Bulimia nervosa involves episodes of binge eating followed by various means to purge the food. This eating disorder was first described in the medical literature in 1979 and classified as a clinical psychiatric disorder in 1980. It is most common among young adults of college age, although some high school students are also at risk. Susceptible people often have genetic factors and lifestyle patterns that predispose them to becoming overweight, and many try frequent weight-reduction diets as teenagers. Like people with anorexia nervosa, those with bulimia nervosa are usually female and successful. Unlike anorexics, however, they are usually at or slightly above a normal weight. Females with bulimia nervosa are also more likely to be sexually active than those with anorexia nervosa.
The person with bulimia nervosa may think of food constantly. In contrast to the anorexic person, who turns away from food when faced with problems, the bulimic person turns toward food in critical situations. Also, unlike those with anorexia nervosa, people with bulimia nervosa recognize their behavior as abnormal. These people often have very low self-esteem and are depressed. Approximately half of the people with bulimia nervosa have major depression. Lingering effects of child abuse may be one reason for these feelings. Many bulimic persons report that they have been sexually abused. The world sees their competence, while inside they feel out of control, ashamed, and frustrated.
Bulimic people tend to be impulsive, which may be expressed as stealing, drug and alcohol abuse, self-mutilation, or attempted suicide. Some experts have suggested that part of the problem may actually arise from an inability to control responses to impulse and desire. Some studies have demonstrated that bulimic people tend to come from disengaged families—ones that are loosely organized. Roles for family members are not clearly defined. Too little protection is provided for family members, rules are very loose, and a great deal of conflict exists. Anorexic people in comparison tend to have families so actively engaged that roles may be too well defined.