Anorexia Nervosa vs Bulimia Nervosa
Anorexia Nervosa and Bulimia Nervosa are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Anorexia Nervosa vs Bulimia Nervosa at a glance
- Anorexia Nervosa: Restriction of intake leading to significantly low body weight, intense fear of weight gain, and disturbed body image.
- Bulimia Nervosa: Recurrent binge eating with inappropriate compensatory behaviors; normal or above-normal weight.
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Side-by-side comparison
| Feature | Anorexia Nervosa | Bulimia Nervosa |
|---|---|---|
| At a glance | Restriction of intake leading to significantly low body weight, intense fear of weight gain, and disturbed body image. | Recurrent binge eating with inappropriate compensatory behaviors; normal or above-normal weight. |
| Classic presentation | Severe dietary restriction; rule-driven eating; excessive exercise; calorie counting; body checking; Subtypes: restricting type vs binge-eating/purging type; Amenorrhea common but not required for DSM-5-TR diagnosis; Cold intolerance, fatigue, constipation, dizziness, syncope; Cachexia, lanugo, dry skin, brittle hair, peripheral edema;… | Binge: eating an objectively large amount of food in <2 hours with sense of loss of control; Compensatory behaviors: self-induced vomiting (most common), laxative or diuretic misuse, fasting, excessive exercise; Both occur on average >=1/week for >=3 months; Body shape and weight unduly influence self-evaluation; Russell's sign (knuckle… |
| Workup / key labs | DSM-5-TR: (A) Restriction of energy intake relative to requirements leading to significantly low body weight in context of age/sex/developmental trajectory/health; (B) Intense fear of gaining weight or becoming fat, or persistent behavior interfering with weight gain; (C) Disturbance in body weight/shape experience, undue influence on… | DSM-5-TR: (A) Recurrent binge eating — large amount + loss of control; (B) Recurrent inappropriate compensatory behaviors; (C) Both occur on average >=1/week for >=3 months; (D) Self-evaluation unduly influenced by body shape/weight; (E) Disturbance does not occur exclusively during anorexia nervosa episodes. Severity by frequency: mild… |
| Imaging | DEXA for bone density; ECG essential prior to refeeding | Not routinely indicated; CXR if subcutaneous emphysema or chest pain (Boerhaave) |
| First-line treatment | Multidisciplinary team — primary care, mental health, dietitian, family; Family-based treatment (Maudsley) — first-line for adolescents; Cognitive behavioral therapy for eating disorders (CBT-ED), enhanced CBT (CBT-E) — adults; Nutritional rehabilitation with structured meal plan and gradual weight restoration; Medical hospitalization… | Cognitive behavioral therapy for eating disorders (CBT-ED) — strongest evidence base; Interpersonal therapy (IPT) — alternative; Family-based treatment for adolescents; Fluoxetine 60 mg/day — FDA-approved; reduces binge/purge frequency; Nutritional counseling — structured eating to interrupt restriction-binge cycle |
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