How to differentiate between binge eating type anorexia nervosa and bullimia nervosa?
Distinguishing between binge eating type anorexia nervosa (AN-BE) and bulimia nervosa (BN) can be challenging because both disorders involve disordered eating behaviors, including episodes of binge eating. However, there are some key differences that can help in differentiation:
- Weight and Body Image Concerns:
- AN-BE: Individuals with AN-BE typically have a fear of gaining weight or becoming fat, as well as a distorted body image. Despite engaging in binge eating episodes, they maintain a low body weight that is significantly below what is considered healthy for their age and height.
- BN: Individuals with BN also have concerns about body weight and shape, but unlike those with AN-BE, they are typically within a normal weight range or may even be overweight. They may engage in binge eating followed by compensatory behaviors such as self-induced vomiting, laxative abuse, fasting, or excessive exercise to prevent weight gain.
- Compensatory Behaviors:
- AN-BE: Individuals with AN-BE do not engage in regular compensatory behaviors to counteract the effects of binge eating. Instead, they may restrict their food intake, engage in excessive exercise, or use other methods to control their weight.
- BN: Compensatory behaviors are a hallmark feature of BN. After binge eating episodes, individuals with BN typically engage in purging behaviors (such as self-induced vomiting or misuse of laxatives or diuretics) or non-purging behaviors (such as fasting or excessive exercise) to prevent weight gain.
- Frequency and Severity of Binge Eating Episodes:
- AN-BE: Binge eating episodes in AN-BE may occur less frequently and may not be as severe as those seen in BN. Individuals with AN-BE may engage in occasional episodes of binge eating but do not meet the criteria for bulimia nervosa.
- BN: Binge eating episodes in BN are frequent and recurrent, occurring on average at least once a week for three months. These episodes are characterized by a sense of loss of control and consuming a large amount of food in a discrete period, followed by feelings of guilt, shame, or distress.
- Medical Complications:
- AN-BE: Individuals with AN-BE are at risk of medical complications associated with severe malnutrition and low body weight, such as electrolyte imbalances, cardiac abnormalities, osteoporosis, and hormonal disturbances.
- BN: Individuals with BN are at risk of medical complications associated with purging behaviors, such as electrolyte imbalances, dehydration, dental erosion, gastrointestinal problems, and esophageal damage.
- Psychological Factors:
- AN-BE: Individuals with AN-BE may have obsessive-compulsive tendencies related to food and body weight, as well as perfectionistic traits.
- BN: Individuals with BN often have low self-esteem, feelings of worthlessness, and mood disturbances such as depression or anxiety.
It’s important to note that some individuals may exhibit symptoms that overlap between AN-BE and BN. Additionally, individuals may transition between different eating disorder diagnoses over time. A comprehensive assessment by a qualified mental health professional is essential for accurate diagnosis and appropriate treatment planning.