The person with bulimia is usually average or slightly above average weight for height and so is often less recognisable than the person with anorexia. Usually, anorexia begins with a weight loss, either resulting from a physical illness or from dieting. Favourable comments cause the person to believe that if thin is good, then thinner is better. The body does not react well to starvation, and erratic behaviour begins to dominate the person's life. Often bulimia starts with rigid weight reduction dieting.
Inadequate nutrition causes tiredness and powerful urges to binge eat.
Vomiting after a binge seems to bring a sense of relief, but this is temporary and soon turns to depression and guilt. The person with bulimia may experience chemical imbalances in the body which bring about lethargy, depression and clouded thinking. Nevertheless, actual causes remain disputed, with biological, psychological and social factors involved. The physical effects can be very serious, but are generally reversible if the illnesses are tackled in the early stages. However, if left untreated, severe anorexia and bulimia can be fatal.