Although body weight may appear normal, the distress of the binge-purge cycle adds to feelings of guilt, worthlessness and depression. Anorexics, far more visible because of their underweight bodies, may also induce vomiting, or keep their weight extremely low by eating minute amounts of food and exercising vigorously. They may still continue to regard themselves as overweight, no matter how skeletal they appear to others. Although the outward signs of the disorders are associated with food and body size, it is generally thought that anorexia and bulimia are strongly induce by low self-esteem and difficulties dealing with the pressures of daily living. Anorexia and bulimia severely affect the lives of families and friends as well as the sufferer.
Parents often comment on the deceptions practised by their sick child.
While anorexics will usually deny having a problem, bulimics will go to great length to conceal their eating disorder. The brothers and sisters of a sufferer often become co-conspiritors with their sibling to keep the truth from their parents. Very often, the sufferer manages to conceal the eating disorder for a considerable length of time. The strain of living with the eating disordered person can create divisions in the family. The first step is to bring the problem into the open, taking great care and sensitivity.