Anorexia Nervosa vs Bulimia Nervosa
Both are eating disorders, but the NCLEX expects you to match specific lab values, physical findings, and mortality data to the correct diagnosis. Picking the wrong electrolyte pattern or missing refeeding syndrome risk on an anorexia question can cost you the item — and in practice, the patient's life.
Side-by-side comparison
- Severe caloric restriction
- Significantly underweight (BMI < 17.5)
- Binge then purge (vomit, laxatives, diuretics)
- Usually normal or slightly above weight
- ★Lanugo, hypothermia, dry/yellow skin
- Emaciation, muscle wasting
- Sees self as fat; denies problem (ego-syntonic)
- ★Russell's sign (knuckle calluses)
- Parotid swelling; dental enamel erosion
- Aware, ashamed (ego-dystonic)
- Hypokalemia, hyponatremia, hypoglycemia
- Bradycardia, prolonged QT on ECG
- ★Hypokalemia + metabolic alkalosis (vomiting)
- Hypomagnesemia if laxative abuse
- Medical stabilization first
- Slow refeeding; supervised meals & weights
- Interrupt binge-purge cycle
- Supervise 1 hr post-meal; monitor electrolytes
- Weight restoration, then CBT
- No FDA-approved drug
- CBT first-line
- Fluoxetine 60 mg — FDA-approved
- Refeeding risk; realistic weight goals
- Address body-image distortion
- Stop self-induced vomiting; dental care
- Identify binge triggers; no ipecac
- ★Refeeding syndrome: ↓ phosphate, cardiac failure
- Bradycardia → cardiac arrest
- Hypokalemic dysrhythmias
- Esophageal tear (Mallory-Weiss)
- Highest mortality of any psych disorder
- Osteoporosis; cardiac arrest
- Chronic electrolyte imbalance; esophagitis
Anorexia Nervosa
- Severe caloric restriction
- Significantly underweight (BMI < 17.5)
Bulimia Nervosa
- Binge then purge (vomit, laxatives, diuretics)
- Usually normal or slightly above weight
Anorexia Nervosa
- ★Lanugo, hypothermia, dry/yellow skin
- Emaciation, muscle wasting
- Sees self as fat; denies problem (ego-syntonic)
Bulimia Nervosa
- ★Russell's sign (knuckle calluses)
- Parotid swelling; dental enamel erosion
- Aware, ashamed (ego-dystonic)
Anorexia Nervosa
- Hypokalemia, hyponatremia, hypoglycemia
- Bradycardia, prolonged QT on ECG
Bulimia Nervosa
- ★Hypokalemia + metabolic alkalosis (vomiting)
- Hypomagnesemia if laxative abuse
Anorexia Nervosa
- Medical stabilization first
- Slow refeeding; supervised meals & weights
Bulimia Nervosa
- Interrupt binge-purge cycle
- Supervise 1 hr post-meal; monitor electrolytes
Anorexia Nervosa
- Weight restoration, then CBT
- No FDA-approved drug
Bulimia Nervosa
- CBT first-line
- Fluoxetine 60 mg — FDA-approved
Anorexia Nervosa
- Refeeding risk; realistic weight goals
- Address body-image distortion
Bulimia Nervosa
- Stop self-induced vomiting; dental care
- Identify binge triggers; no ipecac
Anorexia Nervosa
- ★Refeeding syndrome: ↓ phosphate, cardiac failure
- Bradycardia → cardiac arrest
Bulimia Nervosa
- Hypokalemic dysrhythmias
- Esophageal tear (Mallory-Weiss)
Anorexia Nervosa
- Highest mortality of any psych disorder
- Osteoporosis; cardiac arrest
Bulimia Nervosa
- Chronic electrolyte imbalance; esophagitis
★ marks the fact that sets a column apart.
Clinical Pearl
Underweight + lanugo + refeeding risk = anorexia. Normal weight + Russell's sign + metabolic alkalosis = bulimia.
Play this as a game — free
Drill Anorexia Nervosa vs Bulimia Nervosa in Swipe Right & Speed Sort. 14-day free trial, no card required.