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What’s the Difference Between Anorexia Nervosa and Bulimia Nervosa?

signGiven the similarities between bulimia nervosa and anorexia nervosa, binge-eating/purging type, there's room for confusion when making a diagnosis, whether on the ASWB exam or in real life. Let's take a look at what the DSM says about each.

What is anorexia nervosa?

Criteria for anorexia nervosa are as follows:

A. Restriction of energy intake leading to significantly low body weight.

B. Intense fear of gaining weight despite significantly low weight.

C. Disturbance in the way one's body weight or shape is experienced, undue influence of body weight shape on self-evaluation, or persistent lack of recognition of the seriousness of current low body weight.

What are the types of anorexia nervosa?

There are two subtypes in anorexia nervosa:

Restricting type. Weight loss accomplished primarily through dieting, fasting, and/or excessive exercise (not recurrent binging or purging).

Binge-eating/purging type. Recurrent episodes of binge eating or purging (self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

What is bulimia nervosa?

Criteria for bulimia nervosa are as follows:

A. Recurrent episodes of binge eating (overeating in a discrete period of time with a sensed lack of control regarding the eating).

B. Recurrent inappropriate compensatory behaviors to prevent weight gain (e.g., self-induced vomiting, misuse of laxatives, diuretics, or other medications; fasting; excessive exercise).

C. Lasts once a week for three months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. Does not occur exclusively during episodes of anorexia nervosa.

What's the difference between anorexia nervosa, binge/purging-type and bulimia nervosa?

Both anorexia nervosa and bulimia nervosa involve negative self-evaluation of body shape and weight. Both involve behaviors to avoid weight gain such as self-induced vomiting. However, in anorexia nervosa, the disorder leads to significantly low body weight, where bulimia nervosa does not.

The difference is the ways severity is coded for anorexia and bulimia helps highlight the essential difference between the two diagnoses.

For anorexia nervosa, severity is based on body mass index (BMI). For example, "mild" indicates a BMI less than or equal to 17 kilograms per square meter. "Extreme" indicates a BMI of less than fifteen kilograms per square meter.

For bulimia nervosa, severity is based on the frequency of behaviors. For 1-3 episodes per week, a specifier of "mild" is applied. "Extreme" is used for 14 or more episodes per week.

The difference is not the behavior itself, it's the result.

Free ASWB Exam Practice

The ASWB exam often tests to assess knowledge of differentials between commonly occurring DSM disorders like anorexia and bulimia. A sample question:

A 17-year-old client who appears noticeably underweight reports frequently forcing herself to vomit after meals in order to "stay skinny for cheerleading." The MOST likely DSM diagnosis for this client is a type of:

A. Bulimia nervosa

B. Body dysmorphic disorder

C. Rumination disorder

D. Anorexia nervosa

Unless you're caught by the distractors, body dysmorphic disorder (which is not diagnosed when an eating disorder is present) and rumination disorder (not described here), knowing the difference between anorexia and bulimia quickly gets you to the correct answer. The client is "noticeably underweight." You have your essential information. The phrase "a type of" at the end of the question stem is an additional clue. The client is most likely suffering from anorexia nervosa, binge/purging-type. The answer is D.

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Susan Passed the ASWB Masters: “A giant weight off my shoulders.”

susan passed the aswb masters exam"SWTP and trust in myself were critical to passing my exam. This has been a long time coming for me. Passing on my first try was such a relief and a giant weight off my shoulders. I graduated Dec 21, 2018. Taking my test in my last semester really enhanced my job hunting journey.  I start my first social work job on Feb 8!"

Congratulations, Susan!

Ready to get that pre-licensure weight off your shoulders? Get started with our free practice test or cut to he chase and choose exams here. (Try out coupon code PASS10. It may save you an additional ten percent on your practice test purchase!)

Looking forward to seeing your pass-sheet selfie soon.

Good luck!

Faith Passed the LCSW Exam

faith passed the clinical exam Faith passed the ASWB Clinical exam--here she is in a celebratory mood. When you pass the LCSW exam, it could be the last big exam--aside from maybe a driver's test--that you ever have to study for. Definitely worth celebrating!

Going in prepared helps boost your chances of passing a lot. You know the basics of the exam, right? 170 questions, four hours, all multiple choice, almost all vignettes, no trick questions.

Knowing how it feels to sit for 170 questions isn't something you can easily imagine. Practice tests, like the ones here at SWTP, take a lot of the guessing away. Some people need snack breaks or bathroom breaks. Others like to plough right through the whole thing. Some get compassion fatigue reading vignette after vignette. They aren't fairy tales. Some get simple reading fatigue. Taking practice tests helps you learn exam content and also learn who you are these days when it comes to a giant exam like this.

There's no right or wrong to snacking, not snacking, tiring, not tiring. It is what it is. But knowing what it is before sitting down for the real thing makes good sense.

Congratulations, Faith, and all recent licensing exam passers at all levels. Way to go.

Still working toward licensure. Everyone's rooting for you. Happy studying and good luck!

Diagnose This: Gradual Memory Loss and Occasional Confusion

boxerHere's another free ASWB exam practice question from our old bonus exam. The more practice you get, the better.

A man in his 40s comes to a mental health clinic complaining of gradual memory loss and occasional confusion, such as getting lost on the way to a job he has held for years. The man is a retired boxer who suffered multiple concussions during his career. The MOST likely diagnosis for this client is:


A. Post-traumatic stress disorder
B. Alzheimer's disease
C. Delirium
D. Chronic traumatic encephalopathy

What do you think?

Narrowing it down: With delirium, the onset of confusion is generally rapid; this client reports that his memory and confusion has been getting worse over time. The client does not mention any of the signs of post-traumatic stress disorder. Although Alzheimer's disease is the most common form of dementia, the patient's relatively young age, along with his history of head trauma, make him a more likely candidate for chronic traumatic encephalopathy. So you have  your answer: D.

This is tricky, which is why we left it off our full-length practice tests. To try out the questions that made the grade, sign up.

Happy studying and good luck on the exam!



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Free ASWB Exam Practice Question: Ego Defenses

alley Free practice to prepare you for the social work licensing exam.

A clinician is working with a seven-year-old who has been sexually assaulted by a neighbor. The neighbor is now in prison. The child's mother reports that the child often hits her and screams, "I hate you!" Which ego defense mechanism is the child using?

A. Repression
B. Sublimation
C. Displacement
D. Projection

What do you think?

Taking the answers one by one:

Repression refers to an unconscious forgetting or pulling an unpleasant memory or event into the subconscious. The child in this scenario shows no signs of repression.

Sublimation is acting out one's feelings in a socially acceptable manner. The boy in this scenario is acting out violently, so he's not sublimating.

Projection involves projecting things about yourself onto someone or something else. For instance, a mother who is worried about leaving her children with a certain babysitter may say something like, "The dog doesn't like her," instead of admitting her own concerns.

That leaves one answer:

Displacement involves taking one's feelings towards one person or thing and acting them out on another, safer, person or thing. The classic example is the man who goes home and kicks his dog after a fight with his boss. The child in this scenario is taking out his anger towards the babysitter on the mother.

Of course, the child may have legitimate grievances with the mother. It's possible that a defense mechanism isn't being demonstrated in the vignette. But even a question that may have a better answer requires that you choose from one of the answers provided. In this case, that's C, displacement.

Ready to get started with full-length, real-time ASWB exam practice? Sign up.