Eating Disorders 229slightly older than anorexics, with the peak of onset being between 15 and
19 years (Lucas and Soundy, 1993). There is also some evidence that those
patients diagnosed more recently may be older at first presentation than
those diagnosed in previous decades (Vaught et al., 2007). In terms of
ethnicity and class, the data for bulimia are as confusing as those for anorexia.
For ethnicity, one study examined cases of bulimia in Arab female under-
graduates in London and in Cairo and reported six cases in London and
none in their home environment (Nasser, 1986). Another study compared
Asian girls in the UK with an indigenous group of similarly aged girls and
reported figures of 3.4 percent in the Asian girls compared to 0.6 percent
in the indigenous population. Both these studies have been used to support
the acculturation hypothesis also described in the context of anorexia, which
suggests that eating disorders are higher in those populations which have
moved from their own country to one where eating disorders are more com-
mon (Mumford, Whitehouse, and Platts, 1991). In terms of social class,
bulimia nervosa appears to affect a broader spectrum of the population
than anorexia nervosa, with patient populations coming from a wider range
of backgrounds (Gard and Freeman, 1996).
What do bulimics do?Bulimic women are usually within the normal weight range and maintain
this weight through the processes of bingeing and purging. Bingeing
involves eating a large amount of food in a discrete amount of time; foods
eaten include sweet high-fat foods such as ice cream, doughnuts, pudding,
chocolate, cookies, and cakes. Other foods eaten include breads and pasta,
cheeses, meats, and snack foods such as peanuts and potato chips (e.g., Reiff,
1992). Kaye et al. (1992) measured the food intake of a group of normal-weight
women with bulimia and reported an average food intake of 7,101 kcals
during a bingeing episode compared to a daily intake of 1,844 kcals by
normal-weight healthy women. Hetherington et al. (1994) also examined the
eating behavior of 10 bulimic women over a period of 7 consecutive days
and reported an average daily intake of 10,034 kcals. Such binges are
accompanied by feelings of loss of control, are usually carried out in secret,
involve very quick eating, and consist mainly of the foods that the patient is
attempting to exclude from their diet. However, not all binges involve the
consumption of enormous amounts of food. The core characteristic of a
binge is that it is perceived by the individual to be a binge episode. Although
there is substantial variability in the amounts eaten by bulimics, the patients
themselves can clearly distinguish between normal and bulimic episodes of