Within their lifetime, an estimated one in two hundred females will suffer from anorexia nervosa, and three in one hundred females will suffer from bulimia nervosa. Both of these incredibly common eating disorders have many complications and complex causes based on each case, but can be directly linked to societal standards of beauty and thinness often depicted in the media and result in many females, and males, dealing with self-esteem issues.
Now is the time to discover the difference between both of these eating disorders, the symptoms and signs to be aware of, and the treatment options available for individuals to ensure they get back on the right track to being healthy and loving themselves once again.
What Is Anorexia?
Anorexia nervosa, most commonly known as just anorexia, is an eating disorder characterized by an abnormally low body weight, as the individual afflicted with this eating disorder has an intense fear of gaining weight and a distorted perception of weight as they associate their self-worth with thinness. Individuals dealing with anorexia place a significantly high value on controlling their weight, shape, and overall appearance, and go to extreme measures to maintain their thin appearance, which can greatly interfere with their lives.
To continue to lose weight and to prevent themselves from gaining it back, patients suffering from anorexia will usually severely restrict the amount of food they eat throughout the day. They may also control their caloric intake by vomiting, consuming laxatives, diet aids, diuretics, enemas, or excessively exercising. Anorexia is truly not about the consumption of food, but rather is an unhealthy method used by individuals trying to cope with emotional and mental health issues, and gain a sense of control within their life by controlling what they put into their bodies.
What Is Bulimia?
Bulimia nervosa, commonly known as simply bulimia, is a severe and potentially life-threatening eating disorder characterized by individuals who secretly binge eat or eat an abundant amount of food at one time, then purge as a method to try and expel the extra calories from food in an unhealthy manner. For instance, an individual affected by bulimia may force vomiting or engage in excessive exercise. Bulimia has two categories: purging bulimia and nonpurging bulimia. Purging bulimia is regularly self-induced vomiting or the misuse of laxatives, diuretics, or enemas after binge eating. Nonpurging bulimia is when an individual uses different methods to rid themselves of calories and to prevent weight gain, such as through fasting, strict dieting, or excessive exercise, while still binge eating.
Similar to anorexia, individuals who suffer from bulimia associate their self-worth with how thin they are, and is related to emotional and mental health issues the person is trying to cope with. The main difference between anorexia and bulimia is an anorexic will not eat, but rather starve themselves, while a bulimic will eat but purge or vomit immediately after eating so their body will not absorb all the calories to ensure there is no weight gain.
Causes & Risk Factors Of Eating Disorders
The exact causes for anorexia and bulimia are unknown, however, there are many factors that can play a significant part in an eating disorder's development, including emotional and mental health, biology, societal expectations, peer pressure, and other issues. Specifically, anorexia is associated with obsessive-compulsive tendencies, anxiety, or a need for perfectionism, which can lead to individuals developing it.
Risk factors increasing an individual’s chance of developing an eating disorder include being female, as females are more than likely to develop one compared to males, age usually in the late teens into early adulthood, biology with a possible serotonin deficiency, relatives with an eating disorder, or being overweight as a child. Other factors include psychological and emotional issues such as anxiety, stress, low self-esteem or traumatic events, media and societal pressure found on television shows, movies, in music, and in magazines relaying the message that thinness equals success and popularity, and sports, work or artistic pressures associated with better performance.
Signs & Symptoms To Be Aware Of
First, it can be difficult to notice signs and symptoms as many patients dealing with an eating disorder often go to great extremes to hide their condition from loved ones. It can also be difficult to notice as what is considered a low body weight is different for each individual. For anorexia, the physical signs and symptoms are related to starvation, but can also include emotional and behavioral issues associated with an unrealistic perception of body weight and an extreme fear of gaining weight. Anorexia physical symptoms include extreme weight loss, a thin appearance, abnormal blood counts, fatigue, insomnia, dizziness, bluish discoloration of the fingers, the absence of menstruation, thinning hair, constipation, and abdominal pain, as well as dry or yellowish skin.
Other physical symptoms include intolerance of the cold, irregular heart rhythms, low blood pressure, dehydration, swelling of the arms or legs, and eroded teeth and calluses on the knuckles from induced vomiting. Emotional symptoms of anorexia are severely restricting food intake, frequently skipping meals or refusing to eat, adopting rigid eating habits, lack of emotion, decreased libido, covering up in layers of clothing, irritability, social withdrawal, and insomnia.
Signs & Symptoms Continued
Symptoms of bulimia include feeling out of control of their eating behavior, eating until the point of discomfort or abdominal pain, eating an extreme abundance of food in a binge episode compared to a normal meal or snack, forcing themselves to vomit or exercise after binging, and restricting calories or avoiding certain foods between binges. Both eating disorders display similar symptoms such as an obsession with food and being preoccupied with their body shape and weight, living in constant fear of gaining weight, misusing laxatives, enemas, or diuretics, excessively exercising, using dietary supplements to lose weight, and restricting calorie consumption.
Diagnosing An Eating Disorder
To diagnose an individual with either anorexia or bulimia, up to several tests and continuous observation and examination may occur to accurately diagnose the type of eating disorder and the severity of it. Tests include a physical exam, lab tests, a psychological evaluation, and other studies. A physical exam can include measuring the patient’s height and weight, checking their vital signs such as their heart rate, blood pressure, and temperature, analyzing the skin and nails for any noticeable issues, listening to the heart and lungs, and examining the abdomen region. Lab tests can include a complete blood count (CBC) and more in-depth, specialized blood tests to check the patient’s electrolytes and protein levels, as well as to analyze how the liver, kidney, and thyroid are functioning.
A psychological evaluation typically includes a doctor or mental health professional asking the individual about their thoughts, feelings, and eating habits. A complete psychological self-assessment may also be done. Other studies can include an x-ray to check the patient’s bone density, stress fractures, or broken bones, and to also look for heart problems or if pneumonia is present. An electrocardiogram can be performed to also check for heart irregularities. A mental health professional can also use the diagnostic criteria for anorexia and bulimia in the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association.
Complications An Eating Disorder Can Lead To
Regardless of what type it is, an eating disorder can lead to numerous critical and life-threatening complications. Possible complications associated with bulimia are dehydration which can lead to kidney failure, heart problems such as an irregular heartbeat or heart failure, severe tooth decay and gum disease, absent or irregular menstrual cycles, digestive problems, anxiety and depression, misusing alcohol and drugs, and even suicide. Complications associated with anorexia include irregular heartbeats or arrhythmias, blood disorders such as anemia, heart problems such as mitral valve prolapse or heart failure, bone loss (osteoporosis), and loss of muscle.
Other complications include gastrointestinal problems such as constipation, bloating or nausea, electrolyte abnormalities, kidney problems, an irregular or absent menstrual cycle, depression, anxiety, and personality disorders, obsessive-compulsive disorders, and even suicide.
Treatment for eating disorders is typically done using a team approach, including doctors, mental health professionals, dietitians, and family support for the patient. Continuous therapy and nutrition education are essential for an individual's continuing recovery. In severe cases, hospitalization is usually the first step, especially if the patient is experiencing a heart rhythm disturbance, dehydration, electrolyte imbalances, or a psychiatric issue. Hospitalization can be required if the patient has medical complications, is severely malnourished, refusal to eat, and serious psychiatric problems. Certain clinics may also offer specialized treatment for individuals with eating disorders, rather than full hospitalization, and can offer a patient day or residential programs, such as more intensive treatment over longer periods of time and frequent monitoring due to the complications anorexia and bulimia may bring.
In severe cases, patients suffering from anorexia may require a feeding tube that is inserted in the nose and goes to the stomach, called a nasogastric tube. The first goal of treatment when dealing with anorexia or bulimia is to get the individual back to a healthy weight and to learn what proper nutrition is and how to make healthy choices. So far, there are no medications approved to treat anorexia as none have been found to work very well. However, for patients dealing with bulimia, the best treatment option is a combination of psychotherapy and antidepressants, which have proven to help patients overcome the disorder.
Although there is no absolute way to prevent anorexia or bulimia, an individual may be able to redirect either their own path or that of a loved one towards healthier behavior or professional treatment before the symptoms worsen. Some helpful tips include fostering and reinforcing a healthy body image for children and teenagers and instilling confidence in them to embrace themselves, no matter their size or shape. An individual can also speak with a pediatrician or doctor about early signs of an eating disorder and can help to prevent it from developing.
Additionally, if a person notices a loved one who appears to be having food and body image issues, they can consider supportively talking to that individual about these issues and how they can help. Although there is no guaranteed way to prevent an eating disorder from happening either to the individual themselves or a loved one, try to offer support if you notice a loved one is suffering from these issues. Also, practice self-love every day by reciting affirmations to yourself, make healthier choices, avoid triggers such as the media, and reach out to someone if you notice you’re suffering from self-esteem issues.