Bulimia vs Binge Eating: How Are They Different?
While these two disorders do have similarities, binge eating disorder is different than bulimia nervosa based on what does or doesn’t happen after binge eating.
Diagnostically we differentiate these two disorders by looking at either the presence or absence of what we call “compensatory behaviors.” These are behaviors that people engage in to try and “undo” the impacts of a binge. This looks like: throwing up, laxative use, periods of starvation and/or excessive exercise.
Binge eating is the common denominator between the two disorders, and includes feeling out of control, and eating a large enough amount of food that most people find themselves feeling stuffed, uncomfortable, and even sick. It’s common for binge eating to be in secret, and there tends to be a lot of shame around it.
How is Binge Eating Different from Bulimia Nervosa?
The DSM-5 distinguishes binge eating disorder (BED) as different than bulimia nervosa (BN) based on the presence or absence of purging post-binge. And yes, purging does not just mean throwing up, it encompasses any behavior that attempts to reduce the impacts of binge eating.
In acknowledging the difference between binge eating and bulimia, I have to state that there are many similarities between the two, and people can experience both throughout the course of their eating disorder struggle as well.
It’s important to mention that with both disorders there are often great impacts on health, and there are typically enormous amounts of shame and hiding which is equally impactful to health and wellbeing. If you are struggling with one of these disorders (or a mixture of the two that lands you in a category like an “unspecified eating disorder”) just know that you’re not alone, you’re not inherently bad or without willpower, and you can heal.
Signs and Symptoms of Bulimia
Behavioral changes like always going to the bathroom after eating, or sporatic intense exercise
Medical complications in various organs relating to self-induced vomiting and laxative abuse
Preoccupation with body shape and size
Fear of weight gain and loss of control around food
Episodes of eating abnormally large amounts of food in one sitting, followed by compensatory behaviors
Electrolyte imbalances
Restriction or dieting behaviors followed by secretive eating
Signs and Symptoms of Binge Eating
The individuals I see with binge eating disorder are often both tired of binge eating, and also find some sense of comfort in the actual moments of binge eating. That might sound confusing (or it might totally resonate!), but truly binge eating can be an escape from reality, and a place to get away from harder feelings. I have found in my own counseling practice that a large amount of individuals experiencing binge eating disorder also have had experiences of childhood emotional neglect. Binging provides coping and comfort when these essentials have been otherwise hard to come by.
Here are some other signs and symptoms of binge eating disorder:
Excessive diet restrictions that trigger binging
Unmanaged mental health issues like depression or anxiety that trigger binge eating
Excessive concerns with food, weight, and body shape
Alexithymia and difficulty identifying or regulating emotions
Struggles with impulsivity
Body dissatisfaction or body image issues
Eating behaviors such as restrictive morning eating, double meals, and nocturnal eating
Eating as the primary source of emotional comfort
Secretive eating
Treating Binge Eating and Bulimia
This might sound a bit obvious, but the first step in getting treated is to get properly assessed, which means ensuring that your provider isn’t letting assumptions about weight get in the way of seeing what you’re truly struggling with.
For instance, I’ve had several clients come into my office with a diagnosis of binge eating disorder who really have atypical anorexia, because providers who aren’t aware of their weight biases see someone in a larger body and think “they must be consuming large amounts of food!”
So treating binge eating and bulimia start with ensuring that you’ve been properly assessed, and understanding that these disorders aren’t your fault.
Research indicates the importance of finding eating disorder specialists and using a multidisciplinary approach. Treating binge eating and bulimia is typically some combination of care with a dietitian, a mental health counselor, a psychiatrist, and a doctor.
Here are some key treatment goals:
Ensuring medical stability—that there aren’t serious health concerns as a byproduct of the eating disorder behaviors like purging.
Reducing restriction to reduce binge eating. To reduce binge eating you must reduce restriction… and hint, there’s 2 types of restriction!
P.S. I go into this in detail in my support for restricting and binging course.
Finding ways to accept and cope with difficult emotions–since on some level eating behaviors and purging behaviors are just a way to cope with something that feels unmanageable.
P.S. There’s a course for this too: The Coping Now Bundle
Treating co-occurring struggles/disorders like depression, anxiety, ocd, and trauma using modalities like CBT and ACT.
Correcting disordered eating and addressing body image issues and weight discrimination–For children and adolescents it’s imperative to have family-based treatment.
Parents needing guidance can see my course “the eating disorder informed parent.”
If you think you might be struggling with binge eating disorder or bulimia, get help by reaching out to an eating disorder dietitian or therapist. You can also check out one of my online courses for support with restricting, binging and to move towards more freedom:
Support with Restricting & Binging ($35)
Resources:
Amianto F, Ottone L, Abbate Daga G, Fassino S. Binge-eating disorder diagnosis and treatment: a recap in front of DSM-5. BMC Psychiatry. 2015 Apr 3;15:70. doi: 10.1186/s12888-015-0445-6. PMID: 25885566; PMCID: PMC4397811.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4397811/
Castillo M, Weiselberg E. Bulimia Nervosa/Purging Disorder. Curr Probl Pediatr Adolesc Health Care. 2017 Apr;47(4):85-94. doi: 10.1016/j.cppeds.2017.02.004. PMID: 28532966.
https://pubmed.ncbi.nlm.nih.gov/28532966/
Gorrell S, Le Grange D. Update on Treatments for Adolescent Bulimia Nervosa. Child Adolesc Psychiatr Clin N Am. 2019 Oct;28(4):537-547. doi: 10.1016/j.chc.2019.05.002. Epub 2019 Jul 4. PMID: 31443872; PMCID: PMC6709693.
