Eating disorder treatment is a complicated practice that requires deeply personalized planning. When starting a program, the treatment team must accurately diagnose which eating disorder and which co-occurring issues are present. Anorexia nervosa (AN) and bulimia nervosa (BN) are two frequently occurring disorders that require an accurate diagnosis. When it comes to achieving a full recovery, differentiating between the two is an important first step.
There are several shared symptoms of AN and BN that can be difficult to separate. At their core, anorexia nervosa and bulimia nervosa share underlying causes, such as distorted body image, but the treatment applied to the two disorders must be differentiated. The treatment team and family members of the individual with one or both of these disorders should be aware of the commonalities and the differences, and prepare accordingly.
What Are the Risk Factors For AN and BN?
Certain personality traits, family histories, and sociocultural factors can put a person at a higher risk of developing an eating disorder than the general population. As an example, a “type A” personality featuring perfectionist tendencies may manifest in calorie restriction or purging as the person strives to achieve their “ideal” body. Other risk factors include obsessive-compulsive disorder and other anxiety disorders, depression, and a negative body image and self-esteem.
Pressure by peers, friends, and the media to conform to cultural norms can also influence people already prone to facing a high risk of developing disordered eating habits. Activities that stress weight loss or appearance, such as gymnastics, swimming, wrestling, or ballet, can also lead to disordered eating behaviors. Often, people at risk for developing anorexia nervosa or bulimia nervosa will begin to express dissatisfaction with their weight at a young age – normally, this takes place in early adolescence to young adulthood, but some cases have been reported of kids as young as 7 beginning to show disordered behavior.
What Are the Early Warning Signs of Eating Disorders?
The warning signs of anorexia nervosa and bulimia nervosa in adolescents are often subtle and easily concealed. Family and close friends may not be aware that their loved one is hiding their lack of food intake or purging behaviors. One of the biggest warning signs is a hesitance to eat full meals, or developing food rituals such as keeping different foods separate on the plate. People developing an eating disorder may avoid certain food groups, skip meals, or even refuse to eat for an extended period of time. Other early warning signs include trying out various fad or crash diets, altering their mealtimes, or excessively exercising. The first signs of bulimia nervosa can include hiding food and engaging in binge eating episodes, with or without purging.
The central commonality in developing BN and AN is a changing, and critical perception of their own weight, size, and shape. This indicates a deteriorating and increasingly distorted body image, which is a factor in virtually every eating disorder. This can be prevalent during puberty, as teenagers’ bodies are changing rapidly and peer pressure (including self-comparisons to peers) is strong. Complaints about their weight or clothes not fitting, even if there is no cause for concern, are the best indicator there might be a problem.
Common Signs and Symptoms of Bulimia Nervosa
A distinctive and well-known form of eating disorder, bulimia nervosa is characterized by recurring binge eating episodes that are followed by purging behaviors; these include self-induce vomiting as well as abuse of laxatives and exercise binges. The binge eating episodes, normally done in private, involve eating a large amount of food in a short period. The person with BN feels a strong lack of control over their behaviors during these episodes. To make an official diagnosis per the DSM-V, these episodes have to occur at least once a week for at least three months’ time. Early intervention is helpful in recovering from eating disorders, so it’s important to keep a close eye on the person in question and get professional recovery therapists involved as soon as possible.
Emotional and behavioral signs are the best way for loved ones to watch for bulimia nervosa symptoms. As BN progresses, there may be physical symptoms that indicate there is a need for treatment. These signs may include discoloration and decay of the teeth, facial swelling, swollen glands in the throat, and weight fluctuations. Unlike in clients with anorexia nervosa, people who have BN are not always underweight and can be overweight.
Emotional bulimia nervosa symptoms tend to arise in the form of mood swings, intense scrutiny of physical appearance, guilt from restrictive diets, and an inability to focus.
Most behavioral changes are centered on eating habits and dieting. As mentioned, experimenting with fad or extreme diets is a strong potential sign of bulimia nervosa. Bulimia nervosa sufferers often go to the bathroom right after meals and/or spend a long time there as they induce vomiting. Difficulties sleeping and withdrawal from social activities are also common signs of bulimia nervosa eating disorder. Missing food from the fridge or cupboard, or finding food wrappers in large amounts in the trash are signs that binge eating episodes are happening.
Common Signs and Symptoms of Anorexia Nervosa
Anorexia nervosa also begins most often in early adolescence, although it can start at any time. A poor body image and a growing obsession with body weight normally precede full-blown AN. This preoccupation with inaccurate body image perceptions might dramatically affect their social life and actions around mealtimes. As with BN, they might develop rituals around eating and dramatically increase exercise to lose weight.
Extreme weight loss and malnutrition are the prime physical symptoms of anorexia nervosa. Without adequate intake of food and water, the body’s organs cease to function properly. Dry skin, dizziness, fatigue, and constipation are also common symptoms. The constipation may come with severe abdominal pain that prevents the completion of daily activities. When AN has progressed untreated for some time, it’s possible to develop a fine layer of body hair called lanugo.
Anorexia nervosa wreaks havoc on a person’s social life and emotional health. They may seem moody, depressed, and irritable on a regular basis, and may withdraw from social situations, especially if they involve a meal or eating. The emotional distortions that cause and perpetuate AN may take years of counseling and cognitive therapy to resolve.
Similarities Between Anorexia Nervosa and Bulimia Nervosa Behaviors
Both anorexia nervosa and bulimia nervosa are centered around a feeling of being overweight, despite any evidence to the contrary, and a poor body image. People with anorexia nervosa or bulimia nervosa may display a strong fear of gaining weight. They may also have chronically low self-esteem and obsessions with maintaining a thin figure.
Anorexia nervosa and bulimia nervosa both also cause behaviors that release dopamine in the brain, which is the chemical that causes feelings of pleasure. This tends to reinforce compulsive behaviors concerning food and eating that can impede normal daily activities. In both cases, these compulsive behaviors continue even though the individual’s health begins to suffer.
Anorexia nervosa and bulimia nervosa are both frequently associated with other mental health disorders such as anxiety, obsessive-compulsive disorder, and depression. It’s not uncommon for a person to develop both AN and BN, simultaneously or alternatively. There is a much higher chance of developing substance abuse disorder if a person has either disorder as well.
There is no single cause for either anorexia nervosa or bulimia nervosa, although certain genetic and biological factors indicate someone is at risk. The prognosis for people with anorexia nervosa and bulimia nervosa depends on their ability to seek treatment and follow the recovery plan. Recovery is possible in most cases, provided the symptoms are caught early and treatment is secured.
Treatment Methodologies for Anorexia Nervosa and Bulimia Nervosa
Although the disorders have many similarities, every person who seeks treatment is different. This means that the plan of attack for treatment should be uniquely tailored to each client’s needs. Modern eating disorder treatment centers often structure their programs around a leveling system with tweaks for each client.
These treatment programs allow clients to challenge their eating disorders using activities that scale with the accomplishments made to date. As the client progresses from level to level, and learn to trust the therapists and themselves, they may earn certain privileges that reinforce positive and non-disordered behaviors. These privileges may come in the form of outings that help prepare clients to resume their daily lives after discharge.
With the help of nutritionists and dieticians, clients gradually learn how to appropriately choose their foods for meals and snacks. This often includes increasing self-reliance in meal planning and eating schedules that can have a long-lasting effect after the person moves on from residential treatment to a return home. At this point, clients may move to a less intensive treatment program for continued help with their eating disorder.
How to Secure Support from Anorexia Nervosa and Bulimia Nervosa Treatment Centers
When the signs and symptoms of anorexia nervosa and bulimia nervosa arise, it’s essential to reach out for help. OPC’s treatment center offers comprehensive programs designed to help our clients make a full recovery from eating disorders. Every one of our clients receives a personalized treatment plan designed to assuage their disordered eating behaviors and other co-occurring disorders. We can help people of all genders replace their eating disorder with healthy thought patterns and coping skills for a lasting recovery.