Anorexia Nervosa vs Bulimia Nervosa - Difference and Comparison

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	Anorexia Nervosa	Bulimia Nervosa
Onset:	mid adolescence	late adolescence
Prevalance in women:	0.5%	1-3%
Weight:	Markedly reduced	usually normal
Menstruation:	Absent	usually normal
Binge eating:	25-50%	required for diagnosis
Mortality:	~5% per decade	low
Cardiovascular:	low BP, decreased heart rate	usually normal
Skin / extremities:	dry skin, lanugo hair	usually normal
Glucose levels:	Hypoglycemia	usually normal
Sex hormones level:	Low estrogen or testosterone	usually normal
LH and FSH level:	low	usually normal
Thyroxine levels:	low normal	usually normal
Cortisol levels:	increased	usually normal

Anorexia nervosa and Bulimia nervosa are both types of psychiatric disorders characterized by severe disturbances in eating behaviors. Both occur primarily in previously healthy young women who become overly concerned with their body weight and shape. Many patients with Bulimia nervosa have past histories of anorexic behavior. On the other hand, many patients with Anorexia nervosa have histories of binge eating and purging behavior. Both of them are more prevalent in cultures where food is plentiful and in which being thin is associated with attractiveness.

In spite of having so many similarities there are certain differences in between the two which make them separate entities. Some of the major differences are:

1 Diagnostic criteria:
2 Clinical characteristics:
3 Physical and laboratory findings:
4 Treatment:
5 References

[edit] Diagnostic criteria:

For anorexia nervosa,
There is refusal by the patient to maintain body weight at or above a minimally normal weight for age and height. There is intense fear of gaining weight or becoming fat even though underweight.
In post menarchal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles.

For Bulimia nervosa,
There are recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

Eating, in a discrete period of time an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
Sense of lack of control over eating during the episode. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self induced vomiting, misuse of laxatives or diuretics, enemas, or other medications; fasting; or excessive exercise.

[edit] Clinical characteristics:

Anorexia nervosa has onset in mid adolescence whereas Bulimia usually starts in late adolescence or adulthood.
Weight at diagnosis is markedly decreased in Anorexia Nervosa while it is usually normal in Bulimia.
Amenorrhea is usually absent in patients with Anorexia Nervosa while it is usually normal in the other group of patients.
Binge eating is present in 25-50 % of patients with anorexia nervosa while it is present in 100 % of patients with Bulimia nervosa.
Mortality is around 5% in 10 years for Anorexia nervosa while it is very low in Bulimia nervosa.
Antisocial behavior can be found in patients with Bulimia Nervosa while it is rare in patients with Anorexia nervosa

[edit] Physical and laboratory findings:

Cardiovascular changes are more common in patients with Anorexia nervosa like decreased heart rate and decreased B.P. while these changes are rare with Bulimia Nervosa.
Skin changes like lanugo hair, dryness etc. are common associates of patients with Anorexia Nervosa while they are rare in patients with Bulimia Nervosa
Hormonal imbalances like low estrogen or testosterone, low LH and FSH, low normal thyroxine etc. are common in patients with Anorexia Nervosa while they are rare in patients with Bulimia nervosa

[edit] Treatment:

For Anorexia Nervosa the most effective form of psychotherapy is family therapy in which the family members of the patients are also consulted by the psychiatrist along with the patient
For Bulimia Nervosa the most effective form of treatment is cognitive and behavioral therapy along with antidepressant