Physiological Characteristics and Medical ComplicationsAnorexic and Bulimic clients are at risk of serious medical consequences. Consequences range from gastrointestinal distress to death. The mortality rate for anorexia is roughly 10 percent. Although most individuals with eating disorders endeavor to present a facade of good health, the severity and variety of their physical ailments tell an alarmingly different story. Bulimic sufferers with extreme purging by laxatives or vomiting may show obvious electrolyte imbalance in lab work. Those with anorexia may yield somewhat normal blood lab values, only to later have sudden failure of the heart or another organ of the body.
Anorexia Nervosa Bulimia Nervosa
Body Weight 85% or less of normal body weight Weight fluctuations with body weight below, at, or above normal range due to alternative bingeing and fasting
Slowed Heart Rate Weakening of the heart due to malnourishment Potential heart arrhythmia and irregularities related to electrolyte imbalance
Body Fluid Regulation Dehydration, possible impaired renal function Swollen glands, puffiness around the face, and burst blood vessels in eyes. Edema (swelling due to retention of body fluids). Possible impaired renal function.
Blood Pressure Low blood pressure Normal or fluctuating blood pressure
Body Temperature Sensitive to cold Cold hands and feet No Change
Body Hair Growth of body hair (lanugo)
Immune system Lowered resistance to infection
Movement and Functioning Dizziness and muscular weakness Chemical imbalance caused by low potassium (and sodium) which can produce dehydration, muscular fatigue, cardiac rhythm irregularities, cardiac arrest.
Imbalances Emaciation, dehydration altered brain function and size Fluid and electrolyte imbalance.   Edema accompanying refeeding.
Heart Problems Slow heart rate
Low blood pressure
Reduced body temperature
Weakness of heart muscle
Possible heart arrhythmia and irregularities.
Muscular Symptoms Loss of muscle tissue Overall muscular weakness
Gastrointestinal disorders Sluggish bowel, bloating Abdominal pain, esophageal or gastric dilation or rupture, non-responsive bowel.
Menstrual Period Menstrual irregularities, including amenorrhea. Menstrual irregularities possible
Nutritional Problems Nutritional imbalance, Anemia Vitamin deficiencies
Bone and Dental Osteoporosis Tooth decay and gum erosion from regurgitated stomach acids.   Enlarged salivary glands
Other Symptoms Fatigue, abdominal pain and constipation (stomach distress and hiatal hernia). Headaches, fatigue, and damage to esophagus: sore throat, hoarse voice, abdominal pain and constipation (stomach distress and hiatal hernia).
Behavioral CharacteristicsAnorexic clients often see their restricted caloric intake as brave and as a high achievement. They tend to prize challenges over comfort. By contrast, bulimic clients view their behaviors as shameful and disgusting. In order to recover, clients need help learning to understand the connection between their beliefs about themselves and their eating disorder behaviors. They often view themselves with such hatred they feel deserving of the painful eating disorder behavior. They need to see that their eating disordered behavior is not an achievement, but an illness. The individual suffering from destructive eating disorder behavior must begin to challenge a negative mindset and learn to create and allow positive feelings and thoughts about themselves.
Anorexia Nervosa (common patterns)* Bulimia Nervosa (common patterns)*
Bingeing and Food Control Excessive dieting, food control, and fasting. Collects recipes and likes to cook/bake, but sometimes refuses to eat with family. Tension at mealtimes; Fear of food, avoidance of consumption. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. Fear of inability to stop eating voluntarily (bingeing), a feeling that one cannot stop eating or control what or how much one is eating.
Purging Fasting and / orCompulsive exercising Fasting and / or compulsive exercising alternating with bingeing
Eating Behavior Food rituals: calorie counting, rigid rules, and schedules. Secretive food foraging and hoarding, especially at night. Shoplifting and/or petty stealing of money to buy binge food. Vomiting; laxative, diuretic, or diet pill abuse; or use of other emetics (syrup of ipecac).
Sleeping Behavior Insomnia and early morning awakening Various sleep disturbances
Clothing and Dressing Rituals Frequent weighing, layering of clothes Often dresses to hide body shape.
Social Behavior Social withdrawal, physically and emotionally.
Focus on job and / or school work
Social irregularities, alternating withdrawal with erratic need for social contact and approval. Chaotic relationships and interaction possible
Abusive Behavior Self-hatred and feeling of unworthiness. Drug and / or alcohol abuse possible. Suicidal gestures or attempts. Self-hatred and self mutilation, feeling of self-disgust.
Emotional and Cognitive CharacteristicsIndividuals suffering from eating disorders have restricted emotions and often cannot identify their feelings. What they are aware of is extremely negative thoughts related to their body, which becomes an effective diversion from their emotional turmoil and pain. Their thoughts are obsessive and their feelings are often avoided and hidden, even from themselves.
Anorexia Nervosa (common patterns)* Bulimia Nervosa (common patterns)*
Body Image Problems Intense fear of becoming fat;
Distorted body image.
Preoccupation with appearance and “image”, overly concerned   about body weight and size.
Perfectionist Behavior Perfectionist: thinnest, smartest, neatest. Dichotomous thinking: all or nothing, black or white. Perfectionist: high performance and achievement expectations. Perfectionist inside, but sometimes chaotic outside. Facade of normalcy, seemingly “got it together”.
Self-esteem Depression;
Low sense of self-worth.
Low self-esteem: self-loathing, self-disgust, and depression.
Motivation for help Denial, usually doesn’t want help, desire to solve problems alone. Usually wants help desperately, yet shame may prevent reaching   out.
Sexuality Decreased interest in sex. May be promiscuous or confused about sexuality, a mask for a   desire to be accepted and respected.
Social Behavior Self-centered and non-social, isolation from others; Irritable Constant feeling of being out of control; vacillates between isolation and extreme need for external validation
Cognitive Symptoms Difficulty thinking clearly, potential severe cognitive deficits due to malnourishment. Inability to accurately identify and express feelings. Out of touch with one’s feelings, e.g., anger, affection, humor. Thoughts obsessive and focused on the eating disorder cycle.
*Patterns, systems and traits may vary from one person to another
Adapted in part from Mary Pabst, MSW, Maryland Association for Anorexia Nervosa and Bulimia (MAANA), from Panhellenic Task Force.