The differences between bulimia and anorexia nervosa
The main criteria differences involve weight: an anorexic must have a body mass index of less than 17.5. Typically an anorexic is defined by the refusal to maintain a normal weight by self-starvation.
Another criterion which must usually be met is amenorrhea, the loss of a female's menstrual cycle not caused by the normal cessation of menstruation during menopause for a period of three months. Generally the anorexic does not engage in regular binging and purging sessions. If binging and purging occurs but rarely, and the patient also fails to maintain a minimum weight, they are classified as a purging anorexic, due to the underweight criterion being met and cessation of menstruation.
There are two sub-types of bulimia nervosa: purging and non-purging.
Purging type is the more common type of bulimia, and involves any of self-induced vomiting, laxatives, diuretics, enemas, or Ipecac, to rapidly extricate the contents from their body.
Non-purging type occurs in only approximately 6%-8% of bulimia cases, as it is a less effective means of ridding the body of such a large number of calories. It involves doing excessive exercise or fasting after a binge, to counteract the large amount of calories previously ingested. This often occurs in purging-type bulimics, but is a secondary form of weight control.
Characteristically, bulimics feel more shame and out of control with their behaviors, as the anorexic meticulously controls their intake, a symptom that calms their anxiety around food as she/he feels she/he has control of it, naïve to the notion that it, in fact, controls her/him. For this reason, the bulimic is more likely to admit to having a problem, as they do not feel they are in control of their behavior. The anorexic is more likely to believe they are in control of their eating and much less likely to admit that a problem exists.
Anorexics and bulimics have an overpowering sense of self determined by their body and their perceptions of it. They trace all their achievements and successes to it, and so are often depressed as they feel they are consistently failing to achieve the perfect body. Bulimics feel that they are a failure because she/he cannot achieve a low weight, and this outlook infiltrates into all aspects of their lives. Anorexics cannot see that they are underweight and constantly work towards a goal that they cannot meet. They too allow this failure to define their self worth. As both the anorexic and bulimic never feel satisfaction in the more important part of their lives, depression often accompanies these disorders.
Treatment
Treatment is most effective early in the development of the disorder, but since bulimia is often easy to hide, diagnosis and treatment often come when the disorder has already become a static part of the patient’s life.
Historically, bulimics were often hospitalized to end the pattern and then released as soon as the symptoms had been relieved. But this is now infrequently used, as this only addresses the surface of the problem, and soon after discharge the symptoms often reappeared as severe, if not worse.
Several residential treatment centers offer long term support, counseling, and symptom interruption. The most popular form of treatment involves therapy, often group psychotherapy or cognitive behavioral therapy. Anorexics and bulimics typically go through the same types of treatment and are members of these same treatment groups. This is because anorexia and bulimia often go hand in hand, and often patients have at some point suffered from both. Some refer to this as "symptom swapping". These forms of therapy address both the underlying issues which cause the patient to engage in these behaviors, and the food symptoms. Sadly, most people with eating disorders will never have the chance to receive treatment from a facility that specializes in eating disorders. The Hollywood Anorexic type checking in and out of rehab is the minority. Usually, eating disordered people are professionally, socially and financially devastated by their illness. Most insurance companies will only cover brief inpatient stays in general hospital psych wards. This ultimately leaves the eating disordered person more confused, more desperate and sicker than before. Specialized treatment is necessary for recovery. Few can afford it and few receive it. Consequently, many continue to die from these mental illnesses.
In combination with therapy, many psychiatrists prescribe anti-depressants or anti-psychotics. Anti-depressants come in different forms, and the most promising one has been Prozac. In a study of 382 bulimics, those who took 20 to 60 mg of Prozac reduced their symptoms from 45% to 67%, respectively. It is possible that several other drugs could be more effective, but often insurance companies will not pay for other drugs until the patient has tried Prozac, because it has some positive outcome results. Anti-psychotics are used in smaller doses than for treating schizophrenia. With an eating disorder, the patient perceives reality differently and has difficulty grasping what it is like to eat normally.
Unfortunately, since this disorder has only recently been recognized by the DSM, long-term outcomes of people with the disorder are unknown. Current research indicates that up to 30% of patients rapidly relapse, while 40% are chronically symptomatic.
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The rate in which the patient receives treatment is the most important factor affecting prognosis. Those who receive treatment early on for the disorder have the highest and most permanent recovery rates.
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