The binges are followed by vomiting or by the use of laxatives or diuretics. Between binges, sufferers may compulsively exercise or go on strict diets. Except in extreme cases, they also eat normally at times. The problem may develop at any age from adolescence to forty but usually becomes clinically serious several years later than anorexia. In a woman of normal weight, bulimia is not as physically dangerous as anorexia, but it can cause stomach aches, nausea, bloating, fatigue, weakness, sore muscles, fluid retention, erosion of dental enamel by acidic vomit, and scars on the hand from pushing fingers down the throat.
Many women suffer from anorexia and bulimia at the same time or alternate between the two.
About half of anorectic patients also have bulimia, and about forty percent of severely bulimic patients have a history of anorexia. The combination is particularly debilitating both physically and emotionally. Bulimic anorectics are usually older, have been ill longer, and they are more likely to be anxious, depressed, emotionally unstable, or alcoholic. They are slower to recover and more likely to commit suicide. Simple bulimia is easier to treat than anorexia, partly because bulimic patients usually want to be treated.