Talking about eating behavior disorders implies talking about the two most frequent: anorexia and bulimia. Although both are widely known, the differences between them are really not always clear.
Eating disorders (EDs) constitute a health challenge for today’s population . The figures of those affected by this group of psychopathologies have reached such a magnitude that one can speak, without a doubt, of an entire mental health pandemic. When these types of food-related problems began to appear in the population a few decades ago, the prototypical profile was that of a bone-deep teenager who steadfastly refused to eat.
The treatment in this scenario consisted of returning the young woman to a healthy nutritional state through hospital admission. Once she regained her normal weight, she was discharged and she returned to her life with nothing more than the message “you have to eat” received from doctors and family.
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The problem of eating behavior disorders (ED)
Today this scenario has changed a lot. The number of patients diagnosed with anorexia and/or bulimia has grown, although this can be explained, in part, because many more cases are detected today than in the past. Currently, eating disorders and the dynamics that characterize them are much better known, although an effective treatment for all patients has not yet been found. Therapists who work with eating problems on a daily basis often feel frustrated, as treatment and subsequent recovery never follow a linear course.
On the contrary, until a patient with an eating disorder is fully recovered, improvements and relapses usually alternate and, in general, long therapeutic processes are involved . Despite all that has been said, more and more progress is being made. Today, around 50% fully recover from this serious problem, while 30% do so partially and 20% live chronically with the disorder. In addition, patients usually receive treatment much earlier than before, so it is unusual to reach stages of great physical deterioration.
It is also important to note that current treatment is much more comprehensive than at present. The recovery of the physical state is, of course, essential, but this is only the first rung of a long ladder of progress to be made. The visible symptomatology, manifested in the form of binge eating and restrictions, is only the tip of a large iceberg. For this reason, the treatment must go beyond the superficial and delve into nuclear aspects such as bond relationships, emotions and the person’s affections.
Eating disorders are, like most psychopathological disorders, multifactorial . This means that they never have a single cause, but instead appear as a result of the confluence of multiple variables. Among the aspects that feed the appearance of these problems are, of course, social networks. These have served as an amplifying window on food myths, extreme perfection, and fads like intermittent fasting and real fooding.
If we add other ingredients to this (unhealthy ties, attachment figures, diffuse limits of roles in the family, prioritizing the wishes of others before our own, need for control, low self-esteem, etc.) we have the broth ideal crop for an eating disorder knocking on the door. In this article we will try to differentiate the two most common eating disorders: anorexia and bulimia.
How are anorexia and bulimia different?
As we said, within the so-called eating behavior disorders we can find several types, although the two most common and well-known are anorexia and bulimia nervosa. It should be noted that, although anorexia and bulimia are frequently referred to as separate diagnostic categories, the truth is that this is not exactly the case in clinical reality.
Many times it is observed how the same person goes through periods more prone to bulimia that alternate with others closer to anorexia. Similarly, the symptoms are often mixed . However, knowing the diagnostic pictures in theory is important, since it serves as a guide for subsequent intervention. Next, we are going to see the differences between anorexia and bulimia.
1. Weight loss
A first important difference has to do with weight loss. In anorexia this is a central characteristic, so that the patient shows a body mass index (BMI) lower than what is considered normal according to her age.
In contrast, in the case of bulimia, weight loss does not occur . This aspect makes bulimia difficult to detect, especially in the early stages of the disorder. The bulimic patient shows a normal BMI and may even be slightly overweight. This is explained due to the cycle of binge eating and purging typical of bulimia.
Binge eating consists of episodes where the person loses control of himself and eats excessive amounts of food, usually choosing those rich in sugars and fats. After these episodes, the patient experiences strong feelings of guilt and anxiety, for which she proceeds to perform compensatory behaviors in order to avoid weight gain.
The most common is to resort to vomiting, although there are also those who use laxatives and diuretics for this purpose. Systematic purges are known to cause a slowdown in metabolism, which facilitates weight gain. This is because, although the body cannot assimilate the content that the person vomits, it does reduce their basal energy expenditure .
2. Binge eating
As we said, bulimia is a disorder whose core characteristic is the existence of binge eating, which may or may not be followed by compensatory behaviors. On the other hand, in anorexia we will not observe the lack of control of eating typical of bulimia . An anorexic patient will never be able to eat high amounts of calories because her strict control prevents her from doing so. Only in some cases, after several days of restriction, she can get to skip her self-imposed not to eat and try, for example, a sandwich. However, this is not objectively a binge eating itself, although the patient does experience it as such.
3. Vomiting
Vomiting can occur in purging-type anorexia, as in bulimia. However, the difference between the two lies in the background. While in bulimia vomiting is a compensatory strategy that occurs after a binge , in anorexia it appears after a normal intake. This goes along the same lines as what we discussed earlier. Although objectively, binge eating does not occur in anorexia, patients experience it as if they were ingesting quantities typical of a bulimic episode.
4. Control
Control is a central element in TCAs in general. However, the relationship that patients have with control will be very different depending on whether we are talking about anorexia or bulimia. In the case of anorexia, it is observed that there is a strong desire for control . This manifests itself through food in the form of severe caloric restriction.
However, food rigidity is just a reflection of inflexible patterns at a deeper level. This makes people with anorexia extremely perfectionists, lovers of order, brilliant academically… This control absorbs so much energy that there are hardly any reserves left for social or leisure activities. Relationships with others are isolated, there is no interest in socialization or sexual desire of any kind. Leisure is often restricted to activities related to food or exercise, but never beyond.
In the case of bulimia we can observe the opposite pole, since there is an absolute lack of control . People who suffer from this eating disorder usually have poor impulse control and show behavior patterns as chaotic as their way of eating. It is common for there to be phases of absolute disinhibition, manifested in the form of sexual promiscuity, excessive shopping, social openness… which alternate with totally opposite stages of seclusion, inhibition and rejection of social relationships.
5. Emotion
At an emotional level we will also observe very different patterns in both cases. In anorexia, two phenomena known as anhedonia and alexithymia frequently occur . The first refers to the inability to enjoy things, while the second consists of the difficulty in identifying and expressing one’s own emotions, which usually leads to a deep emotional disconnection and a very flat affect.
Patients often report their own experiences, even very painful ones, in a neutral and emotionless manner. In addition, they tend to analyze and process all their experiences not from their emotions, but from logic and rationality. Generally, those who suffer from this disorder tend to perform very well academically, so the register of logic and reason is much more comfortable for them than that of affection.
In the case of bulimia we find, again, the opposite pole. What characterizes the emotional state of someone with bulimia is instability . Emotions are experienced with great intensity, but they flow excessively quickly and hardly last. This means that, as in anorexia, there is confusion about one’s own emotions, although as we can see it is a very different nuance.
This excessive intensity of affection can be overwhelming for the people who suffer from it, so it is common that in addition to binge eating, other means of “relief” are used, such as self-harm. By inflicting harm on oneself, physical pain acts as a kind of anesthesia for emotional pain, something very typical of a bulimic condition.
To the classic question “what do you do?” I always answer “basically I am a psychologist”. In fact, my academic training has revolved around the psychology of development, education and community, a field of study influenced my volunteer activities, as well as my first work experiences in personal services.