Anorexia and bulimia are two different sides of the same coin. While anorexia is often apparent, bulimia is secretive. While anorexics starve themselves for fear of putting on weight, bulimia patients indulge first in overeating, often in isolation, and then induce vomiting; they overuse diuretics and laxatives and indulge in excessive exercise and fasting.

As bulimia progresses in patients, 30% to 80% vacillate between anorexia and bulimia; this is a condition that is known as bulimarexia. Bulimia is considered to be genetic in nature and often results in increased incidence of mood disorders and substance abuse, mainly diuretics and laxatives. Of all bulimia patients, 33% indulge in substance abuse. Generally considered perfectionists, bulimia patients show affective instability, poor impulse control, impaired self-concept, and developmental stresses.

Bulimia patients indulge in binge eating, and often eat larger than average portions within just two hours of previously eating. In order to prevent weight gain, they induce vomiting, fasting, excessive exercise, and use laxatives and purgatives. Those who induce vomiting are called purging types and those who don’t are called nonpurging types.

What differentiates anorexics from bulimics is the presence of signs as caries, pyorrhea, and gum disorders in bulimics on account of gastric acid erosion of the tooth enamel, most commonly on the lingual surfaces of the upper teeth. These erosions are irreversible.

Both anorexics and bulimics have excessive preoccupations with body weight, shape, and/or food intake, which is accompanied by grossly inadequate, irregular, or chaotic food intake. Anorexics are normally very hungry but starve themselves since they have a strong aversion to food. Bulimics, on the other hand, have no aversion to food, but have fear of what it might lead to: excessive body weight. Both, however, have the same result – ill health.