They often want to please others but have low self-esteem and problems with assertion. They will also frequently be depressed. High expectations within their families may be another contributing factor. Persons with bulimia also suffer from low self-esteem but tend to be less passive than persons with anorexia nervosa. Individuals with bulimia tend to be more socially active, are more likely to date, and may use alcohol and drugs.
Research suggests that persons with bulimia have a higher general level of anxiety than others.
Thus the binge-purge cycle may function as a mechanism for relieving anxiety and emotional stress. Social factors also seem to contribute to eating disorders. Excessive emphasis within our culture on slim, boyish figures for women makes it increasingly hard for the adolescent girl, already worried about herself and her body, to feel acceptable. Increasing numbers of teenage girls resort to extreme diets or purging in attempts to make their maturing bodies conform to the expectations of society. Some of these individuals will be trapped in the destructive pattern of eating disorders.