Binge Eating Disorder (BED) and Bulimia Nervosa (BN) share some overlapping features—most notably, episodes of binge eating—but they differ in crucial ways that affect both diagnosis and treatment.
1.
Core Differences
|
Feature |
Binge Eating Disorder (BED) |
Bulimia Nervosa (BN) |
|
Binge episodes |
Yes |
Yes |
|
Loss of control |
Yes |
Yes |
|
Compensatory behaviors |
Absent |
Present (vomiting, laxatives, fasting, etc.) |
|
Body image disturbance |
May be present, but not required |
Central to diagnosis |
|
Weight |
Often overweight or obese |
Often within normal weight or slightly underweight |
|
Shame/guilt |
Common |
Common |
2.
Psychological Profile
- Bulimia is more commonly associated with:
- Impulsivity
- Perfectionism
- Greater body image dissatisfaction
- Risk of substance use or self-harm
- BED may involve:
- Emotional eating
- Shame and avoidance of eating in public
- Less overt body image pathology
3.
Treatment Approaches: Similarities and Differences
Shared First-Line Treatment: Psychotherapy
- Cognitive Behavioral Therapy – Enhanced (CBT-E) is first-line for both
- Targets the binge-purge cycle in BN
- Targets emotional eating and loss of control in BED
Other Psychotherapies
- Dialectical Behavior Therapy (DBT): helpful for emotion dysregulation, especially in BN
- Interpersonal Therapy (IPT): evidence-based for both
- Mindfulness-based therapy: promising for BED
4.
Pharmacological Treatments
|
Medication Class |
Bulimia Nervosa |
Binge Eating Disorder |
|
SSRIs (esp. fluoxetine) |
FDA-approved (Fluoxetine 60 mg/day) |
Sometimes used off-label |
|
Topiramate |
Reduces binge and purge episodes |
Effective, but side effects common |
|
Lisdexamfetamine (Vyvanse) |
Not approved |
FDA-approved for BED |
|
Other stimulants |
Not used |
Sometimes used off-label |
5.
Nutritional and Medical Interventions
- Both require:
- Nutritional counseling and food normalization
- Monitoring of electrolytes, especially in BN due to purging
- Treatment of comorbid conditions (depression, anxiety, etc.)
Summary:
- BED = bingeing without purging.
- BN = bingeing with compensatory behaviors and often stronger body image concerns.
- Treatments overlap in psychotherapy, but medications diverge—e.g., fluoxetine for BN vs Vyvanse for BED.
Would you like a PDF summary table of this comparison, or a flowchart of treatment pathways?
