This is typically a cyclic behaviour of bingeing by eating large amounts of food in one go followed by purging to get rid of the food. Purging can be by vomiting, taking laxatives or diuretics, fasting or excessive exercise. Body weight may fluctuate or stay roughly the same, making bulimia harder to spot.^5,13

Bingeing can be driven by difficult emotions or by problems in life and eating may help the person cope. However, the person is not in control of how much or how quickly they eat, and they may binge on foods they think are bad for them or crave, or eat in secret. Feelings of shame or guilt, or hatred towards their body can then prompt the purging phase.

Vomiting can lead to dehydration and electrolyte imbalance, and gastric strain. Gastric acid can irritate the oesophagus, vocal chords, damage teeth and cause swollen salivary glands. Calluses can develop on the backs of the hands if fingers are used to induce vomiting. Long term effects can include heart and intestinal problems, from laxatives, and kidney damage.