What's The Difference Between Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder?
By Katherine Metzelaar, MSN, RDN
Anorexia nervosa, bulimia nervosa, and binge eating disorder are different eating disorders, but there can be significant overlap between them. While each has its own diagnostic criteria, eating disorder behaviors do not always fit neatly into one category.
Anorexia is often associated with restriction and an intense fear of weight gain, while bulimia involves recurrent binge eating followed by behaviors intended to compensate for the binge. Binge eating disorder also involves recurrent binge eating, but without the regular compensatory behaviors associated with bulimia.
At the same time, anorexia and bulimia have many similarities. Both can involve restriction, intense preoccupation with food and body image, fear of weight gain, and behaviors aimed at controlling weight or food intake. And someone’s eating disorder symptoms can change or overlap over time.
Understanding both the differences and similarities can give you a more accurate picture of how eating disorders actually show up, especially because you don’t have to fit perfectly into one diagnostic category to deserve support.
The Differences Between Anorexia, Bulimia, and Binge Eating Disorder
Anorexia Nervosa
Anorexia nervosa is an eating disorder characterized by restriction of energy intake, an intense fear of gaining weight or persistent behaviors that interfere with weight gain, and disturbances in how someone experiences their body weight or shape.
Although restriction is a central feature of anorexia, it is not the only behavior that can occur. Some people with anorexia also experience binge eating or engage in compensatory behaviors such as self-induced vomiting or excessive exercise. This overlap is one reason anorexia and bulimia can sometimes look similar.
It is also important to know that you cannot tell whether someone has anorexia by looking at them. Eating disorders occur across the weight spectrum, and someone can experience significant restriction, malnutrition, and eating disorder symptoms without fitting the stereotype of what anorexia is supposed to look like.
Bulimia Nervosa
Bulimia nervosa is characterized by recurrent episodes of binge eating followed by compensatory behaviors intended to prevent weight gain. These behaviors may include self-induced vomiting, fasting, excessive exercise, or misuse of laxatives or other medications.
Restriction can also be part of bulimia. Someone may restrict their food intake before or after a binge, which can contribute to an ongoing cycle of restriction, binge eating, and compensatory behaviors. This is another reason the distinction between anorexia and bulimia can be more complicated than it first appears.
Like anorexia, bulimia cannot be identified by looking at someone’s body. People with bulimia can be at any body size, and the disorder can be serious even when there are no obvious outward signs.
Binge Eating Disorder
Binge eating disorder is characterized by recurrent episodes of binge eating that involve feeling a loss of control while eating. Unlike bulimia, these episodes are not regularly followed by compensatory behaviors such as vomiting, fasting, or excessive exercise.
Binge eating is also different from simply eating a large amount of food or feeling overly full. An episode typically involves both eating an unusually large amount of food within a particular period of time and feeling unable to stop or control what or how much you are eating. Binge eating disorder is also associated with significant distress around these experiences.
Restriction can still be part of the picture. Some people with binge eating disorder may skip meals, diet, or restrict their intake, and not eating enough can make someone more vulnerable to binge eating. This is one reason looking at the overall pattern of eating, rather than a single behavior, is important when understanding what someone is experiencing.
Anorexia vs. Bulimia: What’s the Difference?
Anorexia and bulimia can involve many of the same thoughts and behaviors around food, weight, and body image, but they are defined differently. Anorexia nervosa is characterized by restriction of energy intake, along with an intense fear of gaining weight or persistent behaviors that interfere with weight gain and disturbances in how body weight or shape is experienced. Bulimia nervosa is characterized by recurrent binge eating followed by compensatory behaviors intended to prevent weight gain.
The distinction can become less clear when you look at how eating disorders actually show up. Someone with anorexia may also binge or purge, while someone with bulimia may significantly restrict their food intake between binge episodes. Both disorders can involve rigid food rules, compulsive exercise, body checking, and an intense preoccupation with food or body size.
This is also why you cannot determine whether someone has anorexia or bulimia based on their appearance or body size. The behaviors someone engages in are only one part of understanding an eating disorder, and two people with different diagnoses may have many similar experiences.
Eating disorders don't always fit neatly into categories
In real life, eating disorders can be much messier than their diagnostic criteria make them sound. Someone's behaviors may change over time, overlap across diagnoses, or cause significant distress without meeting every criterion for one particular eating disorder.
This matters because a diagnosis isn't what determines whether someone's relationship with food deserves attention or support. Not meeting the criteria for anorexia, bulimia, or binge eating disorder does not mean that what you're experiencing isn't serious.
What are the similarities between anorexia and bulimia?
Despite their diagnostic differences, anorexia and bulimia can share many of the same underlying thoughts, fears, and behaviors. Both may involve an intense preoccupation with food and body image, fear of weight gain, rigid rules around eating, restriction, body checking, or exercising in an attempt to influence weight or shape.
Both disorders can also involve significant anxiety, guilt, or shame around food. Eating may become something that requires constant planning or negotiation, and thoughts about food and the body can take up a tremendous amount of mental space.
Perhaps most importantly, both anorexia and bulimia are serious eating disorders regardless of someone's body size. You cannot determine how much someone is struggling simply by looking at them.
Signs and Symptoms That Can Overlap Across Eating Disorders
Preoccupation with food, eating, weight, or body image
Feelings of body dissatisfaction or shame
Anxiety, guilt, or distress around eating
Avoiding social situations that involve food or feeling uncomfortable eating around others
Eating in secret or hiding eating behaviors
Rigid rules about food or eating
Skipping meals or restricting food intake
Body checking, such as frequently weighing yourself or checking your body in mirrors
Exercising in an attempt to compensate for eating or influence weight or shape
Fear of weight gain
Changes in weight, though you cannot tell whether someone has an eating disorder based on their weight or body size
Fatigue, difficulty concentrating, or feeling cold
Changes in hunger and fullness cues
Anxiety, depression, or other changes in mood
Feeling out of control, ashamed, fearful, or overwhelmed around food
Getting Support for an Eating Disorder
If your relationship with food or your body is taking up a significant amount of your mental energy, you don't have to know exactly which diagnosis fits before seeking support. Eating disorder symptoms can overlap and change over time, and treatment can be tailored to what you're actually experiencing.
If you're looking for support, learn more about my eating disorder nutrition counseling approach and what working together can look like.