vomiting also causes the following two electrolyte disorders: hypokalemia (low

potassium) and alkalosis (high blood alkaline level). If severe enough, either of these

disorders can result in cardiac arrhythmia, seizures, and muscle spasms (Rock, 1999).

Laxative abuse can result in abdominal discomfort, constipation, and problems with fecal

retention. If laxative abuse is severe enough, a colonectomy may be necessary (Costin).

Diuretic abuse can result in electrolyte imbalance similar to that of vomiting, and it can

also cause the development of lower leg edema (Walsh et al.).

 The psychological features associated with bulimia include increased depression,

low self-esteem, increased anxiety, social withdrawal, and anger. About one third of

bulimics also suffer from substance abuse or dependence (APA, 1994).

Binge Eating Disorder

 There are five criteria for binge eating disorder (APA, 1994). First, there are

recurrent episodes of binge eating. Similar to bulimia nervosa, binge eating is the eating

of an amount of food that is greater than what most people would eat under similar

circumstances in a discreet period of time. There is also a lack of control over eating

during the episode, such as a feeling that one cannot stop eating or control how much is

eaten. Second, the binge eating episodes must be associated with three or more of the

following: a) eating more rapidly than normal; b) eating until feeling uncomfortably full;

c) eating large amounts of food when not feeling physically hungry; d) eating alone

because of being embarrassed by how much one is eating; and e) feelings of disgust,

depression, or guilt after overeating. Third, there is marked distress regarding binge

eating. Fourth, the binge eating occurs, on average, at least two days a week for six

months. Finally, the binge eating is not associated with the regular use of inappropriate