As many as one percent of all women are believed to have bulimia, an eating disorder characterized by a cycle of binging and purging. Unlike anorexia, in which patients simply do not eat, people with bulimia eat normally or even excessively, then "purge" by forcing themselves often to vomit. Some bulimics purge using laxatives as well as or instead of emetics, or by exercising. Bulimia and anorexia can occur in the same person, part of a broader pattern of eating disorders; both are rooted in an obsession with food, calories, and control.
Although men can and do develop eating disorders, more than 80 percent of people with bulimia are female, although it is difficult to get exact figures for men even more than for women. There is a hereditary component to bulimia; people with bulimic relatives are likely to develop the disorder themselves. As with other eating disorders, bulimia owes a lot to the broader culture. Where thinness and beauty are highly prized, women tend to feel more pressure to develop the sort of obsession with weight that leads to bulimia. People with psychological and emotional issues, such as perfectionism, obsessive-compulsive disorder, poor impulse control, anxiety, or depression, are at risk for bulimia.
Bulimia can be dangerous. Purging through emesis can damage the esophagus and the teeth, and excessive laxative use can permanently alter the functioning of the digestive system. The binge-purge cycle puts a strain on the heart and can lead to dehydration. Signs of bulimia include secrecy, rushing to the bathroom immediately after meals, calluses on the knuckles, and fluctuations in weight. Unlike anorexics, bulimics are not necessarily underweight.
Treatment for bulimia can be a complex process. Beyond psychological help to fix the disordered eating itself—which can be a lifelong process—the actual purging is likely to have damaged the body, and this damage has to be repaired as much as possible. In addition, treating bulimia involves not only the patient but also her or his family and social circle; as with addiction, it is necessary for the patient to be surrounded by people who will encourage recovery, not relapse. The patient also needs to relearn normal, non-disordered eating habits to have a chance of fully recovering.