Can a person have both anorexia and bulimia? That’s a complex question that we will seek to answer throughout this article.
You may have a friend or family member who struggles with an unhealthy relationship with food. Maybe they nibble politely without taking in much food or they don’t often want to eat around others. These can be signs of an eating disorder. Sometimes people who struggle with control develop eating disorders and use food as a means to self-protect.
What is the difference between anorexia and bulimia?
Anorexia is a shortened form of the term anorexia nervosa. Typically, a person suffering from anorexia has a low body weight and restricts their food intake. Someone with anorexia may also purge food after it is eaten through excessive exercise, intentional vomiting, or misusing laxatives.
Bulimia, also a serious eating disorder, is short for bulimia nervosa. It is characterized by someone who eats (sometimes secretly and in large quantities) before trying to purge the excess calories. Techniques of purging may look similar to the anorexic’s struggle with extreme exercise, vomiting, and starving oneself for a period of time after a binge.
Sometimes, well-meaning friends and family try to monitor a person’s behavior to see if it’s in control. They may encourage someone with anorexia to eat or discourage using the restroom after a meal for someone who has bulimia. However, anorexia and bulimia have one main aspect in common: neither of them is really about food.
How are anorexia and bulimia similar?
Both anorexia and bulimia are eating disorders, and both are rooted in control and low self-image. Someone who is bulimic may think about their appearance even when other activities are going on. For example, they may be thinking about their body and comparing themselves to other friends while out on a hike or on a road trip sitting in the car. Everyone else is having fun, laughing, and sharing stories. But your friend may be emotionally distant because his/her mind is captivated by a sense that he/she is not enough.
When a person struggles with anorexia, the root of the issue is often control. They may feel out of control in one or more areas of life or feel uncertain about coping with emotional issues. Restricting their caloric intake may feel empowering at first, but it can be a very dangerous habit that is difficult to overcome.
One caution to keep in mind is that not all who suffer from an eating disorder are thin. Research suggests that one-third of patients admitted to residential care programs for anorexia are not underweight. Yet they exhibit the same thought and behavior patterns as the extremely thin people who also suffer from anorexia.
In fact, research also suggests that a person suffering from an eating disorder is very often at a normal weight.
Can a person have both anorexia and bulimia?
While there can be similar symptoms of both anorexia and bulimia, it’s important to note that the Diagnostic and Statistical Manual of Mental Disorders has specific criteria that a person must meet for a diagnosis of anorexia and for a diagnosis of bulimia.
To be diagnosed with anorexia, the DSM-5-TR identifies three characteristics of behavior: restricting energy intake relative to a person’s need for daily life; intense fear of gaining weight or a refusal to gain weight even if the person is considered underweight; and disturbance in self-perception related to weight, often causing a person to not recognize when he or she is underweight.
Two types of anorexia are restricting and binge-purge. The first one is defined by not binging or purging for three months, and the second one is defined by a series of binge-purge episodes over the course of three months.
On the other hand, bulimia is when a person consumes large quantities of food in a short period of time (usually under two hours) and a feeling of being out of control during the food consumption. A person with bulimia may feel compelled to continue eating even beyond fullness and unable to stop. These binges are frequently followed by some kind of activity to purge the food and avoid weight gain, such as vomiting, over-exercising, or misuse of laxatives.
If a person has bulimia, he or she typically experiences a binge/purge episode at least once a week for more than three months. It’s not uncommon for a person to struggle with anorexia and bulimia in a cycle to overcome disordered eating.
Who is at risk for developing an eating disorder?
There are certain risk factors to help you identify if a person you love is likely to develop an eating disorder. These include a family history of eating disorders; a person who works or participates in a field where there is a high emphasis on body size such as gymnastics, modeling or ballet; a person who struggles to feel “good enough” or strives for perfection at all times; or if a person is struggling to cope with life circumstances, such as a move, a divorce, or the death of a loved one.
Paying attention to risk factors can help as you or those you love grow and change. People between the ages of 12 to 25 are the most likely to develop eating disorders; however, this doesn’t mean that people who are younger than 12 or older than 25 can’t develop anorexia and bulimia.
Also, people who diet or have other conditions may be more susceptible to anorexia and bulimia. Other conditions that can exacerbate or contribute to an eating disorder are anxiety disorders, depression, and obsessive compulsive disorder.
What should I do if I think someone I love has an eating disorder?
If you are afraid that you or someone you love has an eating disorder, it’s important to ask for help sooner rather than later. The earlier you can get help, the better. Not getting help early enough can cause other issues, such as depressive and suicidal thoughts, temptation to self-harm, or even death.
Worrying about the issue or about your loved one is not helpful. If you feel that you’re unable to calmly discuss this with your loved one, consider asking someone close to them who is able to remain calm. Letting the person know that you love and care about her is important. Her sense of authority over her own life may feel threatened, and expressing care and a willingness to help are a step in the right direction.
Also, seek medical attention. Young people can approach their pediatrician, call a nurse help line or seek help from a school counselor if they feel more accessible. Ultimately, counseling helps the most.
What to do if you think you may have an eating disorder
Not all unhealthy eating behaviors fit into the category of anorexia and bulimia. There are other patterns of disordered eating that often require the assistance of a trained counselor in order to overcome.
The counselors who work in our offices specialize in a variety of issues, including anorexia and bulimia. A specially trained counselor can also help recognize if there are other issues going on. If you are struggling with thoughts about food, if you feel like you can’t enjoy everyday activities because of a hyperfocus on food and weight, or if you feel like you’re in a cycle that you can’t stop, call a counselor today.
Telling someone you trust is a good first step. You might talk to an aunt, a teacher, or a friend’s parent. While sharing your struggle with a friend can help, an adult will need to be involved if you are underage. If you are an adult and feel you can’t have an eating disorder (you’re too old, not in the “right” socioeconomic category, or are not underweight), consider this. The majority of patients whom doctors diagnose with eating disorders are not underweight.
There is no one-size-fits-all set of characteristics that quantify an eating disorder. Men, women, and young people all suffer, and there is help available.
You are not alone, and there is life beyond an eating disorder. You can have hope and recover. Reach out to one of our offices to find the right counselor for your needs.
“Not Enough Food”, Courtesy of Elena Leya, Unsplash.com, CC0 License; “Weigh-In”, Courtesy of I Yunmai, Unsplash.com, CC0 License “Ballerina”, Courtesy of David Hofmann, Unsplash.com, CC0 License; “Friends on a Walk”, Courtesy of Joseph Pearson, Unsplash.com, CC0 License