Precipitating factors focus on developmental changes, such as sexual development and menarche in persons aged 10 to 14 years, and identity conflicts in individuals aged 17 to 18 as they transition from home to college or married life (Gurenlian). Perpetuating factors are those that maintain the eating disorder, such as signs and symptoms of starvation and coping strategies engendered by the eating disorder (Gurenlian).

             Bulimia Nervosa is characterized by binge eating and purging (Gurenlian). .

             Purging behavior may include induced vomiting by ipecac or other means, or abuse of laxatives, enemas, diuretics, caffeine, or other stimulants, however, it is more difficult to recognize than anorexia because individuals with bulimia nervosa exhibit no signs of illness and most are of normal weight (Gurenlian). According to the Diagnostic and Statistical Manual of Mental Disorders, binge eating and other behaviors must occur at least twice a week for a period of three months to qualify for the diagnosis of bulimia (Gurenlian). .

             Effects.

             Bulimia can affect multiple organ systems resulting in a variety of medical complications, for example overeating associated with binge episodes can stretch the stomach or delay gastric emptying (Gurenlian). Purging can induce esophagitis, gastroesophageal reflux disease, or esophageal rupturing, and pancreatitis and renal function impairment may occur (Gurenlian). Protein malnutrition, dehydration, and electrolyte imbalances can occur leading to hypokalemia and hypochloremia, muscle cramping, weakness, dizziness, excessive thirst, parasthesia, and syncope, while bruises, calluses, scarring, and abrasions of the fingers may be present, reflecting excessive induced vomiting behaviors. In severe cases, cardiovascular abnormalities can result in arrhythmias, arrest, cardiac rupture, or pneumomediastinum (Gurenlian). .

             Causes.

             Bulimia has been associated with genetic, physiological, psychological, and environmental factors (Gurenlian).