Anorexia nervosa and bulimia nervosa are among the most common, and most well-known, eating disorders in the Western world, though they have begun to turn up in developing countries as well, in recent years. Though there is significant overlap between the two, and their diagnostic criteria, anorexia in a patient is often seen existing prior to bulimia nervosa, which can be considered a little ironic.
Diagnosing Anorexia Nervosa
The majority of individuals assessed for anorexia nervosa are brought into clinics or to doctors at the behest of family or friends, and rarely on their own. The diagnostic criteria, as determined by the Diagnostic and Statistical Manual of Mental Disorders, lists four main criteria: (1) refusal to maintain body weight at or above the minimum for their age and height; (2) intense fear of gaining weight (or becoming "fat") even if currently underweight; (3) distorted self-image, excessive influence of weight and body shape on self-evaluation, or denial of dangerously low body weight; (4) amenorrhea. Amenorrhea is obviously a diagnostic criteria for older adolescents and women, though the age of onset has been seen in occasional rare cases of girls under the age of 10.
Additionally, anorexia nervosa has two potential subtypes: restricting type, and binge-eating/purging type. The restricting type describes an individual who fits the above criteria and does not partake in binge-eating or purging behaviors, while the binge-eating/purging type will regularly engage in binge-eating (though usually not to the same extent as those with bulimia nervosa) and possibly purging behaviors such as induced vomiting or abuse of laxatives, enemas, or diuretics.
The types of foods anorexic patients will typically binge on, though occasionally high in calories and fat, are generally not as high in calories and fat as the foods bulimic patients will typically binge on. Some anorexia sufferers will binge on rice crackers while others on candy or cookies.
Diagnosing Bulimia Nervosa
Bulimia nervosa is usually diagnosed when the patient presenting symptoms is at a normal body weight, or overweight. The diagnostic criteria recurring episodes of binge eating, characterized by consuming an excessive amount of calories in a given period compared to what the average person would consume under similar circumstances. This binge eating will usually provoke considerable psychological distress, including feelings of guilt, disgust, and anger, and is often followed (immediately or eventually) by some form of purging behavior. The binge eating should be accompanied by a sense of having no control over the eating during that time period.
Purging behaviors most commonly thought of are induced vomiting, abuse of laxatives, enemas, diuretics, diet pills or other medications, and may also include excessive amounts of exercise and/or fasting for periods of time to "compensate" for the binge eating behaviors.
Additionally, bulimia nervosa patients, like those presenting with anorexia nervosa, have a self-image that is strongly influenced by body shape and weight. These behaviors should be continuing for a period of at least two weeks at a time over a minimum of three months for a diagnosis.
Like anorexia, bulimia nervosa has two subtypes: purging type and non-purging type. The purging type, specifically, engage in vomiting or other active purging methods, while the non-purging type tend to opt for other inappropriate compensation behaviors such as excessive exercise or fasting, but do not induce vomiting or abuse laxatives or other "active" methods.
Eating Disorders and Sense of Control
One of the greatest differences between anorexia nervosa and bulimia nervosa is a sense of control. Anorexic patients will often pride themselves in their control; their ability to refrain from eating, from binging, from anything they want. This can sometimes be seen as something to aspire to through the eyes of a bulimic, who has an overwhelming sense of having no control.
The anxiety experienced by both types of eating disorders can sometimes manifest as obsessive-compulsive disorder, though the focus of the worrying is weight gain and ultimately becoming fat.
Similarly, recent research has suggested that one out of every five obsessive-compulsive disorder sufferers will develop an eating disorder. Possible theories include this desired sense of "control" which, like bulimics, is lacking in OCD sufferers as well.
Gender, Social, and Cultural Differences in Anorexia and Bulimia
While the majority of individuals diagnosed with having eating disorders are overwhelmingly female, males are also susceptible to developing types of eating disorders.
Studies have shown that immigrants who would not have likely developed an eating disorder in their home country, are just as susceptible in countries such as the U.S. or U.K. A 1986 study of 100 Egyptian women in universities, half in Cairo and the other half in London, showed zero eating disorders among the Egyptian women in Cairo yet 12% of the women in London had developed eating disorders. Similar results were found in studies of Asian women living in the U.S.
Interestingly, African American girls are the least likely to develop eating disorders. Surveys in the U.S. have shown African American girls to have significantly less body dissatisfaction, fewer weight concerns, a more positive self-image and see themselves as thinner than they are compared to Caucasian girls.
Socioeconomically, the majority of eating disorders are diagnosed among middle- and upper-class, where the environment is considered "competitive" and where happiness, success, and even self-worth are largely determined by body measurements, fat percentages, and similar factors.
Treatment of Eating Disorders
It is rare for a patient suffering from anorexia nervosa to seek treatment on their own, so intervention is often the best course of action. This type of individual becomes very good at telling people what they want to hear while continuing their disordered thought patterns and behaviors in secret.
Both disorders are difficult to treat, and treatment typically includes establishing an eating plan and rearranging life activities to limit "alone time." Cognitive behavioral therapy is beneficial initially, more so when family and/or friends can be involved to help with support and progress. Drug treatments have not been effectively established yet, but the FDA has approved Prozac as possibly beneficial to patients suffering from bulimia.
Sources:
Barlow, D., Durand, M. (2009) Abnormal Psychology: An Integrative Approach.
DSM-IV-Tr: Eating Disorders.
Sasha Maggio - Sasha holds her B.A. in Psychology from the University of Hawaii (minor in Japanese) and M.A. in Forensic Psychology from Argosy ...
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