characterized by eating, in a discreet period of time, an amount of food that is greater

than what most people would eat under similar circumstances. There is also a lack of

control over eating during the episode. Second, there is inappropriate compensatory

behavior to prevent weight gain (e.g., self-induced vomiting, fasting, misuse of laxative,

diuretics, enemas). Third, the binge eating and compensatory behaviors must occur at

least twice a week for three months. Fourth, there is body-image disturbance. Fifth, the

behavior does not occur exclusively during episodes of anorexia nervosa.

 There are two types of bulimia nervosa: purging-type and nonpurging-type.

Purging-type bulimics engage in either self-induced vomiting or the misuse of laxatives,

diuretics, or enemas. Nonpurging-type bulimics use other compensatory behaviors such

as fasting or excessive exercise, but they do not regularly engage in self-induced

vomiting or the misuse of laxatives, diuretics, or enemas. It is estimated that between

1.0% and 3.0% of the United States population suffers from bulimia nervosa, and women

are at greatest risk than men (APA, 1994). The risk factors for bulimia nervosa are

similar to those of anorexia nervosa.

 The majority of the physical complications resulting from bulimia nervosa are a

result of purging (e.g., self-induced vomiting, laxative abuse, and diuretic abuse). For

example, sialadenosis, an early complication from self-induced vomiting, is a swelling of

the parotid gland near the area between the jawbone and the neck. This can be reduced

with the cessation of vomiting (Costin, 1999). The acid from self-induced vomiting also

erodes the enamel on teeth, causes inflammation of the gums, and increases the incidence

of dental cavities. The esophagus is also damaged by acid in the stomach during

vomiting, and it can rupture during forceful vomiting (Walsh et al., 2000). Self-induced