People with bulimia nervosa have recurrent episodes of binge eating and once eating has begun they can't control their behaviour anymore. They regularly engage in self-induced vomiting that allows continued eating or termination of the binge. Eating binges are followed by self-criticism and depressed mood, strict dieting or fasting, vigorous exercise or use of diuretics in order to prevent weight gain. Gross overeating may make the stomach burst, and constant vomiting causes dental erosion and glandular swelling in the face. The most effective treatment is cognitive behavioural therapy, and antidepressant drugs are often prescribed. With good treatment 60% to 70% of the patients recover.
Bulimia nervosa was named in 1979. In the 1970s, there was an increase in the number of women with bulimia who were binge-eating and vomiting to retain a very low weight. In the 1980s there were more women with bulimia whose weight was normal, and bulimia in normal-sized women is becoming more common. A multi-impulsive variation on bulimia is emerging which involves self-mutilation, stealing and alcohol/drug-abuse as well as food abuse.
A bulimic woman is often the eldest or only daughter. In about 10% of cases, her father abused alcohol or there may be another kind of addiction in either parent. She often has an enmeshed relationship with her mother, acting as her mother's unofficial therapist, often a marital therapist, since her parents frequently have a poor quality relationship, sexual repression, and the mother is often depressed. A difficult family, particularly associated with an inability to communicate with parents, may lead a young woman to squash down enormous pain and rage with bingeing, while its tranquillizing effects bring a welcome release from tension. She starts to purge when she realizes that overeating will make her fat and unacceptable.