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Comparing Bulimia and Binge Eating Disorder

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Bulimia nervosa (BN) and binge eating disorder (BED) are two different eating disorders that share some of the same characteristics. Both involve consuming what are considered large amounts of food in one sitting or across several hours. But people who have binge eating disorder do not engage in compensatory purging behaviors to make up for food eaten, while those who have bulimia do. 

If you think you may have an eating disorder, it’s important to determine which type you have, so you can get an accurate diagnosis, receive the proper treatment, and work toward full recovery.

Comparing Bulimia and Binge Eating Disorder

What is Bulimia?

Bulimia is an eating disorder characterized by a cycle of binging and then compensating in some way–either by purging, exercising, or restricting food intake–for the amount of food eaten. The underlying reason driving the compensatory behavior is fear of consuming too many calories and gaining weight.

There are three different types of bulimia: purging, non-purging, and atypical bulimia. Purging methods of compensatory behavior can include vomiting or using laxatives, diuretics or enemas. Non-purging methods to compensate for food consumed include exercising excessively or fasting. Atypical bulimia involves fewer binge/purge episodes and doesn’t meet full diagnostic criteria for bulimia nervosa. Purging is the most common type of bulimia, and atypical bulimia is the least common type.

Common personality traits of those with bulimia include perfectionism, compulsiveness, impulsiveness, and sensation seeking. (1)

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What is Binge Eating Disorder?

Binge eating disorder is characterized by eating what is considered a large amount of food in a short period of time and doing so frequently over a longer period of time, feeling out of control while doing so, and experiencing shame afterward. People who have binge eating disorder typically exhibit these behaviors: (2) 

  • Binge eating at least once a week for more than three months
  • Eating more rapidly than normal
  • Eating when not hungry
  • Eating beyond feeling full
  • Secretive eating
  • Feelings of self-disgust
  • Distress about binging
  • Binge eating with the absence of purging
  • Binging to relieve stress or anxiety
  • Feelings of worthlessness
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How Are Bulimia And Binge Eating Disorder Similar?

There are some similarities between bulimia and binge eating disorder. Individuals who have bulimia and those who have binge eating disorder both experience binging episodes in which they eat large quantities of food over a short period of time and do so frequently. 

A desire to lose weight is common in those who have bulimia and binge eating disorder.

Mood disorders, such as depression and anxiety, commonly co-occur with both bulimia and binge eating disorder. (1) 

How are bulimia and binge eating disorder different?

Age of Onset

The age of onset of bulimia is younger than in those with binge eating disorder. Those with binge eating disorder tend to be older and have a family history of obesity. (3,6)

Previous History of Anorexia

Those who have a previous history of anorexia nervosa (AN) are more likely to have binge eating disorder, and less likely to have been treated for an eating disorder. (4) 

Severity

Binge eating disorder and the different types of bulimia vary in severity. Most severe is the purging type of bulimia. Next is the non-purging type. Binge eating disorder is the least severe. Atypical bulimia lies somewhere in between the non-purging type and binge eating disorder. (5,6)

Purging vs. Non-Purging

Those who have binge eating do not have the purging compensatory mechanisms found in those with regular bulimia. (7) Those who have binge eating disorder have less of a restraint and drive for thinness than those with purging or non-purging bulimia. (7) 

Body Dissatisfaction

While body dissatisfaction is common among most eating disorders, it is highest in the non-purging type of bulimia. (9)

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Comparing the Different Types of Bulimia

BMI Differences

While BMI is not an indicator of health and is used here purely to distinguish among the different types of bulimia, research has found differences in BMI among those with different types of bulimia. Those who purge have the lowest BMI of all types of bulimia. The highest BMI is found in those with binge eating disorder. Those with non-purging bulimia and atypical bulimia fall in the middle range, between those who have purging bulimia and those with binge eating disorder. (7,8)

Who is Most and Least Likely to Use Vomiting

Those who engage in purging are significantly more likely to use vomiting than those with atypical bulimia. Those who have atypical bulimia are less likely to use vomiting than those with the non-purging type, according to one study. (8)

Stomach Distress Found in Those Who Purge

Those who purge have greater feelings of stomach fullness and GI distress compared to those who do not purge. (9)

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When to Seek Help

If you suspect you or someone you know may have binge eating disorder or one of these types of bulimia, it’s critical to seek professional help. Eating disorders do not go away by themselves, but full recovery is possible with an accurate diagnosis and proper treatment.

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Frequently asked questions

Resources

  1. Kaye W. Neurobiology of anorexia and bulimia nervosa. Physiol Behav. 2008 Apr 22;94(1):121-35. https://pubmed.ncbi.nlm.nih.gov/18164737/ 
  2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. Published. https://doi.org/10.1176/appi.books.9780890425596
  3. Striegel-Moore RH, Cachelin FM, Dohm FA, Pike KM, Wilfley DE, Fairburn CG. Comparison of binge eating disorder and bulimia nervosa in a community sample. Int J Eat Disord. 2001 mar;29(2):157-65. https://pubmed.ncbi.nlm.nih.gov/11429978/ 
  4. Nunez-Navarro A, Jimenez-Murcia S, et al. Differentiating purging and nonpurging bulimia nervosa and binge eating disorder. Int J Eat Disord. 2011 Sep;44(6):488-96. https://pubmed.ncbi.nlm.nih.gov/20872757/ 
  5. Van Hoeken D, Veling W, Sinke S, Mitchell JE, Hoek HW. The validity and utility of subtyping bulimia nervosa. Int J Eat Disord. 2009 Nov;42(7):595-602. https://pubmed.ncbi.nlm.nih.gov/19621467/ 
  6. Legenbauer T, Herpertz S. Eating disorders – diagnosis and treatment. Dtsch Med Wochenschr. 2008 May;133(18):961-5. https://pubmed.ncbi.nlm.nih.gov/18431706/ 
  7. Jordan J, McIntosh VVW, Carter JD, Rowe S, Taylor K, Frampton CMA, McKenzie JM, Latner J, Joyce PR. Bulimia nervosa-non purging subtype: closer to the bulimia nervosa-purging subtype or to binge eating disorder? Int J Eat Disord. 2014 Apr;47(3):231-8. https://pubmed.ncbi.nlm.nih.gov/24282157/ 
  8. Wade TD. A retrospective comparison of purging type disorders: eating disorder not otherwise specified and bulimia nervosa. Int J Eat Disord. 2007 Jan;40(1):1-6. 
  9. Keel PK, Wolfe BE, Liddle RA, DeYoung KP, Jimerson DC. Clinical features and physiological response to a test meal in purging disorder and bulimia nervosa. Arch Gen Psychiatry. 2007 Sep;64(9):1058-66.

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