Bulimia nervosa is an eating disorder in which the subject experiences periods of binge eating followed by attempts to purge oneself via self-induced vomiting, exercise, enema, etc. Bulimia commonly manifests itself during the late teens although the onset can be delayed by around eight years in some cases.

As an eating disorder, bulimia affects the subject�s physical and mental well-being. The symptoms of bulimia nervosa are similar to those of anorexia nervosa; therefore it is important that the physician make sure of the disorder before commencing treatment. These two disorders affect around 7% of the women in the US. Binge eating is a central feature of bulimia, the subject feels compelled to eat disproportionate amounts of food that is usually rich in calories. The compensatory behavior that follows is in order to avoid weight gain.

The criteria for diagnosing bulimia includes:

Frequent binge eating episodes.
Inappropriate compensatory actions follow the binge eating.
The binge episodes have been occurring at least two times every week for around three months.
Self-esteem influenced by physical appearance.

The extent of the severity of bulimia nervosa can be gauged from the type of compensatory behavior that follows an episode of binge eating. Bulimia is characterized as the purging type if the compensatory behavior includes self-induced vomiting or the use of laxatives. With non-purging bulimia individuals try to compensate with excessive exercise and fasting.

Genetics and societal notions of beauty are two important causes that have been identified as contributors to this disorder. Abnormality in the neurotransmitter systems upsets the regulation of food intake and can lead to binge eating. Studies carried out on patients with bulimia have revealed that a decreased resting metabolic rate and improper regulation of neuroendocrine are recurring factors. Signals of satiety are found to be functioning irregularly due to abnormality in the levels of leptin, ghrelin, and cholecystokinin.

As far as the role of society is concerned, it has been found that bulimia is more prevalent in societies where a slim figure and thinness are valued. Of all the compensating actions, self-induced vomiting is the most detrimental in the long term. It affects overall health, leads to muscle dystrophy, weak teeth, electrolyte imbalance, irregular heartbeat, and sometimes death.

Those with a history of substance abuse and obesity in the family are at greater risk. An interesting point to note is that in individuals predisposed to the condition invariably bulimia is preceded by attempts at dieting.

The situation worsens when the effects of self-induced vomiting are accompanied by the fallout of excessive use of diuretics and laxatives. Unregulated use of diet pills can lead to an increase in blood pressure and cause cerebral hemorrhage. Women are particularly prone to this disorder chiefly because of socio-cultural perceptions of beauty. Up to 40% of college-going girls have reported symptoms of bulimia. Reported incidents of bulimia in the USA are on the rise. Women affected by bulimia nervosa suffer from menstrual irregularities that result from fluctuations in weight, stress, and an increase in the androgen levels. Continual overeating and disgorging can lead to serious complications like gastric rupture and postbinge pancreatitis. Cardiac arrhythmia is one of the leading causes of deaths related to bulimia.

Globally, approximately three percent of the world population suffers from chronic bulimia. There is not enough data to comment on the mortality rates associated with bulimia; however morbid conditions that develop because of bulimia are well documented. These include mood disorders, anxiety disorders, obsessive-compulsive disorder, etc. There seems to be a relation between morbid behavior exhibited by bulimic patients and any form of substance abuse practiced by them. Behavioral changes accompanying bulimia include increase in promiscuity, homosexual behavior, kleptomania, and attempts at suicide. All these point to a weakened resolve.

With regards to the racial distribution of bulimia, it is more prevalent amongst whites. The sexual division shows that an overwhelming number of bulimia patients are women. 9 out of 10 patients are women. Often, men who suffer from bulimia are athletes who have to adhere to strict weight requirements and hence follow stringent diet regimen. Men into sports such as weight-lifting, bodybuilding, horse racing, and boxing are susceptible to the disorder.

Patients with bulimia complain of chest pains, cramps, giddiness, and pain in the abdomen. Apart from diuretics, bulimic persons often consume caffeine and thyroid replacement drugs to try and increase metabolic rates. They may take recourse to herbal medicine to reduce weight. Bitter orange, hoodia, and flax oil are some substances that bulimia patients use. For the lay person, physical attributes of bulimic people are not strikingly different from others. Weight is often normal; the vital signs show no irregularity. Close examination may reveal hypertension and indicate abuse of stimulants. A dehydrated condition, eroded enamel, and enlarged tonsils are often present. A very interesting indicator is the presence of a callus on the index finger that appears to due prolonged efforts at inducing vomiting. The subject should be checked for alopecia and fragile nails.