things are.
NEDA says health consequences due to anorexia can be severe, and they might include:
- Slow heart rate
- Low blood pressure
- Heart failure
- Muscle loss
- Kidney failure
- Hair loss
Despite these health problems, people with anorexia may continue to deprive their bodies of nourishment. Even as they fade away, they may believe that they still have pounds to lose and that they are in control.
Life with Bulimia
Bulimia nervosa is an eating disorder characterized by periods of rapid food intake (bingeing), followed by attempts to rid the body of the food taken in (purging). A bulimia binge is often done in secret, as the person with bulimia often feels shame for that eating behavior. The purge might also happen in secret, and it could be accomplished with vomiting, laxatives, or both.
Bulimia is often tied to some form of trauma that the person with bulimia is unable to resolve. Childhood sexual abuse, relentless bullying at school or work, domestic violence, or rape can all cause bulimia. A person who goes through these events is left with very deep and painful scars, but the events are impossible to change and/or have happened in the past. When the person feels distress due to these events, the person feels compelled to find something soothing. The person can lean on food in order to bring that relief about.
When the binge is over, the person with bulimia can feel intense guilt and remorse about the episode. Most people with bulimia are at least somewhat overweight, and they want to lose weight. They know that bingeing does not lead to weight loss, and they want it to stop, but they do not know how to stop the urge to binge. So they purge instead, hoping to remove the food before it leads to weight gain.
According to NIHM, the lifetime rate of bulimia in women is 0.5 percent, while the lifetime rate in men is 0.1 percent. Anyone, at any age, can develop bulimia.
The health problems associated with bulimia, per NEDA, include:
- Electrolyte imbalances
- Heart failure
- Gastric rupture
- Esophagus rupture
- Tooth decay
- Peptic ulcers
- High blood pressure
- High cholesterol
- Heart disease
- Gallbladder disease
People with bulimia want to lose weight, and they want to lose the urge to binge, since those urges cause disgust and distress. But they may not know how to make things change.
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Treating Eating Disorders
Anorexia and bulimia are clearly very different eating disorders, and as a result, they need different treatment approaches.
People with anorexia benefit from enforced eating programs, so they can gain the energy the brain needs in order to function efficiently. When they can think clearly, they benefit from Cognitive Behavioral Therapy (CBT) that help them to spot the triggers for disordered eating. Once those triggers are easy to see, they can be planned for and combatted.
People with bulimia benefit from entering CBT right away. They may need to lose weight, but it is not a requirement to start therapy. Some eating disorder programs for bulimia use a different diet model in which people eat when hungry and stop when full. This could help people with bulimia to respond to hunger cues appropriately, rather than bingeing.
Both people with anorexia and bulimia remain at risk for very serious problems if they drop out of treatment too soon. ANRED says 20-30 percent of people who do enter treatment for an eating disorder drop out too soon and relapse. Families can help by choosing a treatment program that is both firm and accessible. That firmness discourages early dropout, and the accessibility ensures that people want to stay in care for as long as they can. Families can also help by expressing their pride each day the person stays in care and works toward a solution. With their support, and the help of a treatment team, things could improve in no time at all.