are AN, BN and BED different diseases?

I must apologize for the bias I often show in discussing anorexia more than I do bulimia. There are reasons, if not excuses, for this bias. One is that my daughter had anorexia, not bulimia. Another is that most of the recommendations for one are similar for the other, especially those I care about most (nutritional rehab, behavioral stabilization, separating the illness from the person, no blaming, and parental engagement).

It is my understanding that researchers focus on AN not out of a lack of concern about BN but because anorexia has a clearer diagnosis category in the form of weight in a field with limited research resources.

And of course, anorexia is glamorized more, and bulimia stigmatized more, in the popular imagination.

It is clear that a lot of treatment out there DOES treat eating disorders as if they are similar or the same in origin - same facilities, same clinicians, same page of the DSM. In fact, a lot of treatment purports to treat the cause of these/this illness(es) despite consensus on what, exactly it/they is/are.

But it really is a question to be asked: what is the relationship between anorexia, bulimia AND binge eating disorder? Is it a spectrum? Different manifestations of a common illness?

I don't know. Although some are asking, I don't hear coherence in the field on this. But this I know: bulimia isn't a less dangerous or less important illness - ask the Smeltzers or others who weren't even allowed to have bulimia included on their daughter's death certificate. We need FAR more attention to the issue, and to treatment.


  1. Having known several parents with children who had anorexia for several years, most whom followed the "let them figure it out themselves with a T" treatment and then hearing that they switched to bulimia it seems to me that we may be dealing with a disease that has more in common with both restricting and purging than we may realize. Mine purged AND restricted. She was thin and pale and like you I saw something I couldn't sit back and let continue. She did kick ED's ass and recover but we all know just how dangerous an ED is, regardless of the method of starvation!
    You can say whatever you want to Laura! I have been busier than ever and if you still need recipes this feast mom can share something I'm sure. Seems like everything I eat would qualify.

  2. Recipes absolutely welcome!

    And also if you want to send a picture of family for our slideshow (no names or identifiers, and I delete the photos after the conference) I'd love to have "you" there with us!

  3. I also think the reason anorexia receives more attention is because it is the most acute and dangerous.

    I can't speak about bulimia, but my experience of BED CED is that it is usually although not always a reponse to trying to control, weight. Because it is often a response to something that you have imposed on it, that you may have been told is good, but the body is programmed to fight, I'm not sure it can be called a disease as such. I must admit that a lot will disagree with me, I don't wish to say that my experience is everyone's, but I think more effort should be made to disentangle our wrong beliefs on diet and weight which are the cause I feel of the growth in all disordered eating.

  4. I think it must be the link rather than me, having tried it on a few computers (although I could be wrong). Is there any chance of pointing me further in the direction of the "few who are asking?"

  5. Sorry! And thank you for letting me know - I think I've fixed it!

  6. Thanks - yes it works now. Hmmmm a step away from the transdiagnostic approach. Methinks that's not going to be popular with some of the professionals round here, but it seems to be a well organised study.

  7. I can't really make a judgement on anorexia, for the same reason you don't comment so much on bulimia; it's not where my experience lies.

    My opinion is that binge-eating disorder and bulimia are the same. I was a non-purging bulimic because I rarely threw up. A random person on the internet told me that that meant I had BED not BN. By I used other techniques rather than purging. One comment I saw stated that if you have BED symptoms but aren't overweight, the chances are that you have BN, even if it's not the purging form. A person with BED might occasionally exercise or attempt to fast. A person with non-purging bulimia might binge regularly but not think they're bulimic because they don't live with their head down the toilet. Between the two, is a huge range of various eating patterns that could be classed as one or the other, or shoved into the non-descript category of EDNOS.

    Similarly, where do you draw the line between a bulimic and a binge-purging anorexic?

    The definitions try to devide the disordered community into neatly organised boxes, when there are huge grey areas where the lines between the categories get blurred.

  8. I know the nice little boxes will never be perfect, and they seem dehumanizing, but I still see why we need them. In order to identify what works and doesn't, we have to be able to classify and define change. I hold out hope that by getting those boxes right we'll eventually be able to get rid of them because we're treating the PEOPLE more effectively!


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