Bulimia vs. Binge Eating: Key Differences

Bulimia and binge eating disorder have a lot in common. Both involve episodes of bingeing, and both can be associated with weight gain. But there are significant differences between these two common eating disorders.

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Bulimia and binge eating disorder have a lot in common. Both involve episodes of bingeing, and both can be associated with weight gain. But there are significant differences between these two common eating disorders.

Understanding the similarities and differences between bulimia vs. binge eating is very important for your treatment team. But knowing them could be helpful for you, too, as you work on developing healthy eating habits. 

How Is Bulimia Officially Diagnosed?

No brain scan or blood test can diagnose an eating disorder. Instead, doctors use interviews to understand how their patients eat and how they feel about their bodies. As you answer questions, doctors compare your answers to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

The DSM-5 is an encyclopedia of mental health issues. Doctors pull codes from this book when diagnosing their patients. Often, those codes mean the difference between an insurance company approving and denying a medical claim. 

Per the DSM-5, people with bulimia experience these symptoms more than once per week for three months: [1]

  • Recurrent binge eating: In a set period, people eat much more than they would in a similar situation or time. 
  • Loss of control: People don’t feel like they can stop eating during these episodes. 
  • Compensation: People use methods like vomiting, laxative abuse, or exercise to eliminate calories consumed during the binge.
  • Shape- or size-related distress: Their sense of self is closely tied to how much they weigh or what they look like. 

If your doctor’s questions highlight these episodes, you could qualify for a bulimia diagnosis. With that, you could enroll in treatment and expect your insurance company to help cover the cost. 

How Binge Eating Disorder is Officially Diagnosed

The DSM is updated periodically, and before the fifth edition, binge eating disorder didn’t appear. Doctors saw patients that had a similar set of symptoms, but they didn’t fit nicely into DSM categories. Now they do. 

Per the DSM-5, people with binge eating disorder experience these symptoms at least weekly for three months:

  • Recurrent binge eating: People eat more in one episode than during a similar situation and time. 
  • Distress: They feel very guilty about eating this much at once. 

Your doctor may ask many questions about how much you eat, whether other people are present while you eat, and how you feel afterward. Being honest is essential, as your doctor needs help understanding your symptoms. 

Bulimia vs. Binge Eating Disorder: Similarities

Both eating disorders share common features, risk factors, and consequences.

Eating Patterns

People with bulimia or binge eating disorder may eat regular meals every day, enjoy holiday party food, and dine out with friends. But they have private eating sessions in which they consume an unusual amount of food in a mindless, out-of-control manner. 

A binge looks like this: [2]

  • Time-limited: People eat a large amount within a short window, such as two hours.
  • Unusual: People eat much more during this period than they would normally. For example, a person might eat one sandwich during a two-hour lunch. However, during a binge, the person might eat 12 of them. 
  • Uncontrollable: People can’t seem to stop eating. Some report feeling like they’re absent or away while their bodies eat. 

Both bulimia and binge eating disorder are characterized by binges that happen at least once weekly.

Psychological Distress

While people with bulimia or binge eating disorder have bingeing episodes, they don’t enjoy them. Instead, both types of people feel extremely upset, embarrassed, and upset about how much they eat during these episodes.

Unfortunately, that distress can spark them to binge on food again. Both binge eating disorder and bulimia are cyclical. 

Diabetes Increases the Risk 

Researchers say girls and women with type 1 diabetes have about twice the risk of developing eating disorders compared to their peers. [3] 

Eating disorders like bulimia and binge eating disorder are closely tied to diabetes due to the nature of diabetes control. People must watch their diets closely, count calories, and place foods into good/bad categories. As the pressure to eat “well” rises, these people may break and binge. 

Other Risk Factors 

Researchers aren’t sure what exactly causes binge eating disorder or bulimia. But they think these eating disorders arise due to a combination of these factors: [4]

  • Genetics
  • Biology
  • Behavioral tendencies
  • Psychological factors
  • Social pressure 
  • Family history 

Bulimia & Binge Eating Disorder Differences 

While bulimia and binge eating disorder are very similar, they also come with differentiating factors. 

Number of People Touched by Them

Binge eating disorder is three times more common than bulimia and anorexia combined. [5] While it’s clear that anyone can develop an eating disorder, and risk factors are truly shared among these conditions, far more people have binge eating disorder than any other issue. 

Compensatory Behaviors

What happens after a binge? People with binge eating disorder feel incredibly guilty about the episode and may criticize themselves and promise never to indulge again. People with bulimia are different.

Someone with bulimia springs into action after a binge by vomiting, using laxatives, or otherwise trying to eliminate calories. In severe cases, people with bulimia will engage in these behaviors after ingesting any calories, including those from standard meals. 

While people with binge eating disorder may occasionally diet, vomit, or exercise to lose weight, it’s not a regular part of their routine. [6]

Medication Management

Both bulimia and binge eating disorder respond to therapy, and both can be treated with medications too. But the pharmaceutical solutions experts reach for are different.

In 1994, the U.S. Food and Drug Administration (FDA) approved fluoxetine (Prozac) for bulimia management. In 2015, the FDA approved lisdexamfetamine dimesylate (Vyvanse) for binge eating disorder. [7]

These medications both work to ease symptoms, but they are different substances. 

Research Backing

Bulimia has been part of the medical community’s terminology handbook for decades. Researchers have examined how the disease works, who gets it, and how it’s effectively treated. Binge eating disorder was only formally identified in 2013, so researchers know much less about it. [8]

Weight Gain

Consuming a large amount of food in a short time adds calories to your body. Tactics people with bulimia use aren’t effective at eliminating all calories, and sometimes, people with bulimia gain weight. In contrast, most people with binge eating disorder are overweight.

In one study, 33% of people with bulimia had been obese at one point in life. Of those with binge eating disorder, 87% had been obese. [9]

Consequences

People with bulimia face health problems caused by purging. [10] Those issues include the following:

  • Dehydration
  • Digestive distress
  • Esophageal tears 
  • Heart damage 
  • Heartburn 
  • Tooth decay 

People with bulimia face health problems caused by obesity. [10] Those issues include the following:

  • Diabetes
  • Heart disease 
  • High blood pressure
  • Liver disease 
  • Sleep problems 

While all eating disorders are dangerous, the list of complications differs significantly between these two disorders. 

How to Find Treatment Help

You’re not required to diagnose your own eating disorder. Your doctor can listen to you and help you understand how your eating patterns could harm your health. Talking with your doctor is often the best way to decide your treatment path.

But if you don’t have a doctor you trust, ask your family for help. Tell them what’s bothering you, and ask them to work with you to find a solution. They may have ideas that just never occurred to you, and they could support you as you work to change your eating habits in healthy ways. 

You can also seek out eating disorder treatment facilities near you. Operators can help you understand what to do next, and sometimes, they can smooth the admissions process for you and make it easier to get the help you need.

Don’t wait to get started. Eating disorders resolve best when people get treatment early.

Resources


  1. DSM-V Eating Disorders. (2022). The Victorian Centre of Excellence in Eating Disorders.Retrieved August 12, 2022.
  2. Management and Outcomes of Binge-Eating Disorder. (2015). Comparative Effectiveness Reviews. (2015, December). 
  3. Diabetes and Eating Disorders. (2002). American Diabetes Association. Retrieved August 12, 2022.
  4. Binge Eating Disorder. (2022). U.S. Department of Health and Human Services. Retrieved August 12, 2022. 
  5. Statistics and Research on Eating Disorders. (n.d.). National Eating Disorders Association. Retrieved August 12, 2022.
  6. Definition and Facts for Binge Eating Disorder. (2021). National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved August 12, 2022.
  7. Bello NT, Yeomans BL. (2018). Safety of pharmacotherapy options for bulimia nervosa and binge eating disorder. Expert Opinion on Drug Safety; 17(1):17-23. 
  8. New in the DSM-5: Binge Eating Disorder. (n.d.). National Eating Disorders Association. Retrieved August 12, 2022.
  9. da Luz FQ, Hay P, Touyz S, Sainsbury A. (2018). Obesity with Comorbid Eating Disorders: Associated Health Risks and Treatment Approaches. Nutrients; 10(7):829. 
  10. Health Consequences. (n.d.). The Eating Disorder Foundation. Retrieved August 12, 2022.

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