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A diagnosis of anorexia nervosa, binge eating disorder, or bulimia nervosa is never an easy thing to hear. These well-known eating disorders cause trepidation in families and friends due to the many possible negative health effects anorexia nervosa and bulimia nervosa can have. Positively, these fears can be allayed by the comprehensive care available at anorexia nervosa treatment centers. On the other hand, maybe people don’t have the medical and psychological background to accurately make a diagnosis themselves. For people who aren’t sure whether their loved one has an eating disorder, here’s a handy guide to the respective symptoms of anorexia nervosa and bulimia nervosa which can help clarify the difference and allow them to make the right decision on how to proceed with getting anorexia nervosa treatment.

What Is Anorexia Nervosa?

An anorexia nervosa diagnosis is normally a combination of physical and psychological tests performed by a team of professionals. Anorexia nervosa is considered to be the most dangerous of all mental health disorders, raising the rate of suicide and death by malnutrition to almost 12 times the rate of the non-disordered population. It’s estimated that without anorexia nervosa treatment, 20 percent of people with the disorder will die. It’s essential to make a diagnosis and begin getting them help as early as possible.

So, what are the symptoms of anorexia nervosa? The main defining characteristic is strict avoidance of caloric intake, that is, eating only tiny amounts of food or skipping meals altogether, even to the point of becoming emaciated or malnourished. To put it simply, people with extreme anorexia nervosa symptoms are starving.

Anorexia nervosa has several other complications related to both the physically severe lack of food and nutrition, and to the psychological factors that contribute to it. Friends and family who are close to the individual can look out for:

  • Thinning hair or brittle hair
  • Fine downy hair growth on the body
  • Intolerance to cold
  • Abdominal pain
  • Dried-out or yellowing skin

When examined by a doctor, people with anorexia nervosa will often show the following symptoms:

  • Low blood pressure
  • Anemia
  • Lack of menstruation
  • Malnutrition

Finally, there are some common behavioral and emotional signs to look out for:

  • Preoccupation with weight and body size
  • Distorted perception of one’s weight
  • Avoiding eating in public
  • Insomnia
  • Being suddenly socially withdrawn

What Is Bulimia Nervosa?

Another very well-known eating disorder, bulimia nervosa also has a much higher incidence of mortality than other eating disorders, but bulimia presents some different symptoms than anorexia nervosa. Bulimia nervosa also often carries a distorted and overwhelmingly negative perception of the person’s body and weight which causes disordered behaviors. In contrast to an anorexia nervosa diagnosis, people with bulimia nervosa are not normally underweight or emaciated. They may be overweight in some cases. This is due to the first half of the binge/purge cycle that defines the disorder.

Bulimia nervosa is a series of disordered thoughts and behaviors that stem from a poor body image. People with the disorder will take part in binge eating episodes regularly, in which they will eat large amounts of (often unhealthy) foods in a short period of time. This is normally done in secret, and away from typical mealtimes. These binge eating episodes are followed by purging behaviors which are designed to rid the body of the calories eaten. Most commonly this manifests as self-induced vomiting, but other methods may include abusing laxatives or diuretics, administering enemas, or obsessively exercising. Some common signs of bulimia nervosa include:

  • Preoccupation with body size
  • Cycling through extreme diet phases
  • Rapid weight loss or weight gain
  • Hoarded food, usually hidden away
  • Lots of discarded food wrappers or laxative containers
  • Signs and smells of vomiting
  • Excusing themselves following meals
  • Discomfort around mealtimes or eating in public
  • Discolored teeth and fingers

What Is Binge Eating Disorder?

Although binge eating disorder is less common in adolescents than in adults, it is still the most common eating disorder overall. It’s common enough in teenagers to be a concern; according to some studies, binge eating disorder occurs in between 1.32% and 3% of all children and adolescents. Because it doesn’t involve dramatic weight loss or purging behaviors, binge eating disorder sometimes goes under the radar compared to anorexia nervosa or bulimia nervosa. However, it remains a dangerous disorder that is recognized by the psychiatric community, being listed in the DSM-V.

Binge eating disorder, like bulimia nervosa, consists of compulsive and repeated binge eating episodes and disordered body image/dissatisfaction with body weight. However, there are no purging behaviors afterward, as observed in bulimia nervosa. Because of this, people with binge eating disorder are often overweight or obese. The disorder can bring on health complications related to obesity as well as weight cycling. It can also cause problems in the person’s social life and relationships. Binge eating disorder sufferers are also at higher risk of co-occurring mental health disorders like depression, anxiety, and mood disorders.

Some of the signs of binge eating disorder include:

  • Body image troubles
  • Cycling through extreme diet phases
  • Rapid changes in body weight
  • Gaining weight despite being on a diet
  • Hiding or hoarding food
  • Feelings that their eating is out of control
  • Eating rapidly
  • Eating in secret
  • Eating past the point of feeling full
  • A sense of guilt or shame about eating
  • Feeling uncomfortable at group meals

Sometimes More Than One Eating Disorder Can Happen

 People with eating disorders can have more than one type or cycle between different disorders. For example, a person with anorexia nervosa might occasionally binge and purge when hunger compels them, and then return to calorie restriction. Or a binge eating disorder sufferer might constrict their food intake outside the binge eating episodes to an extreme degree. This can make a specific diagnosis difficult for medical professionals, especially for teenagers. In adolescence, body image becomes more prevalent than before, and quickly growing bodies often prompt a larger appetite. Contacting a professional who specializes in adolescent eating disorders is advisable – they can determine what the best treatment plan should be for teens displaying more than one kind of eating disorder’s symptoms.

Other Eating Disorders That Might Affect Adolescents

 There are other forms of eating disorders, as well. They are not normally as common as the ones we’ve mentioned, but they can also be very serious and require treatment. Here are some symptoms that might indicate their presence:

  • Pica –This psychiatric disorder involves eating items that are not considered food, or have no nutritional value. This might mean eating things like chalk, dirt, ashes, pebbles, or metals. It’s not uncommon for pregnant people or people who are starving to get cravings for non-foods. However, in children, it can be an indication of schizophrenia or OCD. Some of the health effects pica can have include:
    • Parasitic infection
    • Intestinal blockages
    • Bloody stool
    • Choking
  • Orthorexia nervosa–Unlike many eating disorders, orthorexia is not related to body image distortions or a fear of gaining weight. Instead, the individual cuts out certain foods or food groups because they are “unhealthy.” An obsession with healthy eating defines orthorexia; while eating well is encouraged, this disorder can negatively affect a person’s wellbeing and cause extreme weight loss. A person with orthorexia might experience:
    • Distress when exposed to “fear foods”
    • Weight loss and malnutrition
    • Disruption of relationships and work/school
    • Blood and organ diseases like anemia
  • Avoidant/Restrictive Food Intake Disorder (ARFID) – Similar to orthorexia, ARFID’s causes usually don’t include weight insecurity or body image distortions. Instead, the pathological fear of certain foods being dangerous or lethal is the primary cause. People may begin to show ARFID symptoms after choking, for example. They then avoid the food they choked on afterward. Food poisoning or fear or “impure” foods. Symptoms of ARFID include:
    • Weight loss and malnutrition
    • Distress when forced to be around “fear foods”
    • Social and relationship difficulties
  • Atypical anorexia nervosa –One of the criteria for a diagnosis of anorexia nervosa is that the individual becomes severely underweight. However, a person can restrict food intake without this result. In some cases, the person was overweight before restricting. In others, their natural body weight and metabolism prevent it. In either case, weight loss does occur and malnutrition can set in. Atypical anorexia nervosa is very dangerous and can require extensive medical and psychiatric care.

Making a Diagnosis of an Eating Disorder and Getting Treatment

People that are concerned that a loved one is showing signs of an eating disorder like anorexia nervosa or bulimia nervosa can’t make the call themselves – only medical and psychiatric professionals can make a true diagnosis. But If you see the signs and symptoms listed above, it’s worthwhile to contact a professional eating disorder treatment center sooner rather than later. It can make the difference in saving your loved one’s life.


Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.