side by side comparison

Anorexia Nervosa vs Bulimia Nervosa: Restriction vs Binge-Purge Cycle

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.

Comparison

Side-by-side2 compared
Dimension
Anorexia Nervosa
Bulimia Nervosa
Pathophysiology & risk
  • Severe caloric restriction
  • Significantly underweight (BMI < 17.5)
  • Binge then purge (vomit, laxatives, diuretics)
  • Usually normal or slightly above weight
Signs & symptoms
  • ★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)
Diagnostics & labs
  • Hypokalemia, hyponatremia, hypoglycemia
  • Bradycardia, prolonged QT on ECG
  • ★Hypokalemia + metabolic alkalosis (vomiting)
  • Hypomagnesemia if laxative abuse
Nursing priorities
  • Medical stabilization first
  • Slow refeeding; supervised meals & weights
  • Interrupt binge-purge cycle
  • Supervise 1 hr post-meal; monitor electrolytes
Treatment & meds
  • Weight restoration, then CBT
  • No FDA-approved drug
  • CBT first-line
  • Fluoxetine 60 mg — FDA-approved
Patient teaching
  • Refeeding risk; realistic weight goals
  • Address body-image distortion
  • Stop self-induced vomiting; dental care
  • Identify binge triggers; no ipecac
Red flags — escalate
  • ★Refeeding syndrome: ↓ phosphate, cardiac failure
  • Bradycardia → cardiac arrest
  • Hypokalemic dysrhythmias
  • Esophageal tear (Mallory-Weiss)
Complications
  • Highest mortality of any psych disorder
  • Osteoporosis; cardiac arrest
  • Chronic electrolyte imbalance; esophagitis
Pathophysiology & risk

Anorexia Nervosa

  • Severe caloric restriction
  • Significantly underweight (BMI < 17.5)

Bulimia Nervosa

  • Binge then purge (vomit, laxatives, diuretics)
  • Usually normal or slightly above weight
Signs & symptoms

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)
Diagnostics & labs

Anorexia Nervosa

  • Hypokalemia, hyponatremia, hypoglycemia
  • Bradycardia, prolonged QT on ECG

Bulimia Nervosa

  • ★Hypokalemia + metabolic alkalosis (vomiting)
  • Hypomagnesemia if laxative abuse
Nursing priorities

Anorexia Nervosa

  • Medical stabilization first
  • Slow refeeding; supervised meals & weights

Bulimia Nervosa

  • Interrupt binge-purge cycle
  • Supervise 1 hr post-meal; monitor electrolytes
Treatment & meds

Anorexia Nervosa

  • Weight restoration, then CBT
  • No FDA-approved drug

Bulimia Nervosa

  • CBT first-line
  • Fluoxetine 60 mg — FDA-approved
Patient teaching

Anorexia Nervosa

  • Refeeding risk; realistic weight goals
  • Address body-image distortion

Bulimia Nervosa

  • Stop self-induced vomiting; dental care
  • Identify binge triggers; no ipecac
Red flags — escalate

Anorexia Nervosa

  • ★Refeeding syndrome: ↓ phosphate, cardiac failure
  • Bradycardia → cardiac arrest

Bulimia Nervosa

  • Hypokalemic dysrhythmias
  • Esophageal tear (Mallory-Weiss)
Complications

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.

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Component Topics

Anorexia Nervosa & Bulimia Nervosa
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