How Does Binge Eating Disorder Differ from Bulimia Nervosa?

Fighting binge eating in San Diego is hard enough. Struggling with urges to get rid of the food afterward adds another challenge. When binge eating or bulimia is present, it’s more difficult to grab life by the horns and hang on for a wild, fun ride. Sitting in my office in San Diego, California, listening to the baby birds chirp in the nest outside my window, I’m thinking about how binge eating and bulimia hijack people’s lives. Whether you live in California or anywhere else in the world, I hope that my message is coming directly to you—the message that both binge eating disorder and bulimia are complex brain disorders. They have similarities and differences. Despite how hard it is to have bulimia and binge eating disorder, people CAN recover from both. I promise.

Battling Binge Eating Disorder

The binge eating disorder (BED) diagnosis came out in 2013 with the DSM-V (a diagnostic manual for mental disorders). Studies of binge eating behaviors emerged before that, even though the official BED diagnosis didn’t exist. Since 2013, more researchers have examined BED—especially how it manifests in the brain. In the general population, 2-5% of people have BED.

Getting a BED diagnosis means you experience regular binge eating episodes, which comprise eating large amounts of food in a relatively short time—often eating way past the point of fullness. These episodes occur outside of social events when people typically eat a lot of food (e.g., holidays, such as Thanksgiving in the U.S.).

Binge eating episode frequencies vary; BED diagnosis criteria require at least one binge per week for three months*. People commonly experience tremendous distress, guilt, shame, and remorse after the binge. With BED, there is often accompanying depression, anxiety, and low self-esteem. A strong feeling of being out of control or unable to stop is part of BED. There are typically negative body image issues, preoccupation, and obsessive thoughts around food, eating, and weight. People with varied body sizes can have BED.

Busting Bulimia

The first description of bulimia nervosa emerged in 1979. Described as a variation on anorexia nervosa, bulimia’s characteristics involve binge eating, then engaging in behaviors that attempt to compensate for the consumed food. Such behaviors include purging (vomiting), chewing and spitting out the food, using laxatives or other diuretics, and overexercising. Intense preoccupation and ruminating around weight, body image, eating, and food is also present. In the general population, 1-2% of people can have bulimia.

Researchers have found that in the brains of patients with bulimia, dopamine and opioid receptors are compromised, which means that people with bulimia get more pleasure from eating when compared to people without bulimia. I’ve found that many individuals experience a “rush” and a strong sense of relief during the purging process. Like BED, an official diagnosis requires binge/compensation episodes at least once per week for three months*.

When people think about bulimia, they typically think of purging.

Purging or vomiting regularly has negative health consequences, such as tooth decay or staining, pancreatitis, edema, esophageal inflammation or rupture, ulcers, and acid reflux. If you are purging regularly, please see a medical professional and a dentist who specializes in eating disorders so they can work on getting you medically stable.

Laxatives can also have detrimental effects (sodium/potassium irregularities), as can overexercise (injuries, etc.). Please consult a medical professional if you’re also struggling with these behaviors.

NOT the Soul Cycle

Both binge eating and bulimia involve a cycle that frequently includes restriction. You might think, “Wait--what? I’m trying to eat less food and NOT binge. How the heck can I be restricting?” The bottom line is that if you are binge eating, you are restricting. It may not feel like it. Your brain may tell you that you are full and don’t need to eat. You may think there’s NO WAY you can be hungry or should be eating because you just binged or binged/compensated. The truth is that you may be undernourished.

Being nourished includes eating regularly and consistently throughout the day. If you aren’t doing so, there is a possibility that you are restricting. You’re also probably restricting if you have certain foods or categories of foods you avoid. Either way, there are psychological and physiological depravations occurring that can set you up for binging or binging/purging (or doing other compensatory behaviors). It means that when you restrict, you get more pleasure from binging than from eating regularly. More momentary pleasure leads to shame afterward, more restriction, binging, etc.

The restrict-binge cycle is REAL.

The first thing I do when I work with people with BED or bulimia is to get them out of this cycle by eating regularly. It starts with breakfast, eating within an hour, they wake. I then slowly get them to move forward to adding regular meals and snacks. I STRONGLY recommend that individuals struggling with BED or bulimia work with an eating disorder dietitian to ensure that they are getting adequate nutrition and that we can stay on top of any medical conditions that may be present.

Mind Over Matter

Eating disorders are brain disorders. If you struggle with BED or bulimia, some parts of your brain don’t function as efficiently or effectively compared to people without BED or bulimia.

Researchers have discovered that with bulimia and BED, similar brain areas are affected. These parts include emotion management, hunger/fullness regulation, and recognizing the consequences of behaviors. I describe the area of consequences like this: For people without BED and bulimia, they can stop eating when they are full, even though something tastes good, because they can acknowledge the consequences of continuing to eat past fullness or engaging in compensatory behaviors (physical discomfort, shame, guilt, medical problems, etc.). It’s like the lever that comes down when people leave a parking garage—it tells people when to stop. That lever doesn't work properly for individuals grappling with bulimia and BED. At that moment, they aren’t able to acknowledge the consequences, so they can’t stop. It’s not about willpower, either. It’s about the brain.

It’s All About the Stats

Here are some recent research summary points and statistics on bulimia and binge eating that demonstrate how they are brain disorders: The higher the frequency of the binge eating and binge/purge episodes, the more neural activity there is in the brain when compared to having fewer binge or binge/purge episodes (Donnelly et al., 2018). There are brain differences in children with BED compared to kids without BED (Murray et al., 2022). Impulsivity and compulsivity are elevated in the brains of people with BED (Boswell, Potenza, & Girl, 2021). There are lowered mu-opioid receptor availability in the brains of people with BED, which means that the brain's pleasure centers aren’t working effectively (Jousta et al., 2018). With binge eating, there is a loss of control, an increase in compulsivity, and lowered reversal learning, which has to do with the ability to discriminate (Waltmann et al., 2021). When triggered by stressors, people with bulimia had a slowing of motor responses in the brain, in addition to an increase in how old information stored in the brain affects new memory (Westwater et al., 2021).

What Does All This Mean?

It means that if you struggle with binge eating, whether with BED or bulimia, it’s likely that your brain isn’t working as efficiently and effectively when compared to people without these eating disorders. It’s not just one area or one process in the brain—it’s multiple (memory, impulsivity, reward, compulsivity, etc.). Now, I’m not telling you all this to discourage you. Au contraire! I’m giving you this information to convey hope. Brains are resilient. Brains can change, grow, and heal. Your brain can heal, even if you’ve had an eating disorder for many years. Over time, adequate therapeutic and nutritional treatment can change your brain. You can recover.

How Can I Get Help with Binge Eating Vs Bulimia?

Many ways! Check out these options:

🌻 Sign up for my FREE Masterclass: The Ultimate Training on Breaking the Binge Eating Cycle. It’s a live, virtual, 1-hour seminar on Tuesday, September 13th—and it’ll include a FANTASTIC bonus surprise for people who stay through the end! It’s an interactive workshop for binge eating online, and it will address both BED and bulimia.

🌻 Check out my Fall 2022 Freedom From Binge Eating class. It is a live, virtual, 4-week class on Tuesday, September 27th, from 12-1p. It’s an interactive workshop on binge eating. There will be many bonuses, including videos from yours truly, journal prompts, worksheets, and notes from each class! Anyone with BED, bulimia, binge eating, or emotional eating will greatly benefit!

🌻 Join my Instagram LIVES on Thursdays from 12-1p. I have conversations with professionals such as eating disorder dietitians and therapists on many topics, such as binge eating, BED, bulimia, body image, etc. Subscribe to my Instagram @drmariannemiller, and you’ll get bulimia and BED info sent to your phone with my reels, posts, etc.

🌻If you’re in California, you can work with me in therapy!

*If you don’t meet the full diagnostic criteria for binge eating disorder or bulimia; specifically, if you aren’t having binge episodes or binge/purge (or binge/compensate) episodes 1x/week for three weeks, you may qualify for the OSFED (other specified feeding and eating disorder) diagnosis. It’s still an eating disorder. It’s still a brain disorder. You can still recover fully from it.