230 Eating Disorders
food intake (Abraham and Beumont, 1982). The consequences of a binge are
described by Shute (1992): “my stomach, pressing painfully in all directions,
could hold no more. I needed to collapse. Belching in rancid, vomity bursts,
oozing oil from my pores, heavy and numb with self hatred...Avoiding
the mirrors I pulled off my clothes, releasing an unrecognisable belly; my
waistband left a vicious red stripe, but I only looked once” (p. 174).
Sufferers of bulimia nervosa also engage in compensatory behavior as a
means to manage any weight gain caused by the binges. The most common
form is self-induced vomiting, which usually occurs at the end of a binge
but also after episodes of normal eating. One study reported that three-
quarters of their bulimic sample vomited at least once a day and nearly
half vomited twice a day (Fairburn and Cooper, 1984). This is usually achieved
through the gag reflex using fingers, although many bulimics learn to vomit
spontaneously. Vomiting is accompanied by feelings of self-disgust and
loathing, is almost always secret, and may go undetected for years (Cooper
and Cooper, 1987). Vomiting also provides a great sense of relief from the
sense of distension caused by overeating and the fear of weight gain. It can
therefore become habit-forming and encourages further overeating and
further vomiting. In fact, although binge eating may start off as the primary
behavior which causes vomiting, it has been argued that over time vomit-
ing can start to drive the bingeing (Cooper and Cooper, 1987). Bulimics also
use laxatives and diuretics as a means to compensate for bingeing. This behav-
ior can also become habit forming, particularly if the individual develops
tolerance to the substances used and consequently increases their intake.
This cycle of bingeing and purging is accompanied by a set of beliefs
and attitudes concerning food and weight. In particular, bulimics show
overvalued ideas about the importance of attaining and or maintaining
a specific body weight or shape, and report a “morbid fear of fatness”
similar to that found in anorexics (Russell, 1979). Further, they show a
considerable difference between their perceptions of their desired and actual
size. Not all show a pathological desire to lose weight, but most show an
extreme fear of weight gain. This is often reflected in a preoccupation with
weighing and awareness of every shift on the weighing scales’ needle.
What Are the Consequences of Bulimia Nervosa?
Long-term follow-ups of bulimics indicate that about 70 percent recover,
while about 10 percent stay fully symptomatic (Keel et al., 1999). The