When you think of the term “anorexia,” what comes to mind? Most people associate it with being extremely thin and food restriction. But in reality, the differences between anorexia and other eating disorders like bulimia and BED aren’t all that black and white (nearly all eating disorders are rooted in restriction). This point is illustrated clearly by the anorexia binge-purge subtype (AN-BP). Though it’s not commonly known, it’s the second type of anorexia in addition to anorexia restrictive subtype (AN-R). Here’s everything you need to know about the lesser known (but equally serious) form of anorexia.

What is anorexia binge-purge subtype?

Anorexia nervosa restrictive type, the commonly known version of anorexia, is characterized by a severe limitation of food, both in terms of intake and variety. Food restriction is also a characteristic of anorexia binge-purge subtype, but people with AN-BP can also experience episodes of binge eating and purging, or eating large quantities of food in a short amount of time and then “getting rid of” the food they consumed through purging behaviors like vomiting, excessive exercise, or laxative use.

Equip’s VP of Behavioral Health Care, Angela Celio Doyle, PhD, explains that AN-BP does share some hallmark symptoms with restrictive anorexia, including food restriction and the inability to maintain a healthy weight for their body’s needs. “But in addition to restricting food, the person can also feel a loss of control when eating or react to a meal by engaging in some kind of purging behavior afterward,” Doyle says. She adds that patients must exhibit these binge eating and purging behaviors consistently for at least three months to be clinically diagnosed with AN-BP.

“There’s a lot of diagnostic crossover between different eating disorders,” Doyle goes on. “Restrictive anorexia may develop into AN-BP without treatment. Likewise, AN-BP can evolve into bulimia. Although eating disorders can appear very different, at their core they’re very similar in terms of what drives them, and so diagnoses can often overlap or change over time.”

How common is anorexia binge-purge subtype?

It’s difficult to pinpoint the exact number of people struggling with AN-BP, but there are a few data points that give a sense of how common it is.

Research shows that among hospitalized anorexia patients, as many as 47% exhibit binge eating and purging behaviors, and that about 42% of patients with restrictive anorexia eventually transition to disorders involving binge eating and purging.

More generally, up to 4% of females and 0.3% of males experience anorexia nervosa over the course of their lifetime, and so an even smaller percent would be expected to experience binge-purge type. Statistics, however, don’t always tell the full story of the severity and detrimental impact. “Even though these rates seem low at a glance, they still represent millions of people who are struggling with a very serious eating disorder,” Doyle says.

What are the symptoms of anorexia binge-purge subtype?

AN-BP is unique in that patients with this condition experience symptoms from several different eating disorder diagnoses at once. “The most common eating disorder symptoms co-occur with each other in anorexia binge-purge subtype,” says Doyle. “A person with AN-BP has at least two, but sometimes all three cardinal eating disorder behaviors: dietary restriction, binge eating, and purging.”

This combination of restrictive eating accompanied by binge and purge-related behaviors is the most characteristic sign of AN-BP. Here are some of the other most common symptoms of AN-BP

• An intense fear of weight gain
• A distorted perception of weight or body shape
• An overemphasis of the importance of weight or body shape
• Binge eating (consuming a lot of food quickly with a feeling of being out of control)
• Self-induced vomiting
• Misuse of laxatives or diuretics
• Excessive exercise in order to “make up” for meals

You may be wondering what makes AN-BP different from other eating disorders with similar symptoms, like binge eating disorder and bulimia. Typically, a patient receives an AN-BP diagnosis when their symptoms and mindset more closely meet the anorexia nervosa diagnosis, even if they also exhibit the binge eating and purging behaviors characteristics of binge eating disorder or bulimia.

The role of the binge-restrict cycle

Most people with AN-BP experience something known as the binge-restrict cycle, where a period of restriction is followed by episodes of binge eating, which then triggers feelings of shame, in turn resulting in the desire to restrict (or purge) again. Doyle explains that this cycle is the body’s natural response to restricting food intake: “Restriction—even when it’s just eliminating one food group—takes us out of our body’s biological comfort zone. Our bodies know that we need consistent, well-rounded nutrition and it fights back with urges to binge.”

Because of that hard-wired survival mechanism, Doyle says that restricting food generally or certain foods specifically (unless medically necessary) is generally an unsafe and unhealthy tactic. “There are a lot of restrictive patterns that have been co-opted into the diet culture space that can do more harm than good,” she says. “This includes intermittent fasting, cleanses, elimination diets, carb cycling and so on.”

What does treatment for AN-BP look like?

As with all eating disorders, implementing swift, evidence-based treatment is the key to long-term recovery. “Effective treatment for AN-BP exists,” Doyle says. “Enhanced cognitive behavioral therapy (also known as CBT-E) is a specific version of cognitive behavioral therapy specifically for eating disorders, and it’s the first treatment recommended to patients with AN-BP because of its strong evidence for helping the most people.”

Considered one of the most effective treatments for eating disorders, CBT-E can be used to treat a variety of eating disorders through a highly individualized plan that helps patients with:

• Stopping binge and purge behaviors
• Re-establishing regular eating habits
• Confronting their distorted perceptions
• Addressing their disordered thoughts and behaviors

“Stopping binge and purge behaviors can be a huge relief for someone struggling with AN-BP,” Doyle says. “CBT-E also focuses on the thoughts and feelings that drive the eating disorder behaviors so that the person can experience a life that is more and more symptom-free over time.

Like eating disorders themselves, each person struggling with disordered thoughts and behaviors is unique. While treatment approaches vary from person to person, experts agree that a multidisciplinary team as well as social supports, gives patients the best chances of achieving long-term recovery.

“At Equip, we offer CBT-E and our patients work with a team that includes a therapist, a dietitian, medical support, and mentorship by people who have lived experience with an eating disorder,” Doyle says. “Mentorship from someone who has been through something similar, especially for patients with lesser-known conditions like anorexia binge-purge, can provide a lot of much-needed hope.”

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