Interesting article distinguishing different types of bulimia.

Simple Bulimia Nervosa is an illness that begins most commonly when the girls are about 18 yrs of age. They are a fairly normal group before the illness. They tend to have been mildly under confident and unassertive but come from a broad range of unexceptional family backgrounds. They have probably made friends in a normal way at school and are often fairly popular. The illness is frequently triggered by a period of unhappiness and this is often caused by a destructive relationship with a boyfriend. The feeling of self dislike focuses on appearance and dieting is begun in an attempt to improve self esteem. In contrast to an anorexic the diet is not very successful with the rigid control needed breaking down into bouts of cheating. Vomiting is used as part of increased efforts to achieve the weight loss and so the cycle of bingeing and vomiting begins. There is more loss of control as the body's normal mechanisms of appetite control are over ridden and confused. The weight will remain close to normal but the eating pattern becomes gradually worse. This form of bulimia is the least severe but the severity varies considerably. It is likely that there are large numbers of girls with fairly mild symptoms that never come to medical help but there is a significant risk that it will slowly get worse with time. A common time for sufferers to seek help is when they are planning to start a family in their early twenties and are concerned about possible effects on having babies.

Anorexic Bulimia Nervosa is a variant of the illness that is preceded by a bout of Anorexia Nervosa. Quite often this anorexic episode is a brief one and the sufferer begins to recover without treatment. It is followed typically by a short period of stabilised weight just below that at which the menstruation may restart, around 46 kg. The control of the anorexic is not sustained and bingeing begins usually in a very small way but becomes more severe especially once vomiting begins. Often they begin by vomiting after what would for a normal person be an ordinary meal but this leads to a loss of control of the appetite drive and true bingeing gradually starts. Occasionally the vomiting and bingeing start first but then there is a period of significant weight loss in an anorexic phase that includes restrictive eating. The illness becomes dominated by the bingeing and vomiting behaviour but the weight remains low for a while before gradually rising to near and in time above normal. The personality profile and backgrounds of these girls is similar as for a group with Anorexia Nervosa. A description may be found in the leaflet "Introducing Anorexia Nervosa". When there are differences the Bulimic group seem to be slightly less obsessive and to be marginally more mature in emotional development. The are more likely to have boyfriends and to show their feelings.

Multi-impulsive Bulimia Nervosa is a severe variant of Bulimia Nervosa that begins in a similar way to Simple Bulimia and in a similar age group of girls. This group suffer with a range of abnormal behaviours all of which indicate problems of emotional and impulse control. Often some of these other behaviours are already causing difficulty before the Bulimia begins. In association with the eating disorder will be found a mix of other problems including drug abuse, alcohol abuse, deliberate self harm (usually cutting of forearms), stealing and promiscuity. They have a range of backgrounds but it is quite common to find that there is a high level of disturbance within the family. In personality they are likely to have shown evidence of poor impulse control from an early age and they often have rather poor records of schooling, academic achievement, or making friends that last. They have a difficulty in modifying their behaviour because of predictable consequences of their actions and as result helping them to change the pattern of their lives often requires prolonged help. The severity of the illness as with all types of bulimia is varied and in this group it seems to depend on severity of the underlying abnormality personality.