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People with bulimia nervosa consume large amounts of food and then rid their bodies of the excess calories by vomiting, abusing laxatives or diuretics, taking enemas, or exercising obsessively. Some use a combination of all these forms of purging. Because many individuals with bulimia “binge and purge” in secret and maintain normal or above normal body weight, they can often successfully hide their problem from others for years.

Family, friends, and physicians may have difficulty detecting bulimia in someone they know. Many individuals with the disorder remain at normal body weight or above because of their frequent binges and purges, which can range from once or twice a week to several times a day. Dieting heavily between episodes of binging and purging is also common. Eventually, half of those with anorexia will develop bulimia.

As with anorexia, bulimia typically begins during adolescence. The condition occurs most often in women but is also found in men. Many individuals with bulimia, ashamed of their strange habits, do not seek help until they reach their thirties or forties. By this time, their eating behavior is deeply ingrained and more difficult to change.

These cycles often involve rapid and out-of-control eating, which may stop when the bulimic is interrupted by another person or the stomach hurts from overextension, followed by self-induced vomiting or other forms of purging. This cycle may be repeated several times a week or, in more serious cases, several times a day, and may directly cause:

1.Constant weight fluctuations.
2.Calluses or scars on back of hands due to repeated trauma from incisors.
3.Peptic ulcers.
4.Enlarged glands in the neck, under the jaw line.
5.Infertility.
6.Constipation.
7.Gastroparesis or delayed emptying.
8.Oral trauma, in which repetitive insertion of fingers or other objects causes lacerations to the lining of the mouth or throat.
9.Esophagitis, or inflammation of the esophagus.
10.Electrolyte imbalance, which can lead to cardiac arrhythmia, cardiac arrest, and even death.
11.Dehydration and hypokalemia caused by frequent vomiting.
12.Chronic gastric reflux after eating.

When you have bulimia, you may regularly vomit or exercise excessively after binge eating. Sometimes, however, people with bulimia feel a need to purge after eating only a small snack or a normal-size meal.

A binge is considered eating a larger amount of food than most people would eat under similar situations. For instance, when you have bulimia, you may eat an entire cake, rather than just a slice or two. And you may continue eating until you’re painfully full.

Binges often occur in private. Once the binge episode ends, the purging begins. This may mean heading to the bathroom to vomit, hitting the treadmill for hours of exercise, or not eating for long periods of time (fasting). Because most people with bulimia are of normal weight or even slightly overweight, it may not be readily apparent to others that something is wrong.