Anorexia and Bulimia Nervosa: Causes, Effects & Treatment

Introduction: Society, Thinness, and Eating Disorders

American society seems to have an obsession with thinness, particularly for women. Over the last two decades, the United States has seen two eating disorders become increasingly common: anorexia nervosa and bulimia nervosa. In both disorders, the person takes extreme measures to lose weight. The young women who develop these conditions tend toward perfectionism and are often high achievers who try to meet every demand placed on them.

Clinical Profiles of Anorexia and Bulimia Nervosa

Anorexia Nervosa

The person with anorexia — usually a girl — has a distorted sense of her own body image and an exaggerated fear of becoming overweight. It often starts with a moderate diet, but gradually she rejects more and more food until she is eating very little and becomes emaciated, yet believes she looks fat. As she eats less and less, she may think and talk about food constantly, carefully planning her minuscule meals. Some individuals report that the condition gives them a feeling of increased control over their lives.

As weight loss progresses, monthly periods stop, body temperature drops, bones can become less dense, and heart rate may fall dangerously low. If nutritional deficiencies become severe enough, death from cardiac arrest can occur — as it did for singer Karen Carpenter.

Bulimia Nervosa

In bulimia nervosa, the person cannot resist not only eating but overeating — binging on favored foods. She then forces herself to regurgitate the food so she will not absorb the calories. Individuals with bulimia may also overuse laxatives or enemas, take diuretics to shed water weight, or engage in extreme exercise to burn calories.

Binging can be extreme; some people binge up to 40 times in a week — more than five times a day — and usually in secret. They may consume more than 3,000 calories in a short period of time without chewing or even tasting the food. The binge is followed by intense feelings of guilt, which trigger compensatory behaviors to eliminate the food. Those behaviors leave the person feeling hungry again, and the cycle can repeat itself fairly quickly.

Both anorexia and bulimia tend to develop between young adolescence and young adulthood, and may be triggered by a single offhand comment. Karen Carpenter is said to have begun her path to anorexia after a reviewer described her as "pudgy."

Comparing Anorexia and Bulimia Nervosa

The two disorders share important similarities. Both are often triggered by a period of relatively sensible dieting in people who fear becoming overweight. Both can involve substance abuse, frequently involving drugs intended to support weight loss. Both also involve distorted perceptions of one's own appearance.

However, key differences exist. Those with anorexia show more obsessive tendencies, while individuals with bulimia are more focused on pleasing others and tend toward mood swings and emotional instability. Anorexia is more likely to cause menstrual irregularities, while bulimia can damage the throat, teeth, lungs, and gums.