inducing vomiting but also by using laxatives, emetics, and diuretics. The patient is preoccupied with weight and is unable to resist the urge to binge eat. Some 95 percent of the sufferers are women, the same ratio as for anorexia nervosa. Although most sufferers are of normal weight, the disorder can also be seen in extremely thin patients with anorexia nervosa. About 25 percent of obese patients are estimated to binge eat in a manner similar to that of patients with bulimia, but they do not purge. The prevalence of clinically unmistakable bulimia nervosa is estimated at between one and three percent of college-aged women, but many more women have "subclinical" disorders. The disorder occurs most frequently among middle- and upper-middle-class white women, though an increasing number of less affluent and minority patients have been seen recently (Yager, 1991: p. 523).
The onset and course of anorexia nervosa are remarkably predictable. Sometimes the onset follows an upset, such as a failed romance, and sometimes it occurs without a clear precipitant. The patient begins to diet, and after a time the dieting becomes driven by a fear of losing control of the appetite. Many sufferers go no further than this and hover for years on the brink of a more serious disorder. In some young women, severe dieting changes into an implacable pursuit of thinness, an obsession with food and calories, and a sheer abhorrence of body fat. The anorectic typically denies her illness and does not perceive herself as emaciated. She will usually exaggerate her body proportions. She may jog and exercise relentlessly to expend calories. Physical changes accompany the weight loss. Menstruation stops and ovulation ceases. The skin dries out, cheeks and fo
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