Bulimia vs Binge Eating Disorder

What is bulimia?

Bulimia nervosa is an eating disorder that typically involves episodes of binge eating followed by purging behaviors, such as vomiting. Binge eating refers to the uncontrollable consumption of large quantities of food, usually eaten quickly and in a short period of time, typically around two hours ^[1].

An individual may be diagnosed with bulimia nervosa if episodes occur at least once a week for at least 3 months, although a diagnosis can still be made if they occur less regularly ^[2].

Bulimia occurs in up to 2% of the population and can affect people of any age and gender, although it is more likely to affect females and tends to begin in adolescence ^[3].

Someone with bulimia may experience significant weight loss and become slightly underweight, but it is common for people with bulimia to be of normal weight or overweight and to experience regular fluctuations in their weight ^[1].

What is binge eating disorder?

Binge eating disorder is also an eating disorder that involves episodes of binge eating, but unlike bulimia, purging behaviors do not usually occur. As such, people with binge eating disorder may experience significant weight gain and are often overweight or obese, although may experience fluctuations in their weight ^[4].

Due to the potential for significant weight gain, binge eating disorder can lead to obesity, diabetes, heart problems, and other medical complications, and may even be fatal ^[5].

Binge eating disorder is a very common eating disorder and affects people of any age and gender, although it typically occurs in early adulthood, unlike most other eating disorders, which tend to emerge in adolescence ^[5][6].

Bulimia vs binge eating disorder: Signs and symptoms

Similarities

As both bulimia and binge eating disorder involve episodes of binge eating, there are certain similarities in the potential signs and symptoms of the two disorders.

For example, both conditions can include emotional and behavioral symptoms such as ^[1][4][5][7]:

• Binge episodes, in which large amounts of food are eaten in a short time
• Feeling a loss of control or dissociation during binge episodes
• Buying and hoarding foods for the next binge
• Being very secretive about eating behaviors
• Regularly thinking about and planning the next binge
• Dissatisfaction with body image and weight
• Regularly looking in the mirror at perceived body flaws
• Frequent attempts at dieting or fasting
• Social withdrawal
• Changes in mental state, such as depression, anxiety, irritability, and mood swings
• Self-harming behaviors and suicidal thoughts

Both conditions can include physical symptoms such as:

• Feeling very tired
• Stomach pain and cramps
• Irregular bowel movements and constipation
• Trouble concentrating
• Sleep disturbances

Differences – bulimia

Other behavioral and emotional symptoms of bulimia can include ^[1][7][8]:

• Purging behaviors, such as induced vomiting or using laxatives or diuretics
• Engaging in obsessive or excessive exercise
• Going to the bathroom immediately after eating
• Binge-purge episodes, in which binge eating occurs immediately followed by purging behaviors
• Obsessive or ritualistic behaviors around eating, such as only using certain utensils, eating only specific foods, or eating in a specific way
• Often using mints, gum, and mouthwash, or brushing teeth

Other physical symptoms of bulimia can include:

• Regular fluctuations in weight
• Smelling of vomit
• Sore throat
• Feeling very weak, dizzy, or faint
• Often feeling cold
• Callouses on fingers from induced vomiting
• Dental issues from vomiting, such as discoloration or decay
• Hair, skin, and nails becoming dry and brittle
• Hair loss or bald patches
• Swelling around the face
• Fine hair growing on the body or face
• Irregular or missed periods
• Weakened immune system, potentially causing regular illness that takes a long time to recover from
• Slow wound healing

Differences – binge eating disorder

Other emotional and behavioral symptoms of binge eating disorder can include ^[4][5][8]:

• Eating very fast
• Eating when not hungry or when uncomfortably full
• Intense feelings of embarrassment, shame, and guilt after binge episodes
• Feeling disgusted and depressed after binge episodes
• Irregular eating habits, such as potentially missing meals during the day to binge later, or eating continuously throughout the day without stopping
• Low self-esteem and mood

Other physical symptoms of binge eating disorder can include:

• Fluctuations in weight or consistent weight gain
• Changes in skin health, such as acne
• High blood pressure

Bulimia vs binge eating disorder: Causes

The exact causes of bulimia and binge eating disorder are not known, and they may occur due to a combination of risk factors.

Family history

Most eating disorders have a genetic component, meaning that they can be inherited, and there is an increased risk of developing an eating disorder if a family member experiences an eating disorder ^[1][8].

Similarly, a family history of eating disorders can cause environmental risk factors, as growing up in a household where a child is exposed to disordered eating and the associated behaviors can also increase the risk of the development of an eating disorder ^[6].  

It has also been found that a family history of mental health illnesses and addiction can increase the risk of eating disorders ^[9][10].

Prior weight issues

If someone has experienced bullying from peers or criticism in the home due to their weight, this can cause issues with self-esteem and body image and increase the risk of going on to develop an eating disorder ^[6][9][10].

Societal pressures

Societal ideals around body image and beauty, particularly in Western culture and in the media, can have a significant influence on the way people, particularly young people, view their own bodies and expectations around beauty ideals. This can contribute to the development of eating disorders, particularly bulimia and anorexia, as people strive for thinness ^[1][10].

Although this may not directly cause binge eating disorder, it could contribute to the feelings of low self-esteem and shame that people with binge eating disorder experience, thus contributing to the binge eating behaviors that are caused or exacerbated by emotional distress ^[6].

Mental health

Many people with an eating disorder also experience mental health conditions such as depression and anxiety disorders, indicating that poor mental health can contribute to or worsen disordered eating ^[3][10].

Traits such as obsessive, perfectionist, or inflexible personalities are common amongst those with eating disorders that involve restrictive eating, suggesting that these traits can contribute to these eating disorders ^[6][9][10].

Overeating is often used as a coping mechanism to manage emotional distress, so binge eating can sometimes develop as a way to numb negative emotions or feelings of loneliness, or may become habitual, almost like an addiction ^[5].

Abuse

Experiences of abuse, trauma, or bullying in childhood can contribute to the development of eating disorders, as well as other mental health conditions ^[6][9].

Bulimia vs binge eating disorder: Treatment

Treatment for bulimia and binge eating disorder will typically involve input from a multidisciplinary team, including a dietician, specialist therapist, and physician, who will work together to treat the mental and physical aspects of the condition ^[8].

Differences

Physical health treatment may differ between the two conditions, as they can each potentially cause different medical complications.

For example, an individual with bulimia may require treatment for injury to their stomach or throat, or treatment for dehydration, caused by induced vomiting or use of laxatives. They may also require specific dental treatment if vomiting has caused severe damage to their teeth ^[3][9].

For those with bulimia, increasing nutritional intake and reducing purging behaviors will be a priority, particularly if they have experienced significant weight loss and medical complications. This can cause emotional distress and thus requires collaboration with a specialized therapist to help the individual manage this process safely ^[1][7].

Someone with binge eating disorder may require physical health treatment for conditions that have emerged from excessive weight gain, such as heart conditions or diabetes ^[5].

Similarities

Therapy

Both conditions will likely involve the use of specialized therapeutic intervention, such as interpersonal therapy and cognitive behavioral therapy (CBT), to help monitor eating habits, learn triggers and underlying causes, formulate meal plans to help reduce and prevent binge episodes, and manage emotional distress that occurs throughout this process ^[8].

By utilizing therapy, the individual may be able to learn more positive coping strategies and change negative thought patterns and behaviors that contribute to the occurrence of binge episodes ^[3][6]. Often, particularly for those with binge eating disorder, improving mood can reduce binge episodes if eating has been used as a coping mechanism ^[5].

A dietician may be involved in this care, helping to create meal plans that encourage the consumption of healthy and nutritious meals, at regular and consistent times, to help prevent cravings and binge episodes ^[3][9].

Family therapy can be useful, particularly for adolescents with an eating disorder, to provide an opportunity for the family to gain a better understanding of the condition, learn how to help in managing the symptoms, and understand how best to provide care to their loved one ^[1][6][8].

Medication

Typically, medications are not prescribed in the treatment of eating disorders, as the effectiveness of various medications has not been proven, and the risk of side effects may be increased ^[3].

However, fluoxetine, an antidepressant medication of the selective serotonin reuptake inhibitor (SSRI) class, has been shown to be effective in reducing binge eating behaviors, so it may be helpful in the treatment of both bulimia and binge eating disorder if it is deemed appropriate by a medical professional, while also potentially improving mood ^[3][6][9].

Inpatient Care

In some cases, it may be necessary to provide inpatient care if the individual is experiencing serious medical complications or is at a high risk of suicide. While in the hospital, they will be provided with care from a multidisciplinary team to help improve their mental and physical health ^[3][9].