... response to intense hunger. It is usually a response to depression, stress of low self-esteem. During the binge episode, the individual experiences loss of control. With increasing severity the girls' lives become more chaotic with the focus increasingly on the bulimic behaviour. They generally find their own behaviour disgusting and are deeply ashamed of it so that it almost always occurs in secret. The cycle of overeating and purging usually becomes an obsession and is repeated often. The causes of bulimia nervosa remain unknown although there is probably a small genetic contribution. In the sub-clinical form bulimic behaviour is very common in our society. The incidence of bulimia nervosa is usually given as 3% of young women but true incidence is likely o be much greater. The pressure to be thin and to look good and resulting abnormal eating patterns that are regarded as normal are probably partly to blame. ...

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